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Academia Mexicana de Neurología, A.C.

2018, Number 1

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Rev Mex Neuroci 2018; 19 (1)

Recommendations on the diagnosis and treatment of multifocal motor neuropathy

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

Language: Spanish
References: 67
Page: 2-22
PDF size: 468.28 Kb.


ABSTRACT

Introduction. Multifocal motor neuropathy (NMM) is a rare disease characterized by progressive, distal and asymmetrical weakness in extremities, without sensitivity alterations. This autoimmune disease affects the peripheral nerves, causing demyelination, usually with documentable nerve conduction block by electroneurography. Objective. To develop a guideline on definition, diagnosis and treatment of the MMN by using the best existing scientific evidence and when not available, expert consensus.
Methods. A group of neurologists from different institutions representing the Mexican sanitary system and pertaining to the Study Group of Neuromuscular Diseases of the Mexican Academy of Neurology met and carried out a MEDLINE and Cochrane systematic search, selecting the best available evidence on diagnosis and treatment and qualifying the recommendations according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. The recommendations are organized into short statements supported by a brief dissertation on the scientific evidence supporting the statements.
Recommendations. This panel recommends testing and diagnostic criteria proposed by the EFNS/PNS (European Federation of Neurological Societies / Peripheral Nerve Society) with minor modifications that are described in the present document. The panel recommends human intravenous or subcutaneous immunoglobulin in the treatment of MMN. Treatment with cyclophosphamide is only recommended as an add-on to immunoglobulin therapy and not as monotherapy. Eculizumab could potentially offer benefits as add-on therapy, but more studies are needed. Rituximab has shown no benefit in studies of greater scientific rigor. Other immunosuppressive or immunomodulatory agents such as methotrexate, azathioprine, cyclosporine or mofetil mycophenolate have not been shown benefits as monotherapy or add-on therapy, and thus, this panel does not recommended their use in patients with MMN. Plasma exchange offers no benefit and may be associated with clinical deterioration, and therefore its use is contraindicated in patients with MMN.


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