Annals of Clinical Neurophysiology

  • 제25권2호
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  • Pages.84-92
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  • 2023
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  • 2508-691X(pISSN)
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  • 2508-6960(eISSN)
대한임상신경생리학회 (The Korean Society of Clinical Neurophysiology)
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Electrophysiological features and prognosis of peripheral neuropathy associated with IgM monoclonal gammopathy: a single-center analysis in South Korea

  • Sooyoung Kim (Department of Neurology, Chungnam National University Hospital, Chungnam National University College of Medicine) ;
  • Bit Na Lee (Department of Neurology, Severance Hospital, Yonsei University College of Medicine) ;
  • Seung Woo Kim (Department of Neurology, Severance Hospital, Yonsei University College of Medicine) ;
  • Ha Young Shin (Department of Neurology, Severance Hospital, Yonsei University College of Medicine)
  • 투고 : 2023.06.26
  • 심사 : 2023.10.18
  • 발행 : 2023.10.30
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초록

Background: Clinical spectrum of immunoglobulin M (IgM) monoclonal gammopathy varies from IgM monoclonal gammopathy of unknown significance (IgM-MGUS) to hematological malignancies. We evaluated the clinical features, electrophysiological characteristics, and prognosis of patients with peripheral neuropathy associated with IgM monoclonal gammopathy (PN-IgM MG). Methods: We retrospectively evaluated 25 patients with PN-IgM MG. Peripheral neuropathy was classified as axonal, demyelinating, or undetermined, based on electrophysiological studies. We classified the enrolled patients into the IgM-MGUS and malignancy groups, and compared the clinical and electrophysiological features between the groups. Results: Fifteen patients had IgM-MGUS and 10 had hematologic malignancies (Waldenström's macroglobulinemia: two and B-cell non-Hodgkin's lymphoma: eight). In the electrophysiological evaluation, the nerve conduction study (NCS) criteria for demyelination were met in 86.7% of the IgM-MGUS group and 10.0% of the malignancy group. In particular, the distal latencies of the motor NCS in the IgM-MGUS group were significantly prolonged compared to those in the malignancy group (median, 9.1 ± 5.1 [IgM-MGUS], 4.2 ± 1.3 [malignancy], p = 0.003; ulnar, 5.4 ± 1.9 [IgM-MGUS], 2.9 ± 0.9 [malignancy], p = 0.001; fibular, 9.3 ± 5.1 [IgM-MGUS], 3.8 ± 0.3 [malignancy], p = 0.01; P-posterior tibial, 8.3 ± 5.4 [IgM-MGUS], 4.4 ± 1.0 [malignancy], p = 0.04). Overall treatment responses were significantly worse in the malignancy group than in the IgM-MGUS group (p = 0.004), and the modified Rankin Scale score at the last visit was higher in the malignancy group than in the IgM-MGUS group (2.0 ± 1.1 [IgM-MGUS], 4.2 ± 1.7 [malignancy], p = 0.001), although there was no significant difference at the initial assessment. Conclusions: The risk of hematological malignancy should be carefully assessed in patients with PN-IgM MG without electrophysiological demyelination features.

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참고문헌

  1. Kyle RA, Garton JP. The spectrum of IgM monoclonal gammopathy in 430 cases. Mayo Clin Proc 1987;62:719-731. https://doi.org/10.1016/S0025-6196(12)65225-2
  2. Cao XX, Meng Q, Mao YY, Su W, Zhen JF, Shen KN, et al. The clinical spectrum of IgM monoclonal gammopathy: a single center retrospective study of 377 patients. Leuk Res 2016;46:85-88. https://doi.org/10.1016/j.leukres.2016.05.002
  3. Chassande B, Leger JM, Younes-Chennoufi AB, Bengoufa D, Maisonobe T, Bouche P, et al. Peripheral neuropathy associated with IgM monoclonal gammopathy: correlations between M-protein antibody activity and clinical/electrophysiological features in 40 cases. Muscle Nerve 1998;21:55-62. https://doi.org/10.1002/(SICI)1097-4598(199801)21:1<55::AID-MUS8>3.0.CO;2-F
  4. Chaudhry HM, Mauermann ML, Rajkumar SV. Monoclonal gammopathy-associated peripheral neuropathy: diagnosis and management. Mayo Clin Proc 2017;92:838-850. https://doi.org/10.1016/j.mayocp.2017.02.003
  5. Ramchandren S, Lewis RA. Monoclonal gammopathy and neuropathy. Curr Opin Neurol 2009;22:480-485. https://doi.org/10.1097/WCO.0b013e32832fd563
  6. Levine T, Pestronk A, Florence J, Al-Lozi MT, Lopate G, Miller T, et al. Peripheral neuropathies in Waldenstrom's macroglobulinaemia. J Neurol Neurosurg Psychiatry 2006;77:224-228. https://doi.org/10.1136/jnnp.2005.071175
  7. Klein CJ, Moon JS, Mauermann ML, Zeldenrust SR, Wu Y, Dispenzieri A, et al. The neuropathies of Waldenstrom's macroglobulinemia (WM) and IgM-MGUS. Can J Neurol Sci 2011;38:289-295. https://doi.org/10.1017/S0317167100011483
  8. Kim JE, Bae JS. Clinical scales for peripheral neuropathy-revision 2021. J Korean Neurol Assoc 2021;39:2-14. https://doi.org/10.17340/jkna.2021.2.16
  9. Research criteria for diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP). Report from an Ad Hoc Subcommittee of the American Academy of Neurology AIDS Task Force. Neurology 1991;41:617-618. https://doi.org/10.1212/WNL.41.5.617
  10. Shahani BT, Young RR, Potts F, Maccabee P. Terminal latency index (TLI) and late response studies in motor neuron disease (MND), peripheral neuropathies and entrapment syndromes. Acta Neurol Scand 1979;60:118.
  11. Delmont E, Azulay JP, Giorgi R, Attarian S, Verschueren A, Uzenot D, et al. Multifocal motor neuropathy with and without conduction block: a single entity? Neurology 2006;67:592-596. https://doi.org/10.1212/01.wnl.0000234063.51897.20
  12. Silberman J, Lonial S. Review of peripheral neuropathy in plasma cell disorders. Hematol Oncol 2008;26:55-65. https://doi.org/10.1002/hon.845
  13. Jalali S, Shi J, Ahsan N, Wellik L, Serres M, Buko A, et al. Progression from monoclonal gammopathy of undetermined significance of the immunoglobulin M class (IgM-MGUS) to Waldenstrom Macroglobulinemia is associated with an alteration in lipid metabolism. Redox Biol 2021;41:101927.
  14. Niermeijer JM, Fischer K, Eurelings M, Franssen H, Wokke JH, Notermans NC. Prognosis of polyneuropathy due to IgM monoclonal gammopathy: a prospective cohort study. Neurology 2010;74:406-412. https://doi.org/10.1212/WNL.0b013e3181ccc6b9
  15. McMaster ML, Landgren O. Prevalence, clinical aspects, and natural history of IgM MGUS. Cytometry B Clin Cytom 2010; 78:S91-S97. https://doi.org/10.1002/cyto.b.20550