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Academia Mexicana de Neurología, A.C.

2018, Número 1

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Rev Mex Neuroci 2018; 19 (1)


Recomendaciones sobre el diagnóstico y tratamiento de la neuropatía motora multifocal

Chiquete E, Vargas-Cañas ES, Plascencia-Álvarez NI, Ruano-Calderón LA, Zúñiga-García DG, Madrigal-Salas RG, León-Manríquez E, Salmerón-Mercado ME, Carrera-Pineda R, Juárez-Jiménez H

Idioma: Español
Referencias bibliográficas: 67
Paginas: 2-22
Archivo PDF: 468.28 Kb.


RESUMEN

Introducción. La neuropatía motora multifocal (NMM) es una enfermedad rara que se caracteriza por debilidad progresiva y asimétrica de predominio distal en las extremidades, sin alteraciones de la sensibilidad. Esta enfermedad autoinmune afecta a los nervios periféricos, lo que provoca desmielinización, usualmente con bloqueo de la conducción nerviosa documentable por electroneurografía. Objetivo. Elaborar una guía sobre definición, diagnóstico y tratamiento de la NMM utilizando la mejor evidencia científica existente y cuando no esté disponible, el consenso de expertos.
Métodos. Un grupo de neurólogos de diferentes instituciones que representan al sistema sanitario mexicano y pertenecientes al grupo de estudio de Enfermedades Neuromusculares de la Academia Mexicana de Neurología, realizaron una búsqueda en MEDLINE y revisiones sistemáticas Cochrane sobre diagnóstico y tratamiento de la NMM, seleccionando la mejor evidencia disponible clasificando la recomendación de acuerdo al sistema GRADE (Grading of Recommendations Assessment, Development and Evaluation). Las recomendaciones se organizan en enunciados breves y una breve disertación sobre la evidencia científica de la que derivaron.
Recomendaciones. Este panel recomienda utilizar las pruebas y criterios diagnósticos propuestos por la EFNS/PNS (European Federation of Neurological Societies/ Peripheral Nerve Society), mismos que son expuestos en este documento con leves modificaciones. El panel recomienda la inmunoglobulina humana intravenosa o subcutánea en el tratamiento de la NMM. El tratamiento con ciclofosfamida sólo es recomendado como terapia de adición a la inmunoglobulina y no como monoterapia de inicio o sustitución. Potencialmente eculizumab podría ofrecer beneficios como terapia de adición, pero se requiere de más estudios. Rituximab no ha mostrado beneficio en estudios de mayor rigor científico. Otros inmunosupresores o inmunomoduladores tales como metotrexate, azatioprina, ciclosporina o micofenolato de mofetilo no han mostrado beneficios como terapia de adición o en monoterapia, por lo que este panel no recomienda su uso en la NMM. El recambio plasmático no ofrece beneficios y podría asociarse a deterioro clínico, por lo que su uso está contraindicado en pacientes con NMM.


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