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ANTI-SULFATIDE ANTIBODIES IN SENSORY-MOTOR NEUROPATHIES

Indications for measurement
Interpretations of positive results
Laboratory standards
Antibody patterns:
  Specificity for sensory-motor neuropathies

Clinical syndromes
  Demyelinating neuropathy
  Axonal neuropathy
Anti-Sulfatide antibodies: Summary of indications
Indications
  Adult onset neuropathy:
  Clinical neuropathy features
    Distal
    Symmetric
    Sensory > Motor

Likelihood of positive test
  Age > 50
  Gait disorder
  Tremor
  Disability 2 sensory
    or motor loss
  Demyelination
  Serum IgM M-protein: 50%

Lab standards
  80% to 85% clinical specificity

Interpretation of + result
  Diagnosis
    Dx of immune neuropathy
      Distinguish from CIDP
  Prognosis: Slow progression
  Treatment: ? HIG or cytoxan
Positive Results

  IgM vs Sulfatide > 10,000 +
      Low IgM vs Histone H3 +
      IgM M-protein
    Clinical correlation
      Sensory-motor neuropathy
      ± Gait Δ (GALOP)
      Demyelination
      Specificity: 85%

  IgM vs Sulfatide > 5,000 +
      Low IgM vs Histone H3 +
      No M-protein
    Clinical correlation
      Sensory neuropathy
      Axonal
      Specificity: 85%

  IgG vs Sulfatide > 6,000 +
      Low IgG vs GM1
    Clinical correlation
      Sensory neuropathy
      Specificity: 80%

  IgM or IgG vs sulfatide
      between 1,500 and 5,000
    Clinical correlation
      Abnormal but poor clinical
      correlation with neuropathies


I. Clinical Indications for Measurement:


II. Patterns of Anti-Sulfatide Antibodies with Specificity for Sensory-Motor Neuropathies:


III. Testing Laboratory Standards for anti-Sulfatide Antibodies:


IV. Positive Result: Clinical Utility and Interpretations


References
1. JNNP 1997;62:581-585

o Immune Demyelinating Neuropathies
Immune Axonal Neuropathies
Anti-MAG Antibodies
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2/16/00