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From "Giorgio Spagnol" Service of Clinical Neuroimmunology (Drs. Terenghi, Bersano, Carpo, and Nobile-Orazio) and Service of Clinical Neurophysiology (Drs. Cappellari and Barbieri), "Dino Ferrari Centre," Department of Neurological Sciences, Milan University, IRCCS Ospedale Maggiore Policlinico, Milan, Italy.
Address correspondence and reprint requests to Dr. Eduardo Nobile-Orazio, Department of Neurological Sciences, University of Milan, IRCCS Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy; e-mail: eduardo.nobile{at}unimi.it
The authors treated 10 patients with multifocal motor neuropathy (MMN) responding to an initial course of IV immunoglobulin (IVIg) with periodic infusion for 5 to 12 years (mean 8.2 years). At last follow-up, only two patients had maintained the maximal improvement achieved during therapy while eight worsened despite increasing Ig dosage. This decline started after 3 to 7 years (mean 4.8 years) of therapy and correlated with a reduction of distal compound muscle action potential amplitudes (p < 0.019). The effectiveness of IVIg in MMN often declines after several years possibly associated with the development of axonal degeneration.
Received May 6, 2003. Accepted in final form October 19, 2003.
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