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Multifocal motor neuropathy — SCE Neurology MCQ

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EasyNeuromuscularMultifocal motor neuropathySCE Neurology

A 63-year-old man presented with asymmetric distal upper-limb weakness without sensory loss. On examination, reflexes were reduced in weak muscles and there were no pyramidal signs. Initial investigations showed: NCS showed motor conduction block outside entrapment sites; anti-GM1 antibodies were positive. What is the most appropriate management?

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Correct answer: C — Disease-specific immunotherapy or supportive respiratory monitoring

Disease-specific immunotherapy or supportive respiratory monitoring is the best answer because the vignette describes Multifocal motor neuropathy: pure motor asymmetric neuropathy with conduction block suggests MMN. High-dose intravenous methylprednisolone after excluding infection is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Multidisciplinary rehabilitation with goal-setting and Empirical intravenous ceftriaxone after blood cultures are less appropriate because they would require different localisation, timing or test findings; Withdrawal of overused analgesics with headache support would fit a different syndrome. Clinical pearl: MND does not show motor conduction block and has UMN signs.

Reference: NICE NG42; ABN myasthenia gravis guidance; EAN/PNS GBS-CIDP guidance