THE SONOGRAPHIC DYNAMICS OF PERIPHERAL NERVES CROSS SECTIONAL AREA CHANGES IN MULTIFOCAL MOTOR NEUROPATHY TREATED WITH INTRAVENOUS IMMUNOGLOBULIN: CASE REPORT

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.

Keywords

• multifocal motor neuropathy
• conduction block
• high-resolution nerve ultrasound
• cross-sectional area
• intravenous immunoglobulin