Deepinder Maini1, Rajiv Anand1, Varun Rehani1, Atul Prasad1
1Neurology, BLK Max Super Speciality Hospital
Objective:
We retrospectively reviewed 10 patients with treatment-resistant, relapsing, or atypical immune-mediated neuropathy who underwent nodal/paranodal antibody analysis. Clinical phenotype, cerebrospinal fluid, neuro-imaging, nerve conduction studies, antibody profiles, and treatment response were analysed. Antibody testing included NF140, NF155, NF186, CASPR2, sulfatide IgM, GAD65, and unclassified neuronal antibodies using ELISA.
Background:
Immune-mediated neuropathies extend beyond the classical spectrum of GBS and CIDP. Recently, antibodies targeting nodal and paranodal proteins have been recognized as a distinct group of disorders termed autoimmune nodopathies.
Design/Methods:
We retrospectively reviewed 10 patients with treatment-resistant, relapsing, or atypical immune-mediated neuropathy who underwent nodal/paranodal antibody testing. Clinical phenotype, cerebrospinal fluid, neuro-imaging, serial nerve conduction studies, antibody profiles, and treatment response were analyed. Antibody testing included NF140, NF155, NF186, CASPR2, sulfatide IgM, GAD65, and unclassified neuronal antibodies using ELISA.
Results:
Ten patients (mean age 50.4 years; range 29-81 years) with immune-mediated neuropathy were identified. Clinical presentations included acute GBS (n=3), CIDP (n=3), motor-predominant neuropathy mimicking motor neuron disease (n=1), painful small-fiber-predominant neuropathy (n=1), immune-mediated brachial plexopathy (n=1), and GBS-CIDP overlap phenotype (n=1). Nodal/paranodal antibodies were detected in the majority of patients, including neurofascin-155 (n=2), neurofascin-140 (n=2), neurofascin-186 (n=2), and sulfatide IgM (n=2), while two patients demonstrated unclassified neuronal antibodies.
Conclusions:
Autoimmune nodopathies can masquerade as peripheral neuropathy. Integrating clinical phenotype, serial electrophysiology, antibody testing, especially in a resistant and atypical presentation may improve diagnostic accuracy.
Generative AI Usage
No, did not use generative AI in the drafting or editing in this abstract.
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