Anti-GM1 antibodies and impaired blood–nerve barrier may interfere with remyelination in multifocal motor neuropathy

Multifocal motor neuropathy has pure motor manifestation and nonremittent clinical courses. Antiganglioside antibodies, though variable in titers, are characteristically elevated in the majority of these patient. In our cases, pathological findings at the site of conduction block suggested impaired remyelination and disruption of blood–nerve barrier. These findings lead us to postulate that antibodies toward gangliosides or toward unknown antigens containing gangliosides initiate motorspecific demyelination. The lesion, once produced, may persist as a result of impaired remyelination caused by disrupted blood–nerve barrier. The antibodies bound to denuded axons may also interfere with a remyelinative process. If so, antibodies may not always be circulating, thus accounting for variable levels of titers. © 1994 John Wiley & Sons, Inc.