Atypical Motor Neuron Disease or Multifocal Motor Neuropathy

I am 55yr male.Have had 4 EMG(1 lasting 2hr)Feb2004 to Sept2005.No conduction block found.Had 1 unremarkable MRI of C spine March2005.Since Aug.2004 I notice Gaining strength ever so slowly in arm/legs.My symtoms (symptoms) wax/wane and first and only exacerbation was Jan.2004.At that time I could not walk up stairs or pick up a glass of water at arms length. My  bloodwork was  done between Apr.04/Mar.05:CK fluctuates-879/366,EOS-1.4 to.1(0-.6),ESR-16 to42(0-14),IGG is15.9(7-16),Anti GM1 Ganglioside Antibody is 12.3(<20 EU/ML is negative),Parathyroid hormone-9.2(1.3-6.8),Vitamin D 25HYDR is 31(25-200),Vitamin D 1-25 D1HY is 21(40-150).My blood calcium has always been normal.Now my PTH/Vitamin D levels are fine with supplements.The last EMG done Sept.05 show findings that are consistent with Motor Neuron Disease,but are essentially unchanged from EMGs done Sept.04 and May 05.My questions are as follows:1 Can a EMG distinguish between MND and MMN without conduction block showing at all?2 What % contamination factor(HIV/HEP C) is there for Human Immune Globulin?3 Are there any NEW treatments for MMN?4 Do you know of any case of MMN with increase of muscle strength over time?5 Is MMN only a lower motor neuron syndrome?6 Is there an explanation  for my slowly gaining strength when my EMGs are essentially unchanged?Do you know of any other motor neuron disease other than atypical ALS that could cause  my symptoms?HAPPY HOLIDAYS TO ALL AND THANKS FOR THE INTERNATIONAL SERVICE THAT YOU PROVIDE.

[CCF-Neuro-M.D.-PW]

1) MMN requires conduction block for this diagnosis to be made

2) similar to other blood products, approx 1 in a million for HIV and 1 in 400,000 for Hep C

3) I'm not sure what you mean by new, IV immune globulin is the mainstay of therapy

4) depends, but there may be some fluctuation in weakness over time and in response to treatment

5) Yes

6) EMG is a subjective test especially in terms of judging whether more motor units are firing than before, your own impression is probably more sensitive, although the EMG provides more objective evidence than your own symtpoms.

7) I don't know enough about your symptoms to provide you with more of a diagnosis - fluctuating weakness, which is what you seem to describe can be caused by a wide range of conditions such as myesthenia, metabolic myopathies, periodic paralysis, or other immune mediated neuropathies like CIDP.

Good luck