32. Contribution of far-field potentials on motor unit number estimation (MUNE)

Abstract

and chronic inflammatory demyelinating polyneuropathy (CIDP). Case report: A 78-year-old man presented with a 2-week history of ataxia, progressive weakness, and numbness of both hands and feet. His weakness was such that he was unable to ambulate. He has a history of well-controlled diabetes and refractory Crohn’s disease treated with infliximab for 1 year. He had marked distal muscles and mild proximal muscles weakness. He was areflexic throughout and had loss of proprioception below his wrists and knees with preservation of pain sensation. Initial nerve conduction studies (NCSs) of the median, ulnar, peroneal, and tibial motor nerves showed markedly prolonged distal latencies, decreased amplitudes, temporal dispersion, and absent F waves. His sensory NCSs were unresponsive. It was concluded that his CIDP was secondary to infliximab after ruling out other causes. He received intravenous (IV) Solu-Medrol 1 g daily for 3 days and IV immunoglobulin (IVIg) for 5 days with marked improvement. NCSs 6 weeks later showed shortened latencies, shortened F waves, and increased amplitudes. Conclusion: Infliximab is a TNF-alpha inhibitor used in the treatment of Crohn’s disease. It has been rarely linked to MS and CIDP. In this report the patient achieved significant clinical and electrodiagnostic improvement with a combination of IVIg and Solu-Medrol treatment.