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In the double-blind trial,the average neuropathy disability score improved by 2 points from base line(from 62.5 to 60.5)in the sham-exchange group and by 12 points(from 58.3 to 46.3)in the plasma-exchange group(P=0.06).A similar difference was observed in the weakness score,a component of the neuropathy disability score(improvement,1 and 10 points,respectively;P=0. 07).After treatment the summed compound muscle action potentials of motor nerves were 1.2 mV lower(worse)than at base line in the sham-exchange group and 0.4 mV higher(better)in the plasma-exchange group(P=0.07).The greater degree of improvement with plasma exchange was equal in magnitude to or greater than the difference between not being able to walk on the heels or toes and being able to perform these activities.Changes in the vibratory detection threshold,summed motor-nerve conduction velocity,and sensory-nerve action potentials did not differ significantly between the treatment groups.In the open trial,in which patients who initially underwent sham exchange were treated with plasma exchange,the neuropathy disability score(P=0.04),weakness score(P=0.07),and summed compound muscle action potentials(P=0.07)improved more with plasma exchange than they had with sham exchange.In both the double-blind and the open trial,those with IgG or IgA gammopathy had a better response to plasma exchange than those with IgM gammopathy.Plasma exchange appears to be efficacious in neuropathy associated with monoclonal gammopathy of undetermined significance(MGUS),especially of IgG or IgA type. |
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