Neuropathies associated with monoclonal gammopathies

Approximately 10% of patients with idiopathic peripheral neuropathy have an associated serum monoclonal gammopathy or M-protein. This represents six times the incidence of M-proteins found in the general population. In 5% of idiopathic peripheral neuropathy patients the M-protein is associated with an identifiable plasma cell dyscrasia. Sclerotic myeloma is particularly important to recognize because treatment may result in amelioration of the neuropathy and remission of the tumor. Patients with primary systemic amyloidosis often have preferential small fiber involvement with a dissociated sensory loss and autonomic dysfunction. The nerve root infiltration of lymphoproliferative disorders may simulate a polyradiculoneuropathy. In cases without an identifiable cause for the M-protein, referred to as monoclonal gammopathy of undetermined significance (MGUS), the pathophysiologic basis for the neuropathy is poorly defined in most cases. A role for M-proteins with antibody activity to myelin-associated glycoprotein is provocative. This review summarizes current knowledge of this important group of disorders.