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Levetiracetam‐induced rhabdomyolysis: Analysis of reports from the Food and Drug Administration's Adverse Event Reporting System database

We thank Dr. Rajabally for his comments on our study regarding the electrophysiological features of POEMS (polyneuropathy, organomegaly, endocrinopathy, M-protein, skin changes) syndrome compared with monoclonal gammopathy of undetermined significance (MGUS)-related neuropathy. We agree with the comments pointing out that we compared the homogeneous POEMS syndrome with the electrophysiologically heterogeneous MGUS-related neuropathy; nevertheless, we believe that our study provides useful information for physicians who encounter patients with demyelinating neuropathy and monoclonal gammopathy. In our study, we included all types of MGUS-related neuropathies and compared them with the neuropathy seen in POEMS syndrome. We found that electrophysiological features of POEMS syndrome, specifically low compound motor action potential amplitudes (CMAPs), slow motor conduction velocities (MCVs), and high terminal latency indexes (TLIs), can be valuable clues for differentiating POEMS neuropathy from all types of MGUS-related neuropathy including axonal-, DADS (distal acquired demyelinating symmetric)-, and CIDP (chronic inflammatory demyelinating neuropathy)-like neuropathy. As shown in a post-hoc analysis (refer to Table S2 in the Supplementary Material, available online), when compared with IgM MGUS-related neuropathy, the neuropathy of POEMS syndrome becomes more distinct, with additional features, such as less prolonged distal motor latency. A greater reduction in CMAPs and MCVs with higher TLIs were also identified when comparing POEMS neuropathy with IgG/A MGUS-related neuropathy. POEMS patients generally manifest typical clinical characteristics, such extravascular volume overload, endocrinopathy, and organomegaly (refer to Table S1 online). Therefore, POEMS is diagnosed according to clinical criteria. On occasion, the specific pattern of nerve conduction abnormalities can serve as an indicator of POEMS syndrome, particularly early in the course of the syndrome, when obvious clinical features may be lacking. Additional supporting information can be found in the online version of this article.