77. Electrophysiological follow up in anti-MAG polineuropathy after Rituximab therapy

Abstract

Neurophysiological data and clinical outcome after immunotherapy of anti-MAG-associated polineuropathy may diverge. Five patients suffering from demyelinating sensory-motor polyneuropathy with anti-MAG Ab were treated with Rituximab. Study of median, ulnar, peroneal and tibial motor nerves and median, ulnar, radial and sural sensory nerves as well as paraprotein serum levels and B cells count were performed at T0, six (T6) and, when available, twelve (T12) months after treatment. Clinical variations were evaluated with MRC and Rankin scale. Reappearance of absent SAPs/CMAPs was never observed. Variations of 10% or 20% in CV or DML and of one point in clinical scales were considered significant. No discordant changes among different nerves in single patient were found. In three patients conduction values improved in 3/6, 5/6 and 4/4 (10%) or 1/6, 3/6 and 2/4 (20%) of excitable nerves and in two of them the clinical assessment also improved. Conduction values worsened in 3/6 or 2/6 nerves with increasing of Rankin score in one female. The remaining patient, the most severely affected, showed slight improvement of DML and no clinical variation. The current study suggests an extensive electrophysiolgical assessment and tailored follow-up in order to make neurophysiological data more reliable as outcome measure.