Skip to main content
PMC home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1993 Jan;56(1):52–57. doi: 10.1136/jnnp.56.1.52

IgG monoclonal paraproteinaemia and peripheral neuropathy.

A F Bleasel 1, S H Hawke 1, J D Pollard 1, J G McLeod 1
PMCID: PMC1014766  PMID: 8381472

Abstract

Five patients with peripheral neuropathy and benign IgG monoclonal paraproteinemia are reported, all of whom had a sensorimotor neuropathy with a remitting and relapsing course. The serum paraprotein level did not correlate with the patient's clinical status. Electrophsyiological studies showed marked slowing of conduction velocity and conduction block in four of the patients and mild slowing in the other. Sural nerve biopsies demonstrated a demyelinating neuropathy with inflammatory cell infiltrates in each of the five patients. Three of the patients had evidence of myelin/Schwann cell reactivity on immunofluorescence studies and in all nerves dense expression of major histocompatability complex class I and II molecules was evident within the endoneurium, on invading mononuclear cells, endothelial cells and Schwann cells. All the patients responded to treatment, plasmapheresis being particularly effective. Four patients have achieved prolonged remissions after all treatment had ceased. These five cases of peripheral neuropathy and IgG paraproteinaemia were identical in their clinical, electrophysiological and pathological features to patients with chronic inflammatory demyelinating polyneuropathy.

Full text

PDF
55

Images in this article

55Image
on p.55

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bosch E. P., Ansbacher L. E., Goeken J. A., Cancilla P. A. Peripheral neuropathy associated with monoclonal gammopathy. Studies of intraneural injections of monoclonal immunoglobulin sera. J Neuropathol Exp Neurol. 1982 Jul;41(4):446–459. doi: 10.1097/00005072-198207000-00007. [DOI] [PubMed] [Google Scholar]
  2. Chazot G., Berger B., Carrier H., Barbaret C., Bady B., Dumas R., Creyssel R., Schott B. Manifestations neurologiques des gammapathies monoclonales. Formes neurologiques pures.--Etude en immunofluorescence. Rev Neurol (Paris) 1976 Mar;132(3):195–212. [PubMed] [Google Scholar]
  3. Contamin F., Singer B., Mignot B., Ecoffet M., Kazatchkine M. Pol-neuropathie a rechutes, évoluant depuis 19 ans, associée à une gammapathie monoclonale IgG bénigne. Effet favorable de la corticothérapie. Rev Neurol (Paris) 1976 Nov;132(11):741–762. [PubMed] [Google Scholar]
  4. Dalakas M. C., Engel W. K. Polyneuropathy with monoclonal gammopathy: studies of 11 patients. Ann Neurol. 1981 Jul;10(1):45–52. doi: 10.1002/ana.410100109. [DOI] [PubMed] [Google Scholar]
  5. Dalakas M. C., Teräväinen H., Engel W. K. Tremor as a feature of chronic relapsing and dysgammaglobulinemic polyneuropathies. Incidence and management. Arch Neurol. 1984 Jul;41(7):711–714. doi: 10.1001/archneur.1984.04050180033012. [DOI] [PubMed] [Google Scholar]
  6. Dyck P. J., Lais A. C., Ohta M., Bastron J. A., Okazaki H., Groover R. V. Chronic inflammatory polyradiculoneuropathy. Mayo Clin Proc. 1975 Nov;50(11):621–637. [PubMed] [Google Scholar]
  7. Gosselin S., Kyle R. A., Dyck P. J. Neuropathy associated with monoclonal gammopathies of undetermined significance. Ann Neurol. 1991 Jul;30(1):54–61. doi: 10.1002/ana.410300111. [DOI] [PubMed] [Google Scholar]
  8. Haas D. C., Tatum A. H. Plasmapheresis alleviates neuropathy accompanying IgM anti-myelin-associated glycoprotein paraproteinemia. Ann Neurol. 1988 Apr;23(4):394–396. doi: 10.1002/ana.410230415. [DOI] [PubMed] [Google Scholar]
  9. Hays A. P., Lee S. S., Latov N. Immune reactive C3d on the surface of myelin sheaths in neuropathy. J Neuroimmunol. 1988 Jun;18(3):231–244. doi: 10.1016/0165-5728(88)90101-4. [DOI] [PubMed] [Google Scholar]
  10. Hodgkinson S. J., Pollard J. D., McLeod J. G. Cyclosporin A in the treatment of chronic demyelinating polyradiculoneuropathy. J Neurol Neurosurg Psychiatry. 1990 Apr;53(4):327–330. doi: 10.1136/jnnp.53.4.327. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Ilyas A. A., Quarles R. H., Dalakas M. C., Fishman P. H., Brady R. O. Monoclonal IgM in a patient with paraproteinemic polyneuropathy binds to gangliosides containing disialosyl groups. Ann Neurol. 1985 Dec;18(6):655–659. doi: 10.1002/ana.410180605. [DOI] [PubMed] [Google Scholar]
  12. Ilyas A. A., Quarles R. H., MacIntosh T. D., Dobersen M. J., Trapp B. D., Dalakas M. C., Brady R. O. IgM in a human neuropathy related to paraproteinemia binds to a carbohydrate determinant in the myelin-associated glycoprotein and to a ganglioside. Proc Natl Acad Sci U S A. 1984 Feb;81(4):1225–1229. doi: 10.1073/pnas.81.4.1225. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Johansen P., Leegaard O. F. Peripheral neuropathy and paraproteinemia: an immunohistochemical and serologic study. Clin Neuropathol. 1985 May-Jun;4(3):99–104. [PubMed] [Google Scholar]
  14. Kahn S. N., Riches P. G., Kohn J. Paraproteinaemia in neurological disease: incidence, associations, and classification of monoclonal immunoglobulins. J Clin Pathol. 1980 Jul;33(7):617–621. doi: 10.1136/jcp.33.7.617. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Kelly J. J., Adelman L. S., Berkman E., Bhan I. Polyneuropathies associated with IgM monoclonal gammopathies. Arch Neurol. 1988 Dec;45(12):1355–1359. doi: 10.1001/archneur.1988.00520360073015. [DOI] [PubMed] [Google Scholar]
  16. Koski C. L. Characterization of complement-fixing antibodies to peripheral nerve myelin in Guillain-Barré syndrome. Ann Neurol. 1990;27 (Suppl):S44–S47. doi: 10.1002/ana.410270712. [DOI] [PubMed] [Google Scholar]
  17. Koski C. L., Humphrey R., Shin M. L. Anti-peripheral myelin antibody in patients with demyelinating neuropathy: quantitative and kinetic determination of serum antibody by complement component 1 fixation. Proc Natl Acad Sci U S A. 1985 Feb;82(3):905–909. doi: 10.1073/pnas.82.3.905. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Latov N., Sherman W. H., Nemni R., Galassi G., Shyong J. S., Penn A. S., Chess L., Olarte M. R., Rowland L. P., Osserman E. F. Plasma-cell dyscrasia and peripheral neuropathy with a monoclonal antibody to peripheral-nerve myelin. N Engl J Med. 1980 Sep 11;303(11):618–621. doi: 10.1056/NEJM198009113031105. [DOI] [PubMed] [Google Scholar]
  19. McCombe P. A., Pollard J. D., McLeod J. G. Chronic inflammatory demyelinating polyradiculoneuropathy. A clinical and electrophysiological study of 92 cases. Brain. 1987 Dec;110(Pt 6):1617–1630. doi: 10.1093/brain/110.6.1617. [DOI] [PubMed] [Google Scholar]
  20. Melmed C., Frail D., Duncan I., Braun P., Danoff D., Finlayson M., Stewart J. Peripheral neuropathy with IgM kappa monoclonal immunoglobulin directed against myelin-associated glycoprotein. Neurology. 1983 Nov;33(11):1397–1405. doi: 10.1212/wnl.33.11.1397. [DOI] [PubMed] [Google Scholar]
  21. Nemni R., Feltri M. L., Fazio R., Quattrini A., Lorenzetti I., Corbo M., Canal N. Axonal neuropathy with monoclonal IgG kappa that binds to a neurofilament protein. Ann Neurol. 1990 Sep;28(3):361–364. doi: 10.1002/ana.410280309. [DOI] [PubMed] [Google Scholar]
  22. Nobile-Orazio E., Baldini L., Barbieri S., Marmiroli P., Spagnol G., Francomano E., Scarlato G. Treatment of patients with neuropathy and anti-MAG IgM M-proteins. Ann Neurol. 1988 Jul;24(1):93–97. doi: 10.1002/ana.410240118. [DOI] [PubMed] [Google Scholar]
  23. Nyland H., Matre R., Mørk S. Immunological characterization of sural nerve biopsies from patients with Guillain-Barré syndrome. Ann Neurol. 1981;9 (Suppl):80–86. doi: 10.1002/ana.410090713. [DOI] [PubMed] [Google Scholar]
  24. Ohnishi A., Hirano A. Uncompacted myelin lamellae in dysglobulinemic neuropathy. J Neurol Sci. 1981 Jul;51(1):131–140. doi: 10.1016/0022-510x(81)90066-6. [DOI] [PubMed] [Google Scholar]
  25. Osby E., Noring L., Hast R., Kjellin K. G., Knutsson E., Sidén A. Benign monoclonal gammopathy and peripheral neuropathy. Br J Haematol. 1982 Aug;51(4):531–539. doi: 10.1111/j.1365-2141.1982.tb02816.x. [DOI] [PubMed] [Google Scholar]
  26. Pollard J. D., McCombe P. A., Baverstock J., Gatenby P. A., McLeod J. G. Class II antigen expression and T lymphocyte subsets in chronic inflammatory demyelinating polyneuropathy. J Neuroimmunol. 1986 Dec;13(2):123–134. doi: 10.1016/0165-5728(86)90059-7. [DOI] [PubMed] [Google Scholar]
  27. Pollard J. D., McLeod J. G., Feeney D. Peripheral neuropathy in IgM kappa paraproteinaemia: clinical and ultrastructural studies in two patients. Clin Exp Neurol. 1985;21:41–54. [PubMed] [Google Scholar]
  28. Pollard J. D., McLeod J. G., Gatenby P., Kronenberg H. Prediction of response to plasma exchange in chronic relapsing polyneuropathy. A clinico-pathological correlation. J Neurol Sci. 1983 Feb;58(2):269–287. doi: 10.1016/0022-510x(83)90222-8. [DOI] [PubMed] [Google Scholar]
  29. Powell H. C., Rodriguez M., Hughes R. A. Microangiopathy of vasa nervorum in dysglobulinemic neuropathy. Ann Neurol. 1984 Apr;15(4):386–394. doi: 10.1002/ana.410150414. [DOI] [PubMed] [Google Scholar]
  30. Prineas J. Polyneuropathies of undetermined cause. Acta Neurol Scand Suppl. 1970;44:1–72. doi: 10.1111/j.1600-0404.1970.tb07459.x. [DOI] [PubMed] [Google Scholar]
  31. Read D. J., Vanhegan R. I., Matthews W. B. Peripheral neuropathy and benign IgG paraproteinaemia. J Neurol Neurosurg Psychiatry. 1978 Mar;41(3):215–219. doi: 10.1136/jnnp.41.3.215. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Sherman W. H., Olarte M. R., McKiernan G., Sweeney K., Latov N., Hays A. P. Plasma exchange treatment of peripheral neuropathy associated with plasma cell dyscrasia. J Neurol Neurosurg Psychiatry. 1984 Aug;47(8):813–819. doi: 10.1136/jnnp.47.8.813. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Smith I. S., Kahn S. N., Lacey B. W., King R. H., Eames R. A., Whybrew D. J., Thomas P. K. Chronic demyelinating neuropathy associated with benign IgM paraproteinaemia. Brain. 1983 Mar;106(Pt 1):169–195. doi: 10.1093/brain/106.1.169. [DOI] [PubMed] [Google Scholar]
  34. Smith T., Sherman W., Olarte M. R., Lovelace R. E. Peripheral neuropathy associated with plasma cell dyscrasia: a clinical and electrophysiological follow-up study. Acta Neurol Scand. 1987 Apr;75(4):244–248. doi: 10.1111/j.1600-0404.1987.tb07927.x. [DOI] [PubMed] [Google Scholar]
  35. Yeung K. B., Thomas P. K., King R. H., Waddy H., Will R. G., Hughes R. A., Gregson N. A., Leibowitz S. The clinical spectrum of peripheral neuropathies associated with benign monoclonal IgM, IgG and IgA paraproteinaemia. Comparative clinical, immunological and nerve biopsy findings. J Neurol. 1991 Oct;238(7):383–391. doi: 10.1007/BF00319857. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES