Diagnosis and management of multifocal motor neuropathy in the United Kingdom: a multicentre survey

Abstract

Background We conducted a survey to determine the current diagnosis and treatment of multifocal motor neuropathy (MMN) in the United Kingdom. Methods Demographic, diagnostic and treatment data were collected at nine UK neuroscience centres. Results Ninety-five subjects were included. Mean age at diagnosis was 49.9 years (SD: 11.4). Males were more commonly affected (ratio: 1.9:1). Diagnostic delay was > 1 year from the time of first neurological assessment, in > 50% of subjects. Applying modified EFNS/PNS 2010 criteria, 69/95 (72.6%) had definite MMN, 10/95 (10.5%) had probable MMN, 15/95 (15.8%) had possible MMN, through treatment responsiveness in 9/15 (60%) and 1/95 (1.1%) did not meet criteria. Cerebrospinal fluid examination, anti-GM1 antibody testing and brachial plexus magnetic resonance imaging were non-contributory. Immunoglobulin response was reported in 90/92 subjects (97.8%), and 84/90 (93.3%) remained on treatment after a mean of 9.4 years, at a mean dose of 26.2 g/week (range: 4–114). Mean long-term immunoglobulin dose was 30%–60% higher than reported in neighbouring countries. Contrasting with previous reports of frequent loss of immunoglobulin response and functional decline, our physician-assessed long-term outcome was favourable (stable or improving) in 74/84 (88.1%) treated subjects. Interpretation MMN diagnosis and treatment in the United Kingdom are comparable to that of neighbouring countries and follow existing guidelines. Diagnostic delay after the first neurological assessment is considerable. Electrophysiology shows at least one definite/probable conduction block in nearly 90% of cases. The mean long-term immunoglobulin dose is higher in the United Kingdom than reported elsewhere, although highly variable. Whether higher doses of immunoglobulin may improve long-term outcomes requires further study.

Publication DOI: https://doi.org/10.1111/jns.70018
Divisions: College of Health & Life Sciences
Additional Information: Copyright © 2025 The Author(s). Journal of the Peripheral Nervous System published by Wiley Periodicals LLC on behalf of Peripheral Nerve Society. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Uncontrolled Keywords: Adult,Aged,Female,Humans,Male,Middle Aged,Motor Neuron Disease/diagnosis,Polyneuropathies/diagnosis,United Kingdom/epidemiology
Publication ISSN: 1529-8027
Last Modified: 09 May 2025 07:14
Date Deposited: 11 Apr 2025 14:20
Full Text Link:
Related URLs: https://onlinel ... .1111/jns.70018 (Publisher URL)
PURE Output Type: Article
Published Date: 2025-06
Published Online Date: 2025-04-10
Accepted Date: 2025-03-31
Authors: Rajabally, Yusuf A.
Englezou, Christina
Cluett, Grace
Bellanti, Roberto
Rinaldi, Simon
Chin, Mow Wei
Hadden, Robert
Roman, Madalina
Hewamadduma, Chana
Murray, Ashleigh
Elsaddig, Amar
Lavin, Tim
Cousins, Oliver
Nirmalananthan, Niranjanan
Freiha, Joumana
Osman, Chinar
Evans, Matthew
Carr, Aisling
Holt, James K.L.

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