Takeaway
IgG4 autoantibodies against the Fn3Fn4 domain of anti-neurofascin (NF)-155 were associated with severe sensorimotor neuropathy with tremor while IgG3 autoantibodies against the Ig domain of all NF isoforms lead to tetraplegia and cranial nerve involvement.
Why this matters
Anti-NF-155 is the most prevalent paranodal autoantibody and strongly associated with tremor, these results reveal an anti-pan-NF autoimmune neuropathy with a different clinical profile suggesting that testing of IgG subclasses should be performed, and anti-NF screening extended beyond anti-NF-155 as an indicator of clinical manifestations.