Partial but Rapid Recovery from Paralysis after Immunomodulation during Early Stage of Neuralgic Amyotrophy

Nakajima, Masashi; Fujioka, Shinsuke; Ohno, Hideki; Iwamoto, Konosuke

doi:10.1159/000093875

Cited by 32 publications

(28 citation statements)

References 6 publications

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“…Nakajima et al reported a 39-year-old man with NA who was initially treated with intravenous MP, but he showed no response. He was then treated with IVIg and showed good recovery (19). Al Masri et al described an 8-year-old girl with NA during immunosuppression therapy using tacrolimus.…”

Section: Discussionmentioning

confidence: 99%

Intravenous Immunoglobulin (IVIg) with Methylprednisolone Pulse Therapy for Motor Impairment of Neuralgic Amyotrophy: Clinical Observations in 10 Cases

et al. 2012

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Section: Discussionmentioning

confidence: 99%

Intravenous Immunoglobulin (IVIg) with Methylprednisolone Pulse Therapy for Motor Impairment of Neuralgic Amyotrophy: Clinical Observations in 10 Cases

et al. 2012

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“…A few observational studies in patients with brachial neuritis have reported improvement after IVIG treatment [95][96][97] (Class IV).…”

Section: Idiopathic Brachial Neuritismentioning

confidence: 99%

Consensus statement: The use of intravenous immunoglobulin in the treatment of neuromuscular conditions report of the aanem AD HOC committee

et al. 2009

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Intravenous immunoglobulin (IVIG) is a therapeutic biologic agent that has been prescribed for over two decades to treat various neuromuscular conditions. Most of the treatments are given off-label, as little evidence from large randomized trials exists to support its use. Recently, IGIV-C has received an indication for the treatment of chronic inflammatory demyelinating polyneuropathy (CIDP). Because of the lack of evidence, an ad hoc committee of the AANEM was convened to draft a consensus statement on the rational use of IVIG for neuromuscular disorders. Recommendations were categorized as Class I-IV based on the strength of the medical literature. Class I evidence exists to support the prescription of IVIG to treat patients with Guillain-Barré syndrome (GBS), CIDP, multifocal motor neuropathy, refractory exacerbations of myasthenia gravis, Lambert-Eaton syndrome, dermatomyositis, and stiff person syndrome. Treatment of Fisher syndrome, polymyositis, and certain presumed autoimmune neuromuscular disorders is supported only by Class IV studies, whereas there is no convincing data to substantiate the treatment of inclusion body myopathy (IBM), idiopathic neuropathies, brachial plexopathy, or diabetic amyotrophy using IVIG. Treatment with IVIG must be administered in the context of its known adverse effects. There is little evidence to advise the clinician on the proper dosing of IVIG and duration of therapy.

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“…As it is likely that neuralgic amyotrophy attacks are ultimately induced by an auto-immune response to the peripheral nervous system [1][2][3][4][5], efforts have been undertaken to attempt treatment in the acute phase with immunomodulants such as corticosteroids or iv gammaglobuline [6][7][8][9][10][11]. Unfortunately, a randomized controlled trial of corticosteroids failed because it proved impossible to recruit the needed number of participants within the three-year trial period.…”

Section: Introductionmentioning

confidence: 99%

Incidence of neuralgic amyotrophy (Parsonage–Turner syndrome) in a primary care setting: A prospective cohort study

Alfen

Groothuis

Nobacht³

et al. 2015

Neuromuscular Disorders

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ObjectiveNeuralgic amyotrophy is considered a rare peripheral nervous system disorder but in practice seems grossly under recognized, which negatively affects care for these patients. In this study we prospectively counted the one-year incidence rate of classic neuralgic amyotrophy in a primary care setting. MethodsIn a prospective cohort study during the year 2012 we registered all new cases of neck, shoulder or arm complaints from two large primary care centers serving a population of 14,118. Prior to study, general practitioners received a short training on how to diagnose classic neuralgic amyotrophy. Neuralgic amyotrophy was defined according to published criteria irrespective of family history. Only patients with a classic phenotype were counted as definite cases. After inclusion, patients with suspected neuralgic amyotrophy who had not yet seen a neurologist were offered neurologic evaluation for diagnostic confirmation. ResultsOf the 492 patients identified with new onset neck, shoulder or arm complaints, 34 were suspected of having neuralgic amyotrophy. After neurologic evaluation the diagnosis was confirmed in 14 patients. This amounts to a one-year incidence rate for classic neuralgic amyotrophy of 1 per 1000. Data Availability Statement: No centralized data collection was available for this study. Data were collected in an anonymized digital datafile and stored locally by the study group. The primary data file for this study is available as S1 Datafile.Funding: This study was sponsored by an unsolicited and unconditional gift from the Dutch Rare Diseases Fund (Stichting Zeldzame Ziekten Fonds; www.zzf.nl) and the ZABAWAS Foundation (www. zabawas.nl). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. ConclusionsOur findings suggest that neuralgic amyotrophy is 30-50 times more common than previously thought. Unawareness of the disorder and its clinical presentation seems the most likely explanation for this difference. An incidence rate of 1 per 1000 and the long-term sequelae many patients suffer warrant more vigilance in diagnosing the disorder, to pave the way for timely treatment and prevent complications.

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Partial but Rapid Recovery from Paralysis after Immunomodulation during Early Stage of Neuralgic Amyotrophy

Cited by 32 publications

References 6 publications

Intravenous Immunoglobulin (IVIg) with Methylprednisolone Pulse Therapy for Motor Impairment of Neuralgic Amyotrophy: Clinical Observations in 10 Cases

Intravenous Immunoglobulin (IVIg) with Methylprednisolone Pulse Therapy for Motor Impairment of Neuralgic Amyotrophy: Clinical Observations in 10 Cases

Consensus statement: The use of intravenous immunoglobulin in the treatment of neuromuscular conditions report of the aanem AD HOC committee

Incidence of neuralgic amyotrophy (Parsonage–Turner syndrome) in a primary care setting: A prospective cohort study

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