title: Immunosuppressive treatment for multifocal motor neuropathy.
abstract: BACKGROUND
  Multifocal motor neuropathy is a distinct clinical entity characterised by progressive, predominantly distal, asymmetrical limb weakness and minimal sensory abnormality. The pathognomonic feature of this condition is the presence of multiple partial motor nerve conduction blocks. Controlled trials have demonstrated the efficacy of regular intravenous immunoglobulin infusions. Immunosuppressive agents have been used as primary, second-line or adjunctive agents for its treatment. This review was undertaken to identify and review systematically randomised controlled trials of immunosuppressive agents. The use of intravenous immunoglobulin will be the subject of a separate review.
  
  
  OBJECTIVE
  To provide the best available evidence from randomised controlled trials on the role of immunosuppressive agents for the treatment of multifocal motor neuropathy.
  
  
  METHODS
  The Cochrane Neuromuscular Disease Group register was searched for all trials of multifocal motor neuropathy published, using 'multifocal motor neuropathy' OR 'chronic inflammatory demyelinating polyradiculoneuropathy' OR ' conduction block' OR ' motor neuropathy' AND 'immunosuppressive agents', 'immunosuppressants', 'corticosteroids', 'plasma exchange', 'azathioprine', 'cyclophosphamide', 'cyclosporin', 'methotrexate', and 'mycophenolate', 'immunomodulatory agents', 'interferon', 'total lymphoid irradiation' or 'bone marrow transplantation' as search terms. In addition we searched MEDLINE, EMBASE for 2000 and 2001 and CINAHL, LILACS for all years.
  
  
  METHODS
  All randomised controlled trials and quasi-randomised clinical trials in which allocation was not random but was intended to be unbiased (e.g. alternate allocation) were to have been selected. Since no such trials were discovered, all prospective and retrospective case series were included in 'background' or 'discussion' sections of the review.
  
  
  METHODS
  All studies on multifocal motor neuropathy or lower motor neuron weakness with conduction block and no sensory abnormality were scrutinized for data on patients treated with any form of immunosuppressive agents besides intravenous immunoglobulin. The information on the outcome of treatment was then collated and summarised.
  
  
  RESULTS
  We found no randomised controlled trials of any immunosuppressive agents for multifocal motor neuropathy. We summarised the results of retrospective and prospective case series in the discussion of the review.
  
  
  CONCLUSIONS
  There are no randomised controlled trials to indicate whether immunosuppressive agents are beneficial in multifocal motor neuropathy.
authors.affiliation: Department of Neurology, National Neuroscience Institute, 11 Jalan Tam, Tolk Seng, Singapore, Singapore, 308433. tumapathi@yahoo.com
authors.forename: T
authors.initials: T
authors.lastname: Umapathi
authors.forename: R A
authors.initials: RA
authors.lastname: Hughes
authors.forename: E
authors.initials: E
authors.lastname: Nobile-Orazio
authors.forename: J M
authors.initials: JM
authors.lastname: Léger
mesh_terms: D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D011115:Polyneuropathies / Q000188:drug therapy*
chemical_list: D007166:Immunosuppressive Agents