[Multifocal motor neuropathy: an individualized disease of the peripheral nervous system]

Multifocal motor neuropathy is a peripheral nervous system disease described among chronic inflammatory demyelinating polyneuropathies. It is characterized according to both clinical criteria, including chronic asymmetric and multifocal deficit which starts and remains prominent in the upper limbs, and electrophysiological criteria, including persistent multifocal motor conduction blocks in motor nerves. High titers of serum antiganglioside GM1 antibodies are discovered in nearly 40% of cases. Steroids and plasma exchange are not efficient. High doses of intravenous immunoglobulins (i.v.Ig) improved symptoms in the majority of open and controlled published studies. The quality of the response to i.v.Ig may worsen in some patients after a variable number of infusions, leading to immunosuppressive treatments mainly with oral or intravenous cyclophosphamide. Its etiology is unknown but the frequent presence of anti-GM1 antibody high serum titers, the pathological findings in some rare morphological studies, and the response to i.v.Ig favor the hypothesis of an autoimmune disorder.