European Federation of Neurological Societies/Peripheral Nerve Society Guideline on Management of Paraproteinemic Demyelinating Neuropathies. Report of a Joint Task Force of the European Federation of Neurological Societies and the Peripheral Nerve Society--first Revision

J Peripher Nerv Syst. 2010 Sep;15(3):185-95. doi: 10.1111/j.1529-8027.2010.00278.x.

Abstract

The aim of this guideline is to update the 2006 EFNS/PNS guideline on management of patients with a demyelinating neuropathy and a paraprotein (paraproteinemic demyelinating neuropathy [PDN]) by review of evidence and expert consensus. In the absence of adequate evidence, the panel agreed on good practice points: (1) patients with PDN should be investigated for a malignant plasma cell dyscrasia; (2) a monoclonal gammopathy of undetermined significance is more likely to be causing the neuropathy if it is immunoglobulin (Ig)M, anti-neural antibodies are present, and the clinical phenotype is chronic distal sensory neuropathy; (3) patients with IgM PDN usually have predominantly distal sensory impairment, prolonged distal motor latencies, and often anti-myelin-associated glycoprotein antibodies; (4) IgM PDN may respond to immunomodulatory therapies. Their potential benefit should be balanced against possible side effects and the usually slow disease progression; (5) IgG and IgA PDN may be indistinguishable from chronic inflammatory demyelinating polyradiculoneuropathy; and (6) Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy, and Skin changes syndrome is a multi-system malignant PDN.

Publication types

  • Guideline

MeSH terms

  • Europe
  • Evidence-Based Medicine
  • Humans
  • Immunotherapy / methods
  • Immunotherapy / standards
  • Paraproteinemias / complications
  • Paraproteinemias / diagnosis*
  • Paraproteinemias / therapy*
  • Polyradiculoneuropathy / complications
  • Polyradiculoneuropathy / diagnosis*
  • Polyradiculoneuropathy / therapy*