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Autoimmune / Immune Diseases

DISEASES

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Autoimmune neuropathies can include Guillain-Barré syndrome (GBS), chronic inflammatory demyelinating polyneuropathy (CIDP), multifocal motor neuropathy (MMN), and IgM paraproteinemic neuropathy, among others. They present with a broad range of symptoms, including slow or insidious onset and progression, asymmetric or multifocal nerve deficits, and selective involvement of motor, sensory, or autonomic nerves. The overlap of symptoms among syndromes often makes the diagnosis difficult. Presumptive diagnosis is based on the patient’s history and clinical signs and findings on physical exam. Initial laboratory testing aims to rule out underlying causes such as infections, metabolic disturbances, and brain tumors.  If nothing is uncovered, further evaluation, including advanced imaging, nerve conduction studies, and cerebrospinal fluid (CSF) analysis may be required.

Autoimmune neuropathies can also arise as a condition associated with cancer (paraneoplastic). The detection of an autoantibody in the right clinical setting can provide evidence that the peripheral nerve disturbance is immune mediated and may direct treatment, but autoantibody testing cannot be used as the sole diagnostic tool. Anti-myelin-associated glycoprotein (anti-MAG) antibodies are often present in patients with predominant sensory symptoms, and anti-GM1 antibodies are present in patients with predominant motor nerve symptoms.

Symptoms

Guillain-Barré syndrome

  • Prickling, pins and needles sensations in your fingers, toes, ankles or wrists
  • Weakness in your legs that spreads to your upper body
  • Unsteady walking or inability to walk or climb stairs
  • Difficulty with facial movements, including speaking, chewing or swallowing
  • Double vision or inability to move eyes
  • Severe pain that may feel achy, shooting or cramp-like and may be worse at night
  • Difficulty with bladder control or bowel function
  • Rapid heart rate
  • Low or high blood pressure
  • Difficulty breathing
  • Most significant weakness within two weeks after symptoms begin

CIDP (*Often confused with GBS, but symptoms continue for longer)

  • Tingling in your arms and legs
  • Gradual weakening of your arms and legs
  • Loss of reflexes
  • Loss of balance and your ability to walk
  • Loss of feeling in your arms and legs, which often starts with your inability to feel a pin prick

MMN

  • Weakness
  • Cramping
  • Involuntary contractions or twitching
  • Wrist drop or foot drop
  • Wasting (atrophy) of affected muscles
  • Atrophy occurs late in the course of the condition
  • Muscles of the hands and lower arms are most commonly affected, but muscles of the lower limbs may also be involved
  • The symptoms are often asymmetrical

Relevant Dx Tests

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Guillain–Barré syndrome (GBS) is a rare disorder in which the body’s immune system attacks the nerves. Weakness and tingling in the arms and legs are usually the first symptoms. These sensations can quickly spread, eventually paralyzing the whole body. The exact cause of Guillain-Barré syndrome is unknown, however it is often preceded by an infectious illness such as a respiratory infection or influenza.

GBS occurs in several forms:

Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) is the most common form in North America. The most common sign of AIDP is muscle weakness that starts in the lower part of the body and spreads upward.

Miller Fisher syndrome (MFS), in which paralysis starts in the eyes. MFS is also associated with unsteady gait. MFS occurs in about 5 percent of people with GBS and is more common in Asia.

Acute motor axonal neuropathy (AMAN) and acute motor-sensory axonal neuropathy (AMSAN) are less common in the North America are more frequent in China, Japan and Mexico.

Symptoms

  • Prickling, pins and needles sensations in your fingers, toes, ankles or wrists
  • Weakness in your legs that spreads to your upper body
  • Unsteady walking or inability to walk or climb stairs
  • Difficulty with facial movements, including speaking, chewing or swallowing
  • Double vision or inability to move eyes
  • Severe pain that may feel achy, shooting or cramp-like and may be worse at night
  • Difficulty with bladder control or bowel function
  • Rapid heart rate
  • Low or high blood pressure
  • Difficulty breathing
  • Most significant weakness within two weeks after symptoms begin

Relevant Dx Tests

Related Dx Tests