Abstract
Background. Multifocal motor neuropathy (MMN) is а chronical dysimmune disease, which can be treated with intravenous human immunoglobulin (IVIG). Objectives. To follow up the sonographic changes of peripheral nerves in a patient with MMN treated with IVIG. Materials and methods. A 42 y.o. woman with MMN receiving IVIG is described. The cross-sectional area (CSA) of median, ulnar nerves and spinal roots was measured with high-resolution ultrasound (HRUS) after five IVIG courses. Results. Before treatment the asymmetrical CSA increase of median, ulnar nerves and C5, C6, C7 spinal roots was found. 7 weeks after the first IVIG, next 3 IVIG courses with 4 weeks’ intervals HRUS showed normalization of CSA of the peripheral nerves and significant decrease of CSA of the spinal roots; as soon as the interval between the fourth and fifth IVIG was prolonged up to 9 weeks the CSA of the peripheral nerves increased again. Conclusion. The follow up of a MMN patient treated with IVIG confirms the positive sonographic changes of the peripheral nerves and spinal roots. The possible role of HRUS as a method for monitoring changes in the peripheral nerves due to IVIG should be discussed after a larger cohort of patients with MMN and similar diseases is investigated.
Highlights
Multifocal motor neuropathy (MMN) is а chronical dysimmune disease, which can be treated with intravenous human immunoglobulin (IVIG)
To follow up the sonographic changes of peripheral nerves in a patient with MMN treated with IVIG
The cross-sectional area (CSA) of median, ulnar nerves and spinal roots was measured with high-resolution ultrasound (HRUS) after five IVIG courses
Summary
Оценка динамики площади поперечного сечения периферических нервов при мультифокальной моторной нейропатии по данным ультразвукового исследования на фоне внутривенной терапии иммуноглобулинами: описание клинического случая. Мультифокальная моторная нейропатия (ММН) – хроническое дизиммунное заболевание, для терапии которого используется введение внутривенного иммуноглобулина (ВВИГ) человека. Оценка ультразвуковых изменений периферических нервов на фоне ВВИГ у больной ММН. С помощью ультразвукового исследования была выполнена оценка площади поперечного сечения (ППС) срединного, локтевого и спинномозговых нервов плечевого сплетения с обеих сторон на фоне 5 курсов ВВИГ. Наблюдение за пациенткой с ММН, получающей ВВИГ, показало динамику положительных сонографических изменений периферических нервов. Использование ультразвукового исследования в качестве мониторинга состояния периферических нервов на фоне терапии ВВИГ требует анализа большего числа случаев у пациентов с ММН и сходными состояниями. Ключевые слова: мультифокальная моторная нейропатия, блок проведения, ультразвуковое исследование нервов, площадь поперечного сечения, внутривенный иммуноглобулин. Druzhinin2 1Association of Neuromuscular Disorders Specialists, Medical Center “Practical Neurology”; Build. 2, 17 Krzhizhanovskogo St., Moscow 117258, Russia; 2Department of Neurological Diseases with a Course of Medical Genetics and Pediatric Neurology, Yaroslavl’ State Medical University, Ministry of Health of Russia; 25 Revolutsionnaya St., Yaroslavl’ 150000, Russia
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