{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T11:15:06Z","timestamp":1783509306669,"version":"3.55.0"},"reference-count":12,"publisher":"MDPI AG","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:p>Multifocal motor neuropathy (MMN) is a rare motor neuron condition that typically presents as asymmetric muscular dystrophy to the distal upper extremities. As an autoimmune disorder, it is hypothesized that the presence of anti-ganglioside-monosialic acid 1 (anti-GM1) antibodies results in demyelination of axons, propagating symptoms of MMN. Intravenous immunoglobulin infusions have proven effective in restoring muscle tone and function if administered at early onset of the disease symptoms. Although uncommon, MMN can also affect the distal lower extremities. In this study, we present a female patient with muscle atrophy and general weakness to her right lower extremity prior to developing similar symptoms to her left upper extremity. Due to this very uncommon presentation, the pathology was identified late in the progression of the disease. The delay in treatment resulted in a permanent reduction in muscle tone and function in the right lower extremity. To the best of the authors\u2019 knowledge, such a finding has not been reported in the current literature, prompting the need for awareness of a truly uncommon presentation of an already uncommon condition.<\/jats:p>","DOI":"10.7547\/23-139","type":"journal-article","created":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T16:58:59Z","timestamp":1756313939000},"source":"Crossref","is-referenced-by-count":0,"title":["A Rare Lower-Extremity Presentation of Multifocal Motor Neuropathy (MMN) Prior to Upper-Extremity Involvement"],"prefix":"10.3390","volume":"115","author":[{"given":"J. Adrian","family":"Wright","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grayson","family":"Catherwood","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Vanni","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","reference":[{"key":"B1","series-title":"Multifocal Motor Neuropathy. Statpearls","author":"Hameed S","year":"2023","unstructured":"Hameed S, Cascella M: Multifocal Motor Neuropathy. Statpearls, Treasure Island, FL, Treasure Island Publishing, 2023."},{"key":"B2","series-title":"Brain","first-page":"186","article-title":"Demyelination and axonal loss in multifocal motor neuropathy: distribution and relation to weakness","volume":"126","author":"Van Asseldonk JT","year":"2003","unstructured":"Van Asseldonk JT, Van den Berg LH, Van den Berg-Vos RM, et al: Demyelination and axonal loss in multifocal motor neuropathy: distribution and relation to weakness. Brain 126: 186, 2003."},{"key":"B3","series-title":"Muscle Nerve","first-page":"103","article-title":"Multifocal acquired demyelinating neuropathy masquerading as motor neuron disease","volume":"11","author":"Parry GJ","year":"1988","unstructured":"Parry GJ, Clarke S: Multifocal acquired demyelinating neuropathy masquerading as motor neuron disease. Muscle Nerve 11: 103, 1988."},{"key":"B4","series-title":"Eur Neurol","first-page":"193","article-title":"Multifocal motor neuropathy: update on clinical characteristics, pathophysiological concepts and therapeutic options","volume":"63","author":"Meuth SG","year":"2010","unstructured":"Meuth SG, Kleinschnitz C: Multifocal motor neuropathy: update on clinical characteristics, pathophysiological concepts and therapeutic options. Eur Neurol 63: 193, 2010."},{"key":"B5","series-title":"Eur J Neurol","first-page":"62","article-title":"Antibodies to heteromeric glycolipid complexes in multifocal motor neuropathy","volume":"20","author":"Galban-Horcajo F","year":"2013","unstructured":"Galban-Horcajo F, Fitzpatrick AM, Hutton AJ, et al: Antibodies to heteromeric glycolipid complexes in multifocal motor neuropathy. Eur J Neurol 20: 62, 2013."},{"key":"B6","series-title":"J Clin Immunol","first-page":"S112","article-title":"MMN: From immunological cross-talk to conduction block","volume":"34","author":"Harschnitz O","year":"2014","unstructured":"Harschnitz O, Jongbloed BA, Franssen H, et al: MMN: From immunological cross-talk to conduction block. J Clin Immunol 34: S112, 2014."},{"key":"B7","series-title":"J Neurol Neurosurg Psychiatry","first-page":"1145","article-title":"Pharmacokinetics of intravenous immunoglobulin in multifocal motor neuropathy","volume":"85","author":"Vlam L","year":"2014","unstructured":"Vlam L, Cats EA, Willemse E, et al: Pharmacokinetics of intravenous immunoglobulin in multifocal motor neuropathy. J Neurol Neurosurg Psychiatry 85: 1145, 2014."},{"key":"B8","series-title":"Neurology","first-page":"1260","article-title":"Slow resolution of multifocal weakness and fasciculation: a reversible motor neuron syndrome","volume":"36","author":"Chad DA","year":"1986","unstructured":"Chad DA, Hammer K, Sargent J: Slow resolution of multifocal weakness and fasciculation: a reversible motor neuron syndrome. Neurology 36: 1260, 1986."},{"key":"B9","series-title":"Eur Neurol","first-page":"416","article-title":"Motor neuropathy with proximal multifocal persistent conduction block, fasciculations and myokymia. Evolution to tetraplegia","volume":"25","author":"Roth G","year":"1986","unstructured":"Roth G, Rohr J, Magistris MR, et al: Motor neuropathy with proximal multifocal persistent conduction block, fasciculations and myokymia. Evolution to tetraplegia. Eur Neurol 25: 416, 1986."},{"key":"B10","series-title":"Neurology","first-page":"818","article-title":"Correlates of outcome and response to IVIg in 88 patients with multifocal motor neuropathy","volume":"75","author":"Cats EA","year":"2010","unstructured":"Cats EA, van der Pol WL, Piepers S, et al: Correlates of outcome and response to IVIg in 88 patients with multifocal motor neuropathy. Neurology 75: 818, 2010."},{"key":"B11","series-title":"Curr Opin Neurol","first-page":"559","article-title":"Multifocal motor neuropathy","volume":"31","author":"Beadon K","year":"2018","unstructured":"Beadon K, Guimaraes-Costa R, Leger JM: Multifocal motor neuropathy. Curr Opin Neurol 31: 559, 2018."},{"key":"B12","series-title":"J Peripher Nerv Syst","first-page":"296","article-title":"Rasch-built overall disability scale for multifocal motor neuropathy (MMN-RODS(\u00a9))","volume":"20","author":"Vanhoutte EK","year":"2015","unstructured":"Vanhoutte EK, Faber CG, Nes SI, et al: Rasch-built overall disability scale for multifocal motor neuropathy (MMN-RODS(\u00a9)). J Peripher Nerv Syst 20: 296, 2015."}],"container-title":["Journal of the American Podiatric Medical Association"],"original-title":[],"link":[{"URL":"https:\/\/japmaonline.org\/view\/journals\/apms\/115\/4\/23-139.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/japmaonline.org\/downloadpdf\/journals\/apms\/115\/4\/23-139.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/japmaonline.org\/downloadpdf\/journals\/apms\/115\/4\/23-139.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T10:20:15Z","timestamp":1783506015000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1930-8264\/115\/4\/23139"}},"subtitle":["A Case Study"],"short-title":[],"issued":{"date-parts":[[2025,7]]},"references-count":12,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.7547\/23-139","relation":{},"ISSN":["8750-7315"],"issn-type":[{"value":"8750-7315","type":"print"}],"subject":[],"published":{"date-parts":[[2025,7]]}}}