Concurrence of Multifocal Motor Neuropathy and Hashimoto's Thyroiditis

BACKGROUND: Multifocal motor neuropathy (MMN) is an immune-mediated disorder that is characterized by slowly progressive and asymmetrical weakness, but its pathophysiological mechanism is uncertain. The hypothesis that MMN is an immunological disease has been supported by the proven therapeutic effects of intravenous immunoglobulin and the detection of antiganglioside antibodies in MMN patients. The coexistence of MMN with other immune diseases has been rarely reported. CASE REPORT: A 37-year-old woman visited our hospital complaining of weakness in both hands. The clinical manifestations coincided well with MMN: predominantly distal upper-limb weakness, asymmetric involvement, a progressive course, absence of sensory symptoms, absence of pyramidal signs, and sparing of the cranial muscles. The electrophysiological findings also supported a diagnosis of MMN, with motor nerve conduction block in the median, ulnar, and radial nerves, without sensory nerve involvement. The patient was simultaneously diagnosed as having Hashimoto's thyroiditis, which is a well-known immune-mediated disease. CONCLUSIONS: The concurrence of MMN and Hashimoto's thyroiditis in our patient is significant for understanding the immunological characteristics of the two diseases.

Is Antipsychotic Intake a Risk Factor for the Restless Legs Syndrome?

BACKGROUND: Restless-legs syndrome (RLS) is known to be caused by dopaminergic hypofunction in the brain. We investigated whether antipsychotics that act as antidopaminergics increase the risk of RLS. METHODS: We prospectively recruited 72 schizophrenic patients who had been medicated with antipsychotic drugs in a psychiatry clinic. We evaluated RLS diagnostic criteria and basic sleep habits using the Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index by face-to-face interviews using a structured questionnaire. We also applied the Unified Parkinson's Disease Rating Scale to evaluate extrapyramidal symptoms. RESULTS: Three of the 72 patients (4.2%) met RLS criteria, which is similar to the previously reported RLS incidence among the general population in Korea. CONCLUSIONS: There is no evidence that antipsychotics increase the risk of RLS. We believe that the mild antidopaminergic effect of antipsychotics does not overwhelm their prominent antipsychotic effect.

Recurrent Myelitis in Crohn's Disease

Crohn's disease is one of the inflammatory bowel diseases and is characterized by the involvement of the entire depth of the intestinal wall from the anus to the mouth. Neurological complications rarely occur in Crohn's disease and recurrent transverse myelitis has not yet been described in association with it. We report a 50-year-old man with Crohn's disease accompanied by recurrent transverse myelitis. Inflammatory bowel diseases and demyelinating disorders may share an autoimmune pathophysiology.