A severe form of M-protein negative distal acquired demyelinating symmetric neuropathy

Distal acquired demyelinating symmetric neuropathy (DADS) is a variant of chronic inflammatory demyelinating polyneuropathy (CIDP) characterized by symmetrical, distal, sensory or sensorimotor involvement. DADS with M-protein (DADS-M) is less responsive to immunotherapy compared to those without M-p...

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Bibliographic Details
Main Authors: Ong, Tien Lee, Goh, Khean Jin, Shahrizaila, Nortina, Wong, Kum Thong, Tan, Cheng Yin
Format: Article
Published: Medknow Publications 2019
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Online Access:http://eprints.um.edu.my/23797/
https://doi.org/10.4103/0028-3886.273621
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Summary:Distal acquired demyelinating symmetric neuropathy (DADS) is a variant of chronic inflammatory demyelinating polyneuropathy (CIDP) characterized by symmetrical, distal, sensory or sensorimotor involvement. DADS with M-protein (DADS-M) is less responsive to immunotherapy compared to those without M-protein (DADS-I). We report a case of DADS-I with severe clinical presentation viz. early hand involvement with marked wasting, inexcitable peripheral nerves on neurophysiology and poor response to immunotherapy. Despite the unusual presentation, ancillary tests including cerebrospinal fluid analysis, nerve biopsy and nerve ultrasound were supportive of an inflammatory demyelinating polyneuropathy. This case demonstrated the heterogeneity of the disorder and expands the clinical spectrum of DADS neuropathy. © 2019 Neurology India, Neurological Society of India.