Nodo-paranodopathy: Beyond the demyelinating and axonal classification in anti-ganglioside antibody-mediated neuropathies

详细信息    查看全文

• 作者：Antonino Uncini ; Keiichiro Susuki ; Nobuhiro Yuki
• 关键词：Guillain&ndash ; Barré ; syndrome ; Acute motor axonal neuropathy ; Multifocal motor neuropathy ; Anti-ganglioside antibody ; Node of Ranvier
• 刊名：Clinical Neurophysiology
• 出版年：2013
• 出版时间：October, 2013
• 年：2013
• 卷：124
• 期：10
• 页码：1928-1934
• 全文大小：858 K

文摘

In some anti-ganglioside antibody-mediated neuropathies, human and experimental data suggest a common pathogenic mechanism of dysfunction/disruption at the node of Ranvier resulting in a pathophysiologic continuum from transitory nerve conduction failure to axonal degeneration. The traditional classification of polyneuropathies into demyelinating or axonal may generate some confusion in the electrophysiological diagnosis of Guillain-Barr¨¦ syndrome subtypes associated with anti-ganglioside antibodies. The axonal forms show, besides axonal degeneration, promptly reversible nerve conduction failure. This may be interpreted, by a single electrophysiological study, as demyelinating conduction block or distal axonal degeneration leading to errors in classification and in establishing prognosis. Moreover the term axonal may be misleading as it is commonly associated to axonal degeneration and not to a transitory, promptly reversible, dysfunction of the excitable axolemma. To focus on the site of nerve injury and overcome the classification difficulties, we propose the new category of nodo-paranodopathy which seems appropriate to various acute and chronic neuropathies associated with anti-ganglioside antibodies and we think better systematizes the neuropathies characterized by an autoimmune attack targeting the nodal region.