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Open AccessCase Report

Spinal Cord Impairment in Anti-Mag Neuropathy: Evidence from Somatosensory Evoked Potentials

Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128 Rome, Italy
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Author to whom correspondence should be addressed.
Brain Sci. 2020, 10(5), 282; https://doi.org/10.3390/brainsci10050282
Received: 31 March 2020 / Revised: 29 April 2020 / Accepted: 4 May 2020 / Published: 8 May 2020
(This article belongs to the Section Clinical Neuroscience)
Anti-Myelin Associated Glycoprotein (anti-MAG) neurological involvement classically manifests as a peripheral neuropathy with prominent sensitive symptoms. We describe a case report of a patient with positive anti-MAG antibodies presenting with clinical and neurophysiological evidence of spinal cord impairment. A 69-year-old woman came to our attention with subacute onset of dysesthesias at lower limbs and ataxia. Blood routine tests and hematological work-up led to a diagnosis of monoclonal gammopathy of undetermined significance. High titers of anti-MAG antibodies was revealed (34,594.70 BTU/mL, normal range 0–1000). Nerve conduction studies (NCS) ruled out a polyneuropathy at lower limbs. Somatosensory evoked potentials (SSEPs) showed prolonged central conduction time (CTT) at lower limbs, suggesting a dorsal column damage. Brain and spinal cord Magnetic Resonance Imaging (MRI) did not reveal any significant lesion. Analysis of cerebrospinal fluid (CSF) evidenced an albumin-cytologic dissociation. She was treated with corticosteroids with temporary remission of sensory symptoms and normalization of CTT. Subsequently, she developed a multineuropathy which was successfully treated with Rituximab. We discuss the potential role of anti-MAG antibodies in the pathophysiology of dorsal column impairment and the clinical usefulness of SSEPs in monitoring the evolution of anti-MAG neuropathy. View Full-Text
Keywords: anti-MAG; spinal cord; neuropathy; somatosensory evoked potentials anti-MAG; spinal cord; neuropathy; somatosensory evoked potentials
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Boscarino, M.; Lanzone, J.; Ricci, L.; Tombini, M.; Di Lazzaro, V.; Assenza, G. Spinal Cord Impairment in Anti-Mag Neuropathy: Evidence from Somatosensory Evoked Potentials. Brain Sci. 2020, 10, 282.

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