Divyanshu Dubey1, Vanda A Lennon1, Avi Gadoth1, Sean J Pittock1, Eoin P Flanagan1, John E Schmeling1, Andrew McKeon1, Christopher J Klein2. 1. From the Departments of Neurology (D.D., A.G., S.J.P., E.P.F., A.M., C.J.K.) and Laboratory Medicine and Pathology (V.A.L., S.J.P., E.P.F., J.E.S., A.M., C.J.K.), Mayo Clinic, Rochester, MN. 2. From the Departments of Neurology (D.D., A.G., S.J.P., E.P.F., A.M., C.J.K.) and Laboratory Medicine and Pathology (V.A.L., S.J.P., E.P.F., J.E.S., A.M., C.J.K.), Mayo Clinic, Rochester, MN. Christopher.klein@mayo.edu.
Abstract
OBJECTIVE: To establish the phenotype and clinical outcomes of collapsin response-mediator protein-5 (CRMP5) autoimmune neuropathy in comparison with anti-neuronal nuclear antibody type 1 (ANNA1)-immunoglobulin G (IgG) neuropathy. METHODS: Patients with CRMP5-IgG and/or ANNA1-IgGs were identified in our service-line testing, and medical records were reviewed. RESULTS: One hundred five patients with CRMP5-IgG neuropathy (88% smokers; 69% having cancer, most commonly small cell lung cancer [75%]) were identified and compared to 51 patients with ANNA1-IgG neuropathy, 27 with coexisting CRMP5-IgG. Patients with CRMP5 had painful axonal polyradiculoneuropathy (65%), mostly asymmetric onset (84%), with neuropathy predating cancer diagnosis by 185 days (range 60-540 days). Most cases (79%) had moderate to severe neuropathic pain, all on neuropathic medications (median 2, range 1-4), opioids in 39%. Nerve biopsies (n = 2) showed microvascular inflammation with axonal degeneration. Compared to ANNA1 alone, CRMP5 neuropathy has a higher prevalence of pain (79% vs 46%, p = 0.008), asymmetric polyradiculoneuropathy (54% vs 12%, p < 0.001), and inflammatory spinal fluids (elevated CSF protein or nucleated cell count 92% vs 60%, p = 0.022). Cerebellar ataxia (21%), myelopathy (19%), and optic neuritis and/or retinitis (11%) were common neurologic accompaniments. CRMP5 cases had significant pain reduction by immunotherapy (p < 0.001). Specifically, high-dose corticosteroid administration was associated with improvement/stabilization in neuropathy impairment scores (p = 0.012) (Class IV). Patients with CRMP5 had better 5-year survival than patients with ANNA1 (67% vs 32%, p = 0.012). CONCLUSION: Painful axonal asymmetric polyradiculoneuropathy is established as the major CRMP5 autoimmune neuropathy presentation and is distinguishable from other paraneoplastic neuropathies, including by ANNA1 autoimmunity. Patients with this phenotype should be prompted for CRMP5-IgG testing to assist in early cancer diagnosis.
OBJECTIVE: To establish the phenotype and clinical outcomes of collapsin response-mediator protein-5 (CRMP5) autoimmune neuropathy in comparison with anti-neuronal nuclear antibody type 1 (ANNA1)-immunoglobulin G (IgG) neuropathy. METHODS:Patients with CRMP5-IgG and/or ANNA1-IgGs were identified in our service-line testing, and medical records were reviewed. RESULTS: One hundred five patients with CRMP5-IgG neuropathy (88% smokers; 69% having cancer, most commonly small cell lung cancer [75%]) were identified and compared to 51 patients with ANNA1-IgG neuropathy, 27 with coexisting CRMP5-IgG. Patients with CRMP5 had painful axonal polyradiculoneuropathy (65%), mostly asymmetric onset (84%), with neuropathy predating cancer diagnosis by 185 days (range 60-540 days). Most cases (79%) had moderate to severe neuropathic pain, all on neuropathic medications (median 2, range 1-4), opioids in 39%. Nerve biopsies (n = 2) showed microvascular inflammation with axonal degeneration. Compared to ANNA1 alone, CRMP5neuropathy has a higher prevalence of pain (79% vs 46%, p = 0.008), asymmetric polyradiculoneuropathy (54% vs 12%, p < 0.001), and inflammatory spinal fluids (elevated CSF protein or nucleated cell count 92% vs 60%, p = 0.022). Cerebellar ataxia (21%), myelopathy (19%), and optic neuritis and/or retinitis (11%) were common neurologic accompaniments. CRMP5 cases had significant pain reduction by immunotherapy (p < 0.001). Specifically, high-dose corticosteroid administration was associated with improvement/stabilization in neuropathy impairment scores (p = 0.012) (Class IV). Patients with CRMP5 had better 5-year survival than patients with ANNA1 (67% vs 32%, p = 0.012). CONCLUSION: Painful axonal asymmetric polyradiculoneuropathy is established as the major CRMP5autoimmune neuropathy presentation and is distinguishable from other paraneoplastic neuropathies, including by ANNA1 autoimmunity. Patients with this phenotype should be prompted for CRMP5-IgG testing to assist in early cancer diagnosis.
Authors: Stephen A Johnson; Kamal Shouman; Shahar Shelly; Paola Sandroni; Sarah E Berini; P James B Dyck; Ernest Matthew Hoffman; Jay Mandrekar; Zhiyv Niu; Christopher J Lamb; Phillip A Low; Wolfgang Singer; Michelle L Mauermann; John Mills; Divyanshu Dubey; Nathan P Staff; Christopher J Klein Journal: Neurology Date: 2021-10-27 Impact factor: 9.910
Authors: Francesc Graus; Alberto Vogrig; Sergio Muñiz-Castrillo; Jean-Christophe G Antoine; Virginie Desestret; Divyanshu Dubey; Bruno Giometto; Sarosh R Irani; Bastien Joubert; Frank Leypoldt; Andrew McKeon; Harald Prüss; Dimitri Psimaras; Laure Thomas; Maarten J Titulaer; Christian A Vedeler; Jan J Verschuuren; Josep Dalmau; Jerome Honnorat Journal: Neurol Neuroimmunol Neuroinflamm Date: 2021-05-18