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NEUROSURGICAL TREATMENT OF TREMOR IN ANTI-MYELIN-ASSOCIATED GLYCOPROTEIN NEUROPATHY

Anti-myelin-associated glycoprotein (anti-MAG) neuropathy is an antibody-mediated demyelinating neuropathy, with monoclonal immunoglobulin M (IgM) antibodies. It is characterized by a progressive, symmetric, mainly sensory neuropathy and mild distal weakness.1,2 Gait disorder with ataxia is a prominent feature.2 Limb tremor is common, while head, chin, and voice tremor do not occur.2 We report a case of a patient with anti-MAG neuropathy and tremor who had a marked improvement in tremor and quality of life with unilateral thalamic deep brain stimulation (DBS). There have been few other case reports in the literature regarding neuropathic tremor and DBS.3

### Case report.

A right-handed 82-year-old woman with no family history of tremor presented with hand and feet paresthesia, followed by the development of hand tremor 12 months later. Diagnosis of anti-MAG neuropathy was made serologically. Neurophysiologic studies confirmed the presence of a demyelinating, sensorimotor neuropathy with prolongation of the distal motor latencies. The tremor was disabling and prevented feeding and dressing herself as well as performing personal hygiene activities. Corticosteroids, plasma exchange, and IV cyclophosphamide were tried for 12 months without benefit. Primidone and gabapentin also gave little effect. Propranolol was contraindicated due to asthma. Rituximab …