We read with interest the article by Khella et al on the treatment of cryoglobulinemic neuropathy with alpha-interferon (alpha-IFN). Our group has been studying the relationship between HCV and essential mixed cryoglobulinemia (EMC) since 1990. We are a collaborating center of the Italian Group for the Study of Cryoglobulinemias (GISC), and have recently published the results obtained from a large sample (654 patients with EMC). In this context, we have also studied the occurrence of cryoglobulinemia-related neuropathy. Our experience refers mainly to symmetrical and sensory motor neuropathies, although we have studied some cases of mononeuropathy multiplex. The observation that alpha-IFN was able to improve cryoglobulinemic vasculitis led us to investigate its effects on the peripheral nervous system, although some authors reported a worsening of peripheral neuropathy during therapy with alpha-IFN .Ten cryoglobulinemic patients with sensory motor polyneuropathy and HCV infection were treated with alpha-IFN at a dose of 3 mU, three times per week, for a period of 6 to 12 months. Seven patients treated for 6 to 12 months with deflazacort at a dose of 0.5 mg/kg/day were recruited as controls. All patients were submitted to a scoring test to establish the significance of neurologic symptoms (NSS scale) and an EMG study to evaluate: (1) the amplitude of peroneal motor action potential; (2) the sural sensory conduction velocity; (3) the ulnar F-wave latency, and (4) the ulnar and peroneal motor conduction velocities. A significant improvement of peripheral neuropathy was seen only in the group treated with alpha-IFN, as determined by the NSS scale. However, their EMG data at the end of therapy were not significantly different from those of the control patients. Nonetheless, it should be pointed out that in a patient with mononeuropathy multiplex, we did not see any improvement following 1 year of therapy with steroids and alpha-IFN However, in the same patient, treatment with cyclophosphamide was associated with a substantial regression of the symptoms with electroneurographic evidence of reinnervation (unpublished data).Therefore, we agree with Khella et al that cryoglobulinemic vasculitis in patients with HCV infection may benefit from treatment with alpha-IFN. However, a clinical and/or EMG improvement would not necessarily occur in all cases following this therapy. Further studies are needed to ascertain if higher dosages of alpha-IFN or other types of IFN, such as beta-IFN, are able to improve the electroneuromyographic findings.
|Anno di pubblicazione:||1996|
|Titolo:||Treatment of cryoglobulinemic neuropathy with alpha-interferon. Neurology. 1996 Feb;46(2):588-9|
|Autori:||GHINI M; M.T MASCIA; GENTILINI M; MUSSINI C.|
|Appare nelle tipologie:||Articolo su rivista|
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