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Rare disease
CASE REPORT
Morvan’s syndrome treated successfully with rituximab and lacosamide
  1. Olafur Sveinsson1,2,
  2. Faiez Al Nimer1,2,3 and
  3. Fredrik Piehl1,3,2
  1. 1 Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
  2. 2 Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
  3. 3 Center for Neurology, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
  1. Correspondence to Dr Olafur Sveinsson, olafur.sveinsson{at}karolinska.se

Abstract

We describe a woman with both central and peripheral nervous system symptoms consistent with Morvan’s syndrome who was successfully treated with immunosuppression including rituximab and the new antiepileptic drug lacosamide against peripheral nerve hyperexcitability. Despite being over 8 months in hospital and 4 months in an intensive care unit she recovered fully. It is also the first case where cerebrospinal fluid neurofilament-light (NfL) levels were followed during the disease course. The clinical course resembled that of anti-NMDA receptor encephalitis, where patients often recover surprisingly well despite severe symptoms and an extensive time in intensive care. A possible explanation is the comparatively low levels of NfL, indicating disease processes that are not characterised by extensive neuroaxonal degeneration.

  • neurology (drugs and medicines)
  • immunology
  • peripheral nerve disease

https://doi.org/10.1136/bcr-2018-226832

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    Footnotes

    • Patient consent for publication Next of kin consent obtained.

    • Contributors OS was the main treating doctor and wrote the manuscript draft. FAN participated in treating the patient and writing manuscript. FP participated in diagnosing, treating the patient and writing of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.