Cold paresis in multifocal motor neuropathy.
Increased weakness during cold (cold paresis) was reported in single cases of multifocal motor neuropathy (MMN). This was unexpected because demyelination is a feature of MMN and symptoms of demyelination improve, rather than worsen, in cold. It was hypothesized that cold paresis in MMN does not reflect demyelination only, but may indicate the existence of inflammatory nerve lesions with permanently depolarized axons that only just conduct at normal temperature, but fail at lower temperatures. We investigated symptoms of cold paresis in 50 MMN patients, 48 chronic inflammatory demyelinating polyneuropathy (CIDP) patients, 35 progressive spinal muscular atrophy (PSMA) patients, and 25 chronic idiopathic axonal polyneuropathy patients. We also investigated symptoms of increased weakness during warmth (heat paresis). Cold paresis was reported more often than heat paresis. Cold paresis was most frequently reported in MMN. Multivariate analysis indicated that MMN patients had a 4- to 6-fold higher risk of reporting cold paresis than CIDP or PSMA patients. Because cold paresis is not consistent with demyelination, the lesions in MMN may involve other mechanisms than demyelination only. In conclusion, symptoms of cold paresis are common in peripheral nervous system disorders, particularly in MMN. This supports the above-described hypothesis.
Straver
Dirk C G
DC
Neuromuscular Disease Group, Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
van Asseldonk
Jan-Thies H
JT
Notermans
Nicolette C
NC
Wokke
John H J
JH
van den Berg
Leonard H
LH
Franssen
Hessel
H
D000328:Adult; D000368:Aged; D003080:Cold Temperature; D003430:Cross-Sectional Studies; D003711:Demyelinating Diseases / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000209:etiology* / Q000473:pathology*; D011115:Polyneuropathies / Q000150:complications* / Q000473:pathology*; D011795:Surveys and Questionnaires
Rinsho Shinkeigaku. 2002 Sep;42(9):841-8
12710082
J Peripher Nerv Syst. 2010 Sep;15(3):227-37
21040145
Muscle Nerve. 2003 Mar;27(3):285-96
12635114
Amyotroph Lateral Scler. 2006 Mar;7(1):38-45
16546758
Neuroscience. 1990;37(3):829-37
2174135
Neurology. 2010 Aug 31;75(9):818-25
20805527
Muscle Nerve. 1999 Feb;22(2):166-73
10024129
Ann Neurol. 1995 Apr;37(4):421-3
7717678
J Neurol Neurosurg Psychiatry. 1987 Apr;50(4):460-4
3585358
Brain. 2003 Jan;126(Pt 1):186-98
12477706
J Neurol Sci. 2005 Jun 15;233(1-2):3-13
15899499
J Neuropathol Exp Neurol. 2004 Feb;63(2):129-37
14989599
Ann Neurol. 2003 Feb;53(2):174-80
12557283
Pflugers Arch. 1987 Aug;409(6):569-77
2442714
Muscle Nerve. 2001 Jul;24(7):867-82
11410914
Neurology. 1991 May;41(5):617-8
2027473
J Neurol Neurosurg Psychiatry. 2006 Jun;77(6):743-7
16705197
Arch Neurol. 1973 May;28(5):287-92
4696011
Muscle Nerve. 1993 Mar;16(3):301-6
8446129
Ann Neurol. 2000 Dec;48(6):919-26
11117549
J Physiol. 1963 Nov;169:431-7
14079679
Brain. 2005 Jul;128(Pt 7):1642-8
15888541
Muscle Nerve. 1997 Jan;20(1):15-21
8995578
Can J Neurol Sci. 1989 May;16(2):194-7
2543490
Brain. 2003 May;126(Pt 5):1036-47
12690044
Ann Neurol. 1993 Feb;33(2):152-8
8434876
J Physiol. 1955 Apr 28;128(1):28-60
14368574
J Neurol Neurosurg Psychiatry. 1993 Oct;56(10):1066-71
7691991
Brain. 2002 Mar;125(Pt 3):664-75
11872621