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Human immune globulin infusion in the management of multifocal motor neuropathy

Authors Jovanovich E, Karam C

Received 12 September 2015

Accepted for publication 19 November 2015

Published 22 December 2015 Volume 2016:6 Pages 1—12

DOI https://doi.org/10.2147/DNND.S96258

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Mafalda Cacciottolo

Peer reviewer comments 2

Editor who approved publication: Dr Thomas Müller


Elizabeth Jovanovich,1 Chafic Karam2

1Department of Physical Medicine and Rehabilitation, 2Department of Neurology, The University of North Carolina, Chapel Hill, NC, USA

Abstract: Multifocal motor neuropathy (MMN) is a debilitating and rare disease causing profound weakness with minimal to no sensory symptoms. Conduction block is frequently seen on electrodiagnostic testing. An immune-mediated pathology is suspected though the exact underlying pathophysiology has yet to be elucidated. The presence of anti-GM1 ganglioside IgM antibodies coupled with favorable response to intravenous and subcutaneous immunoglobulins supports a complement-mediated mechanism which leads to destruction of nerve tissue with probable predilection to the nodes of Ranvier. High-dose immunoglobulin currently is the only treatment with proven efficacy for MMN patients. Unfortunately, many patients experience decreased responsiveness to immunoglobulins over time, requiring higher and more frequent dosing. In this review, we will focus on the pharmacology, efficacy, safety, and tolerability of intravenous and subcutaneous immune globulin infusion for treatment of MMN.

Keywords: intravenous immunoglobulin, subcutaneous immunoglobulin, multifocal motor neuropathy, immunosuppressive therapies, anti-GM1 ganglioside IgM antibodies, conduction block

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