The spectrum of lower motor neuron syndromes

This review discusses the most important lower motor neuron syndromes. This relatively rare group of syndromes has not been well described clinically. Two subgroups can be distinguished: patients in whom motor neurons (lower motor neuron disease (LMND)) are primarily affected or motor axons and thei...

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Bibliographic Details
Published in:Journal of neurology 2003-11, Vol.250 (11), p.1279-1292
Main Authors: VAN DEN BERG-VOS, R. M, VAN DEN BERG, L. H, VISSER, J, DE VISSER, M, FRANSSEN, H, WOKKE, J. H. J
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Amyotrophic lateral sclerosis
Atrophy
Biological and medical sciences
Central Nervous System - pathology
Child
Child, Preschool
Chronic illnesses
Clinical Trials as Topic
Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases
Denervation
Disease Progression
Female
Humans
Infant
Infant, Newborn
Male
Medical prognosis
Medical sciences
Middle Aged
Motor Neuron Disease
Motor neurone disease
Neurology
Neurosciences
Pathogenesis
Spinal cord
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Summary:This review discusses the most important lower motor neuron syndromes. This relatively rare group of syndromes has not been well described clinically. Two subgroups can be distinguished: patients in whom motor neurons (lower motor neuron disease (LMND)) are primarily affected or motor axons and their surrounding myelin (multifocal motor neuropathy (MMN)), both leading to muscle atrophy and weakness. Both hereditary and sporadic forms of LMND have been described. The discussion of recent advances in the genetic knowledge of several hereditary forms of LMND may lead to a better understanding of the pathophysiology and the development of therapeutic strategies. By contrast, the pathogenesis of sporadic LMND is largely unknown. It is, therefore, difficult to consider the various sporadic forms of LMND, discussed in this review, as separate diseases. Because the diagnostic and therapeutic options may differ, it would seem rational to consider sporadic LMND as a spectrum of syndromes which can be distinguished from each other on the basis of clinical presentation.MMN is a lower motor neuron syndrome with presumed immunemediated pathogenesis. Evidence of motor conduction block on nerve conduction studies and a positive response to treatment with intravenous immunoglobulins (IVIg) are considered the most relevant criteria for the diagnosis of MMN. As it is treatable, it is important to distinguish MMN from LMND. Careful electrophysiological analysis in the search for conduction block is, therefore, required in all adult patients with pure lower motor neuron syndromes. For the individual patient, distinction between the various lower motor neuron syndromes is important as it enables the physician to provide adequate information over the disease course in LMND and to facilitate early treatment in MMN.
ISSN:0340-5354
1432-1459
DOI:10.1007/s00415-003-0235-9