Abstract
Multifocal motor neuropathy (MMN) is a rare immune-mediated disease characterized by slowly progressive, asymmetric, predominantly distal weakness of one or more limbs without sensory loss. The first line of treatment is high-dose intravenous immunoglobulins (IVIg). Subcutaneous immunoglobulins (SCIg)already approved for the treatment of primary immune deficiency have recently been proposed also for the treatment of disimmune peripheral neuropathies such as MMN, and a few trials were performed to see if patients receiving immunomodulatory doses of IVIg could be treated equally well with SCIg. We describe a patient affected by MMN who was included in a protocol of treatment with SCIg for a period of 6 months. He successfully responded to treatment with a stabilization of strength. The patient is still treated with SCIg even after the end of the protocol. This is the first description of an Italian case of a patient affected by MMN successfully treated with SCIg.
Similar content being viewed by others
References
Hughes RAC, Donofrio P, Bril V, Dalakas M (2008) Intravenous immune globulin (10% caprylate-chromatography purified) for the treatment of chronic inflammatory demyelinating polyradiculoneuropathy (ICE study): a randomised placebo-controlled trial. Lancet Neurol 7:136–144
Umapathi T, Hughes RA, Nobile-Orazio E, Léger JM (2009) Immunosuppressant and immunomodulatory treatments for multifocal motor neuropathy. Cochrane Database Syst Rev (1):CD003217
Van Schaik IN, van den Berg LH, de Haan RJ, Vermeulen M (2005) Intravenous immunoglobulin for multifocal motor neuropathy. Cochrane Database Syst Rev (3):CD003217
Nobile-Orazio E, Cappelari A, Priori A (2005) Multifocal motor neuropathy: current concepts and controversies. Muscle Nerve 31:663–680
Olney RK, Lewis RA, Putnam TD, Campellone JV (2003) Consensus criteria for the diagnosis of multifocal motor neuropathy. Muscle Nerve 27:117–121
Van Asseldonk JT, Van den Berg LH, Vos RM, Wieneke GH, Franssen H (2003) Demyelination and axonal loss in multifocal motor neuropathy. Brain 126:186–198
Chapel HM, Spickett GP, Ericson D, Engl W, Eibl MM, Bjorkander J (2000) The comparison of the efficacy and safety of intravenous versus subcutaneous immunoglobulin replacement therapy. J Clin Immunol 20:94–100
Chinen J, Shearer WT (2004) Subcutaneous immunoglobulins: alternative for the hypogammaglobulinemic patient? J Allergy Clin Immunol 114(4):934–935
Gardulf A, Bjorvell H, Andersen V, Bjorkander J, Ericson D, Froland SS, Gustafson R, Hammastrom L, Nystrom T, Soeberg B (1995) Lifelong treatment with gammaglobulin fro primary deficiencies: the patients’ experience of subcutaneous self infusion and home therapy. J Adv Nurs 21(5):917–927
Gardulf A, Nicolay U, Math D, Asensio O, Bernatowska E, Böck A, Costa-Carvalho BT, Granert C, Haag S, Hernández D, Kiessling P, Kus J, Matamoros N, Niehues T, Schmidt S, Schulze I, Borte M (2004) Children and adults with primary antibody deficiencies gain quality of life by subcutaneous IgG self-infusions at home. J Allergy Clin Immunol 114(4):936–942
Eftimov F, Vermeulen M, de Haan RJ, van der Berg LH, van Schaik IV (2009) Subcutaneous immunoglobulin therapy for multifocal motor neuropathy. J Perypheral Nerv Syst 14:93–100
Harbo T, Andersen H, Hess A, Hansen K, Sindrup SH, Jakobsen J (2009) Subcutaneous versus intravenous immunoglobulin in multifocal motor neuropathy: a randomized, single-blinded cross-over trial. Eur J Neurol 16:631–638
Misbah S, Andresen I, Baumann A, Burton J, Comi G, Dacci P, Schmidt DS, Sturzenegger M (2010) Is subcutaneous immunoglobulin therapy equally efficacious as intravenous immunoglobulin in the treatment of multifocal motor neuropathy?—an open label proof-of-concept study. JNNP (submitted)
Acknowledgments
We thank the patient for his participation in this study and CLS Behring for the support.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Dacci, P., Riva, N., Scarlato, M. et al. Subcutaneous immunoglobulin therapy for the treatment of multifocal motor neuropathy: a case report. Neurol Sci 31, 829–831 (2010). https://doi.org/10.1007/s10072-010-0352-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10072-010-0352-z