a greater severity of sensory loss, with a greater severity of sensory loss, with ataxia ataxia and relatively mild or no weakness; and relatively mild or no weakness; damage tends to be permanent and the damage tends to be permanent and degree degree of improvement in IgM of improvement in IgM paraproteinaemic paraproteinaemic neuropathy is much neuropathy is much smaller than the smaller than the improvement observed in improvement observed in CIDP patients. CIDP patients. Nerve conduction studies usually show symmetrical conduction studies usually show symmetrical conduction slowing with markedly prolonged distal conduction slowing with prolonged distal motor motor latencies and reduced or absent sensory latencies and distal attenuation (distal index is responses . Testing for antibodies to neural antigens prolonged) .Test for antibodies to neural antigens (MAG or other neural antigens) may be helpful. (MAG or other neural antigens) may be helpful. Due to the variable and poor response to IVIg, a treatment trial is only indicated for significant progressive disability. Diagnosis is Diagnosis by a neurologist of IgM Yes By which specialty Neurologist The system validates the requirement for required paraproteinaemic neuropathy diagnosis which is unchanged from requiring to be made by a neurologist Diagnosis No By which specialty must be verified Exclusion No exclusion criteria required. Criteria Indications Patients with IgM paraproteinaemic neuropathy IgM paraproteinaemic neuropathy with significant Minor change to wording with replacement of with functional impairment in whom other progressive disability where other therapies have impairment’ with and ‘funcitonal ‘signifcant therapies have failed or are contraindicated or failed or are contraindicated progressive disability’. (A) undesirable New indication for re-entry of patients where relapse with demonstrable deterioration occurs during first 6 months off Ig therapy. (A)
a greater severity of sensory loss, with ataxia and relatively mild or no weakness; damage tends to be permanent and the degree of improvement in IgM paraproteinaemic neuropathy is much smaller than the improvement observed in CIDP patients. conduction studies usually show symmetrical conduction slowing with prolonged distal motor latencies and distal attenuation (distal index is prolonged) .Test for antibodies to neural antigens (MAG or other neural antigens) may be helpful. a greater severity of sensory loss, with ataxia and relatively mild or no weakness; damage tends to be permanent and degree of improvement in IgM paraproteinaemic neuropathy is much smaller than the improvement observed in CIDP patients. Nerve conduction studies usually show symmetrical conduction slowing with markedly prolonged distal motor latencies and reduced or absent sensory responses . Testing for antibodies to neural antigens (MAG or other neural antigens) may be helpful. Due to the variable and poor response to IVIg, a treatment trial is only indicated for significant progressive disability. Diagnosis is required Diagnosis by a neurologist of IgM paraproteinaemic neuropathy Yes By which specialty Neurologist The system validates the requirement for diagnosis which is unchanged from requiring to be made by a neurologist Diagnosis must be verified No By which specialty Exclusion Criteria No exclusion criteria required. Indications Patients with IgM paraproteinaemic neuropathy with functional impairment in whom other therapies have failed or are contraindicated or undesirable IgM paraproteinaemic neuropathy with significant progressive disability where other therapies have failed or are contraindicated Minor change to wording with replacement of ‘funcitonal impairment’ with ‘signifcant and progressive disability’. (A) New indication for re-entry of patients where relapse with demonstrable deterioration occurs during first 6 months off Ig therapy. (A)