title: Immunotherapy-responsive allodynia due to distal acquired demyelinating symmetric (DADS) neuropathy.
abstract: Distal acquired demyelinating symmetric (DADS) neuropathy is a distal variant of chronic inflammatory demyelinating polyradiculoneuropathy. It is characterized by chronic distal symmetric sensory or sensorimotor deficits. Sensory ataxia is a common clinical presentation. Nerve conduction studies typically show markedly prolonged distal motor latencies.
  
  
  
  We report 2 patients with chronic progressive generalized pain and fatigue, with normal neurological examinations except for allodynia.
  
  
  
  Nerve conduction studies were typical of DADS neuropathy. Monoclonal protein studies were negative. Cerebrospinal fluid protein levels were elevated. Sural nerve biopsies revealed segmental demyelination and remyelination. One biopsy had marked endoneurial and epineurial lymphocytic infiltration. Immunomodulatory therapy alleviated the pain and fatigue and markedly improved distal motor latencies in both patients.
  
  
  
  DADS neuropathy can present with pain and a normal neurological examination apart from allodynia. Nerve conduction studies are necessary for diagnosis. These patients respond to immunotherapy better than typical DADS neuropathy patients with sensory ataxia. Muscle Nerve 54: 973-977, 2016.
authors.affiliation: Department of Neurology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA. liewluck.teerin@mayo.edu.|Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, USA. liewluck.teerin@mayo.edu.
authors.forename: Teerin
authors.initials: T
authors.lastname: Liewluck
authors.affiliation: Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, USA.
authors.forename: Janean K
authors.initials: JK
authors.lastname: Engelstad
authors.affiliation: Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, USA. mauermann.michelle@mayo.edu.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Mauermann
mesh_terms: D000328:Adult; D003711:Demyelinating Diseases / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D007167:Immunotherapy / Q000379:methods*; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology / Q000648:ultrastructure; D009431:Neural Conduction / Q000502:physiology; D011129:Polyradiculoneuropathy / Q000150:complications / Q000276:immunology* / Q000473:pathology / Q000628:therapy*
keywords: CIDP; DADS; allodynia; distal acquired demyelinating symmetric neuropathy; sensory CIDP