1. Intranervous immunoglobulin deposits: An underestimated mechanism of neuropathy
- Author
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Karima Ghorab, Didier Cros, Jean-Michel Vallat, Judith Calvo, Laurence Richard, Martine Piaser, Philippe Sindou, Laurent Magy, Service de Neurologie [CHU Limoges], CHU Limoges, Biomolécules Thérapies anti-tumorales (EA4021), and Université de Limoges (UNILIM)-Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST FR CNRS 3503)
- Subjects
Male ,Pathology ,MESH: Immunoglobulins ,Physiology ,Biopsy ,[SDV.NEU.NB]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC]/Neurobiology ,Neural Conduction ,Paraproteinemias ,Fluorescent Antibody Technique ,Cell Count ,Nerve Fibers, Myelinated ,MESH: Biopsy ,MESH: Paraproteinemias ,0302 clinical medicine ,MESH: Neural Conduction ,MESH: Microscopy, Immunoelectron ,MESH: Cryoglobulins ,Nerve Tissue ,Microscopy, Immunoelectron ,MESH: Fluorescent Antibody Technique ,Cryoglobulins ,Motor Neurons ,MESH: Aged ,0303 health sciences ,MESH: Middle Aged ,MESH: Polyneuropathies ,MESH: Electrophysiology ,medicine.diagnostic_test ,biology ,Electrodiagnosis ,MESH: Neurons, Afferent ,Middle Aged ,Pathophysiology ,MESH: Nerve Fibers, Myelinated ,3. Good health ,Electrophysiology ,Monoclonal ,[SDV.IMM]Life Sciences [q-bio]/Immunology ,Female ,[SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC] ,Antibody ,Polyneuropathy ,MESH: Motor Neurons ,Adult ,medicine.medical_specialty ,MESH: Nerve Tissue ,Immunoglobulins ,Polyneuropathies ,03 medical and health sciences ,Cellular and Molecular Neuroscience ,[SDV.BBM.GTP]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Genomics [q-bio.GN] ,Physiology (medical) ,medicine ,Humans ,[SDV.BBM]Life Sciences [q-bio]/Biochemistry, Molecular Biology ,Neurons, Afferent ,Aged ,030304 developmental biology ,[SDV.GEN]Life Sciences [q-bio]/Genetics ,MESH: Humans ,Nerve biopsy ,MESH: Cell Count ,business.industry ,MESH: Adult ,[SDV.BBM.BM]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Molecular biology ,MESH: Electrodiagnosis ,medicine.disease ,MESH: Male ,Lymphoma ,Peripheral neuropathy ,[SDV.GEN.GH]Life Sciences [q-bio]/Genetics/Human genetics ,biology.protein ,Neurology (clinical) ,business ,MESH: Female ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology ,030217 neurology & neurosurgery - Abstract
International audience; There are several pathogenic mechanisms of peripheral nerve involvement in patients with monoclonal dysglobulinemia. Intranervous proliferation of malignant cells, immunoglobulin, or amyloid deposits in the endoneurial space can only be determined by examination of nerve biopsy specimens. We present clinical, electrophysiological, and histological data from seven patients whose polyneuropathy was induced by immunoglobulin deposits in the endoneurial space. As these lesions cannot be demonstrated on clinical and electrophysiological grounds, the indication for nerve biopsy derives from careful analysis of each patient presenting with a polyneuropathy and a monoclonal dysglobulinemia. To visualize and clearly characterize these deposits, electron microscopic examination is indispensable. Immunocytochemical methods using both light and electron microscopy for ultrastructural analysis are of great value. Demonstration of endoneurial immunoglobulin deposits may have major therapeutic consequences. Indeed, identification of these deposits prompted the use of aggressive treatment, which was quite effective in five of our seven patients.
- Published
- 2008