Mononeuritis Multiplex

    
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Posted by ccf neuro M.D.* on August 18, 1997 at 19:32:09:

In Reply to: Mononeuritis Multiplex posted by Jenny Singer on August 18, 1997 at 13:19:21:
  I have been diagnosed with Mononeuritis Multiplex.  The symptoms have been coming on strong for eight months - ulnar nerves in both arms, and toes in both feet.  Excessive sweating, mostly after a meal  Although there have been no difinitive positive resutls for an immune problem, they do believe that is the cause..  I have been on 15 mg. of Prednisone a day for eight months, including Neurontin and Paxil for pain.  I took 100 mg. Imuran for about two months, but it started to affect my liver, so I was taken off of it last week.
  My doctors, (neurologist & rheumatologist) want to to take a more agressive approach now, and offer me 5 choices:  Three of them are chemo drugs, and one is IVIG, and the other, Plasmapheresis.
  They like the Plasmapheresis as the first choice, since there are no side effects.
  What do you think?
  Jenny Singer  (***@****)
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Jenny,
Thank you for your sharing your question about this very interesting disease with us. Mononeuritis multiplex is a disease syndrome in which some underlying disease attacks multiple peripheral nerves in the arms and/or legs, or, more specifically, usually the very small blood vessels that nourish the nerves, called the vasa nervorum. This results in loss of function of the nerves (usually temporary). Underlying causes include an immune disorder called polyarteritis nodosa (PAN), sarcoidosis, diabetes, and less often other causes like deposits of proteins that damage the nerves. Often a nerve biopsy is the only way to make a definite diagnosis, but, of course, you don't want to biopsy an important nerve and be left with  major permanent nerve damage!!! Corticosteroids and immune suppressant drugs (many of which are also used as chemotherapy and organ transplant rejection drugs) are typically the first line treatment for immunological disorders that cause the syndrome. Plasmapheresis is a treatment where the plasma is separated from the red blood cells in the blood, and only the red blood cells are retransfused back into the person. It works by literally removing plasma proteins from the blood, including specifically antibodies that may be causing some of the nerve and blood vessel damage underlying the mononeuritis multiplex. Side effects of this treatment options include bleeding (since proteins that allow the blood to clot are removed along with the "bad" proteins or antibodies you are performing the treatment for), and an incrased risk of infection, since all the "good" antibodies are removed along with the bad ones. If you require multiple treatments, also a cathter must often be placed into a large vein in the body, which may become infected, cause bleeding, or puncture your lung (if placed under the collarbone, where most such catheters go). Sometimes, your blood pressure may drop during a treatment also, although this is unlikely to happen if you are not dehydrated or very sick. Thus, as you can see, plasmapheresis, like any effective treatment for such disorders, is by no means without potential side effects. Immune globulin infusion or gamma globulin infusion is a treatment where pooled human antibodies or gammaglobulins are infused into you over two to five days. Ironically, this is the opposite type of treatment as the plasmapheresis treatments, which REMOVE such antibodies, but it still often works because it is believed that the normal, "good" antibodies that are infused into you compete against the "bad" antibodies in your blood, blocking them from causing as much damage as they could if it weren't for the extra "good " antibodies being added via the treatment. Side effects from this can include fever, and if you are congenitally deficient in one type of immune globulin called type "A", a potentially severe blood reaction. Doctors always measure the level of this type "A" immune globullin before beginning any such infusions. Generally, you must be in the hospital as the infusion is continuous for 2 to 5 days. Both types of treatments (plasmapheresis and immune globulin infusion) are about equally effective in treating most immunologic disorders. If you are interested in a second opinion for your particular case at the Cleveland Clinic, we have one of the world's greatest experiences in diagnosing and treating such disorders. I would specifically suggest Dr. Hiroshi Mitsumoto, Dr. Kerry Levin, or Dr. Robert Shields. The neurology department's number is 216-444-5559, or 1-800-223-2273 ext 45559. Information provided on the forum is intended for general medical informational purposes only. Actual diagnosis and treatment of your specific codition should be strictly in conjunction with your treating physician(s). We hope you finf the information interesting and useful.

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