Journal List > J Rheum Dis > v.20(3) > 1064039

Kim, Kang, Lee, Han, Lim, Song, Seo, and Kim: Multifocal Motor Neuropathy with Conduction Blocks During TNF-alpha Antagonist Therapy in a Patient with Spondyloarthropathy

Abstract

Tumor necrosis factor (TNF)-alpha antagonist has been proven to have benefit for rheumatologic diseases. Because TNF-alpha is not only an important mediator of inflammation in human body, but plays many physiologic roles, it can cause unique adverse effects or complications related to these functions. Adverse effects involving neurological systems, such as Guillain-Barre syndrome, Chronic inflammatory demyelinating polyneuropathy, multifocal motor neuropathy with conduction blocks (MMNCB), distal symmetric polyneuropathy, and small fibers neuropathy have been previously reported. However, only several cases of infliximab-associated MMNCB are reported. We report a case of MMNCB which developed while treating spondyloarthropathy with infliximab.

References

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Figure 1.
Serial motor nerve conduction studies of the right median nerve and left radial nerve among the 4 months. (A, B) The first study was done at 14 days after symptom onset, muscle response after stimu-lation at the axilla is 50% reduced in amplitude and area as compared with that after more distal stimu-lation at the forearm. This fits the definition of focal motor conduction block across that nerve segment. (C, D) Four months after stopping infliximab, the conduction blocks had slightly improved in the right median nerve and left radial nerve. APB: abductor pollicis brevis, EIP: extensor indicis proprius.
jrd-20-177f1.tif
Table 1.
Nerve conduction study in the patient
Motor (R/L) Terminal latency (ms) Amplitude (mV) Conduction velocity (m/s) F-latency (ms)
Median (APB)        
  Wrist 2.8/2.7 10/12   24.3/UC
  Elbow 6.7/6.6 2.3/12 56.4/54.9  
  Axillary 8.6/7.5 2.1/1.4 61.6/36.8  
  Erb's UC/9.55      
Ulnar (ADM)        
  Wrist 2.1/2.1 10.1/10.9   24.6/27.1
  B.Elbow 5.7/5.6 9/8.7 54.7/59.2  
  A.Elbow 7.3/7.4 9/7.4 65.2/52.8  
  Axillary 9.5/8.2 9/7.4 61.2/69.3  
Radial (EIP)        
  Forearm 1.5/1.4 3.5/3.8    
  Elbow 4.9/4.6 3.3/0.8 71.6/69.8  

R/L: right/left, F-latency: F-wave, APB: abductor pollicis brevis, ADM: abductor digiti/minimi, EIP: extensor indicis proprius, UC: unchecked, B.Elbow: below elbow, A.Elbow: above elbow.

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