Sulfatide antibody-mediated neuropathy: an analysis of clinical characteristics and immunotherapeutic responses

Sulfatide antibodies, targeting glycosphingolipids linked to myelin phospholipids, play a key role in immune-mediated peripheral neuropathies. However, their clinical features and response to immunotherapy remain unclear. A retrospective analysis of 19 sulfatide antibodies-mediated neuropathy cases from Nanjing Drum Tower Hospital (July 2019 to July 2024) assessed clinical scores (MRC, INCAT, HFGS) at admission, discharge, and 3–6 months post-discharge, with detailed documentation of clinical characteristics, electromyography findings, and treatment responses. A total of 19 patients were enrolled, including 10 Guillain–Barré syndrome (GBS, 53%) and 9 chronic inflammatory demyelinating polyneuropathy (CIDP, 47%) cases. All had distal limb weakness, with two patients (11%) showing central nervous system involvement. Electromyography revealed that anti-sulfatide antibody caused damage to both myelin and axons， not only in motor nerves but also in sensory nerves. Regarding treatment, 89% patients responded well to immunotherapy. However, one CIDP patient worsened with corticosteroids, and two patients died during follow-up. Compared to the sulfatide with poly-antibodies group, the sole sulfatide antibody group demonstrated more severe clinical symptoms, with lower MRC scores (<i>p</i> = 0.0140) and higher HFGS (<i>p</i> = 0.0052) and INCAT (<i>p</i> = 0.0057) scores. Consistently, the sole sulfatide antibody group presented lower nerve amplitudes (<i>p</i> = 0.0498) and conduction velocity (<i>p</i> &lt; 0.05) as well. Interestingly, this group of patients showed greater improvement after immunotherapy (<i>p</i> &lt; 0.05), particularly in GBS patients. Sulfatide antibodies may attack peripheral nerves and the brainstem. The prognosis is relatively good for most patients by immunotherapy. Patients with sole sulfatide antibody exhibited more severe symptoms and electrophysiological issues but responded better to treatment.