Polyneuropathies and chronic inflammatory demyelinating polyradiculoneuropathy in multiple sclerosis

Narupat Suanprasert, Bruce V. Taylor, Christopher J. Klein, Matthew M. Roforth, Chafic Karam, B. Mark Keegan, P. James B. Dyck

Research output: Contribution to journalArticle

Abstract

Background: Polyneuropathies co-occurring with multiple sclerosis (MS) may be underdiagnosed while causing additional disability burden. Objective: To determine polyneuropathy presence and type in MS and compare MS with chronic inflammatory demyelinating polyradiculoneuropathy (MS-CIDP) versus MS with other non-inflammatory polyneuropathies. Methods: Retrospective chart review of Mayo Clinic cases diagnosed with MS and polyneuropathy. Serum from MS-CIDP for pan-IgG autoantibodies to neurofascin-155 were tested when available. Results: From 1980–2013, 133 co-existing MS/ polyneuropathy cases were identified. Twenty-eight MS patients had inflammatory neuropathy (11 CIDP, 5 plexopathy, 2 vasculitis, 4 monoclonal gammopathy-associated, 6 other), 15 inherited neuropathy (8 axonal, 7 demyelinating), 32 diabetic sensorimotor polyneuropathy, and 58 other. 109 had neuropathy beginning simultaneous to or after MS diagnosis (82%). Compared to MS cases with other polyneuropathy subtypes, MS-CIDP cases had absent or reduced ankle reflexes (100 vs. 70%, p = 0.04), earlier age of neuropathy recognition (52 vs. 58 years, p = 0.048), worse impairment (NIS 27 vs. 22 points, p < 0.03), and more acquired demyelinating electrophysiology features (46% vs. 9%, p < 0.003). Of MS-CIDP cases with available serum, 1-in-3 had IgG4 autoantibodies to neurofascin-155. Conclusion: (1) Polyneuropathies occurring in MS contribute to neurological disability. (2) Diagnosing polyneuropathies in people with MS is challenging and, likely, under-diagnosed. Recognition is important as some polyneuropathies (e.g., CIDP) are treatable. (3) The probable over-representation of inflammatory neuropathy (especially CIDP) in MS suggests a shared dysimmune pathogenesis, supported by autoantibodies to neurofascin-155.

Original languageEnglish (US)
Pages (from-to)284-290
Number of pages7
JournalMultiple Sclerosis and Related Disorders
Volume30
DOIs
StatePublished - May 1 2019

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Keywords

  • Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)
  • Multiple sclerosis (MS)
  • Neurofascin-155
  • Non-inflammatory polyneuropathy

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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