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Characterization of neuropathies associated with elevated IgM serum levels.
J Neurol Sci. 2005 Feb 15; 228(2):155-60.JN

Abstract

BACKGROUND

In contrast to the IgM monoclonal gammopathies the neuropathy associated with polyclonal IgM gammopathy has not been well characterized.

OBJECTIVE

To characterize the neuropathy in patients with elevated serum IgM.

DESIGN

Retrospective review.

SETTING

Academically based neuropathy center.

PATIENTS

45 patients with elevated quantitative immunoglobulin M were identified.

MAIN OUTCOME MEASURES

Patients are described with regard to clinical phenotype, electrodiagnostic features of demyelination or focality, presence of IgM monoclonal gammopathy, and presence of autoantibody activity.

RESULTS

Elevated IgM levels occurred in 45 (11.5%) of 391 patients. Of these, 24 (53%) had polyclonal gammopathy and 21 (47%) had an IgM monoclonal gammopathy. Anti-nerve antibodies occurred in 14/21 (67%) of patients with monoclonal gammopathy, as compared to 1/24 (4%) with polyclonal gammopathy. Clinically, most patients in all groups had a predominantly large fiber sensory neuropathy. Thirty patients underwent electrodiagnostic testing. Of these, 22/30 (73%) fulfilled at least one published criteria for CIDP, including 92% of the monoclonal gammopathy patients and 59% of the polyclonal gammopathy patients. Fifteen of the 30 patients had evidence of focality or multifocality, with 14 of these 15 showing evidence of demyelination.

CONCLUSIONS

Monoclonal and polyclonal IgM patients have similar distributions of neuropathy phenotypes. Neuropathy in association with elevated serum IgM, with or without monoclonal gammopathy or autoantibody activity, is more likely to be demyelinating or multifocal. Serum quantitative IgM level and immunofixation in neuropathy patients may aid in identification of an immune mediated or a demyelinating component.

Authors+Show Affiliations

Peripheral Neuropathy Center, Department of Neurology, Weill Medical College of Cornell University, 635 Madison Ave., Suite 400, New York, NY 10022, USA. argoldfarb@juno.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15694197

Citation

Goldfarb, Adina R., et al. "Characterization of Neuropathies Associated With Elevated IgM Serum Levels." Journal of the Neurological Sciences, vol. 228, no. 2, 2005, pp. 155-60.
Goldfarb AR, Sander HW, Brannagan TH, et al. Characterization of neuropathies associated with elevated IgM serum levels. J Neurol Sci. 2005;228(2):155-60.
Goldfarb, A. R., Sander, H. W., Brannagan, T. H., Magda, P., & Latov, N. (2005). Characterization of neuropathies associated with elevated IgM serum levels. Journal of the Neurological Sciences, 228(2), 155-60.
Goldfarb AR, et al. Characterization of Neuropathies Associated With Elevated IgM Serum Levels. J Neurol Sci. 2005 Feb 15;228(2):155-60. PubMed PMID: 15694197.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Characterization of neuropathies associated with elevated IgM serum levels. AU - Goldfarb,Adina R, AU - Sander,Howard W, AU - Brannagan,Thomas H,3rd AU - Magda,Paul, AU - Latov,Norman, Y1 - 2004/12/24/ PY - 2004/07/30/received PY - 2004/10/01/revised PY - 2004/11/16/accepted PY - 2005/2/8/pubmed PY - 2005/5/14/medline PY - 2005/2/8/entrez SP - 155 EP - 60 JF - Journal of the neurological sciences JO - J. Neurol. Sci. VL - 228 IS - 2 N2 - BACKGROUND: In contrast to the IgM monoclonal gammopathies the neuropathy associated with polyclonal IgM gammopathy has not been well characterized. OBJECTIVE: To characterize the neuropathy in patients with elevated serum IgM. DESIGN: Retrospective review. SETTING: Academically based neuropathy center. PATIENTS: 45 patients with elevated quantitative immunoglobulin M were identified. MAIN OUTCOME MEASURES: Patients are described with regard to clinical phenotype, electrodiagnostic features of demyelination or focality, presence of IgM monoclonal gammopathy, and presence of autoantibody activity. RESULTS: Elevated IgM levels occurred in 45 (11.5%) of 391 patients. Of these, 24 (53%) had polyclonal gammopathy and 21 (47%) had an IgM monoclonal gammopathy. Anti-nerve antibodies occurred in 14/21 (67%) of patients with monoclonal gammopathy, as compared to 1/24 (4%) with polyclonal gammopathy. Clinically, most patients in all groups had a predominantly large fiber sensory neuropathy. Thirty patients underwent electrodiagnostic testing. Of these, 22/30 (73%) fulfilled at least one published criteria for CIDP, including 92% of the monoclonal gammopathy patients and 59% of the polyclonal gammopathy patients. Fifteen of the 30 patients had evidence of focality or multifocality, with 14 of these 15 showing evidence of demyelination. CONCLUSIONS: Monoclonal and polyclonal IgM patients have similar distributions of neuropathy phenotypes. Neuropathy in association with elevated serum IgM, with or without monoclonal gammopathy or autoantibody activity, is more likely to be demyelinating or multifocal. Serum quantitative IgM level and immunofixation in neuropathy patients may aid in identification of an immune mediated or a demyelinating component. SN - 0022-510X UR - https://www.unboundmedicine.com/medline/citation/15694197/Characterization_of_neuropathies_associated_with_elevated_IgM_serum_levels_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-510X(04)00472-1 DB - PRIME DP - Unbound Medicine ER -