Subject(s)
Dementia/diagnosis , Stroke/diagnosis , Activities of Daily Living , Aged , Dementia/etiology , Dementia/psychology , Disability Evaluation , Female , Humans , Interview, Psychological , Male , Middle Aged , Neuropsychological Tests , Reproducibility of Results , Stroke/complications , Stroke/psychology , TelephoneABSTRACT
We report the clinical response and biological effects of treatment with rituximab and fludarabine (RF) in five patients with IgM anti-myelin-associated glycoprotein (MAG) demyelinating neuropathy. Between November 2006 and October 2009, four men and one woman aged 52-85 years received intravenous rituximab at 375 mg/m(2) on day 1 and oral fludarabine at 40 mg/m(2) /day from days 1 to 5, in a treatment cycle that was repeated every month for up to 6 months. Two patients had IgM monoclonal gammopathy of undetermined significance and three low tumor mass Waldenstrom's macroglobulinemia. Four patients showed a major hematological response with a decrease in anti-MAG titer in three and clearing in one. One patient did not respond. For the responding patients, symptoms and electrophysiological parameters improved significantly. No patient relapsed at post-RF treatment follow-up (12-45 months), and no toxicity was reported. The combination of RF induced significant responses in IgM anti-MAG demyelinating neuropathies, without toxicity. Clinical improvements were correlated to hematological and immunological results.
Subject(s)
Antibodies, Monoclonal, Murine-Derived/administration & dosage , Immunologic Factors/administration & dosage , Polyradiculoneuropathy/drug therapy , Vidarabine/analogs & derivatives , Aged , Aged, 80 and over , Autoantibodies/blood , Autoantibodies/immunology , Autoantigens/immunology , Drug Therapy, Combination , Female , Follow-Up Studies , Humans , Immunoglobulin M/blood , Immunoglobulin M/immunology , Male , Middle Aged , Myelin-Associated Glycoprotein/immunology , Paraproteinemias/blood , Paraproteinemias/drug therapy , Paraproteinemias/immunology , Polyradiculoneuropathy/blood , Polyradiculoneuropathy/immunology , Rituximab , Vidarabine/administration & dosageABSTRACT
We present the case of a 65-year-old man with latent thiamine deficiency who manifested lower limb neuropathy after receiving spinal anesthesia. We discuss our care of this patient and include a discussion of thiamine deficiency generally, its possible origins, symptoms, and recommended techniques for treatment of these patients.