Comparing neuropathy in multiple myeloma and AL amyloidosis
Martin Ballegaard1,2,3, Laerke Marie Nelson4, Peter Gimsing2,5
1Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen, Denmark.
Journal of the Peripheral Nervous System : JPNS
|December 28, 2020
Summary
Peripheral neuropathy (PN) is more severe in AL amyloidosis patients than in multiple myeloma patients, with higher clinical scores but similar nerve conduction study findings. Both conditions show axonal neuropathy.
Area of Science:
- Neurology
- Hematology
- Clinical Electrophysiology
Background:
- Peripheral neuropathy (PN) is common in plasma cell dyscrasias.
- Limited data exists on comparative nerve dysfunction across different monoclonal gammopathies.
Purpose of the Study:
- To compare the clinical and electrophysiological impact of nerve dysfunction in multiple myeloma (MM) and AL amyloidosis (ALA).
Main Methods:
- Evaluated 76 untreated MM and 27 ALA patients.
- Assessed symptoms, clinical findings, and nerve conduction studies (NCS).
- Utilized Total Neuropathy Scores (TNS) and NCS for PN diagnosis.
Main Results:
- Higher TNS scores in ALA patients (P=.02) indicated more severe PN.
- NCS-based PN diagnosis did not significantly differ between groups (P=.13).
- ALA patients showed higher TNS vibration, pin sensory, and reflex scores, and elevated vibration thresholds (P=.01).
- NCS revealed more frequent axonal tibial neuropathy with lower motor response amplitudes in ALA (P=.02).
Conclusions:
- AL amyloidosis patients exhibit more severe peripheral neuropathy than multiple myeloma patients.
- While clinical scores and vibration thresholds are higher in ALA, NCS findings for sensory involvement are similar.
- Nerve conduction studies consistently indicated axonal neuropathy in both conditions.
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