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Multifocal Motor Neuropathy: Current Therapies and Novel Strategies

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Abstract

Multifocal motor neuropathy (MMN) is a purely motor mononeuritis multiplex characterized by the presence of conduction block on motor but not on sensory nerves and by the presence of high titers of anti-GM1 antibodies. Several data point to a pathogenetic role of the immune system in this neuropathy, although this has not yet been proved. Several uncontrolled studies and randomized controlled trials have demonstrated the efficacy of therapy with high-dose intravenous immunoglobulin (IVIg) in MMN. However, this therapy has a short-lasting effect that needs to be maintained with periodic infusions. This can be partly overcome by the use of subcutaneous immunoglobulin (SCIg) at the same dose. The high cost and need for repeated infusions have led to the search for other immune therapies, the efficacy of which have not yet been confirmed in randomized trials. In addition, some therapies, including corticosteroids and plasma exchange, are not only ineffective but have been associated with clinical worsening. More recently, a number of novel therapies have been investigated in MMN, including interferon-β1a, the anti-CD20 monoclonal antibody rituximab and the complement inhibitor eculizumab. Preliminary data from open-label uncontrolled studies show that some patients improve after these therapies; however, randomized controlled trials are needed to confirm efficacy. Until then, IVIg (and SCIg) remains the mainstay of treatment in MMN, and the use of other immune therapies should only be considered for patients not responding to, or becoming resistant to, IVIg.

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Conflicts of interest

No sources of funding were used to assist in the preparation of this article. Eduardo Nobile-Orazio has acted as ad hoc consultant for Baxter, USA; CSL Behring, Australia; Kedrion, Italy; and Novartis, Switzerland. He has received personal compensation for lecturing from Baxter, Italy; Grifols, Spain; and Talecris, USA. He has received travel grants to attend Scientific Meetings from Baxter, Italy; Grifols, Italy; Kedrion, Italy; and Novartis, Italy. Francesca Gallia has nothing to report.

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  1. Department of Medical Biotechnology and Translational Medicine (BIOMETRA), 2nd Neurology, Humanitas Clinical and Research Center, IRCCS Humanitas Clinical Institute, Milan University, Via Manzoni 56, Rozzano, 20089, Milan, Italy

    Eduardo Nobile-Orazio & Francesca Gallia

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Correspondence to Eduardo Nobile-Orazio.

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Nobile-Orazio, E., Gallia, F. Multifocal Motor Neuropathy: Current Therapies and Novel Strategies. Drugs 73, 397–406 (2013). https://doi.org/10.1007/s40265-013-0029-z

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