An acquired demyelinating peripheral neuropathy of presumed autoimmune aetiology.
Proximal symmetrical weakness is present in most patients. Atypical cases often have proximal asymmetrical weakness.
Nerve conduction studies are the main diagnostic tool, but lack sensitivity; treatment should not be withheld if electrodiagnostic criteria are not met and symptoms are consistent with the diagnosis.
Treatment includes intravenous immunoglobulin, subcutaneous immunoglobulin, corticosteroids, and plasma exchange; long-term immunosuppressive therapy may be needed to prevent relapse. Lack of at least a partial response to one or two first-line agents should cast doubt on the diagnosis.
Differentiation from Guillain-Barre syndrome (GBS) is important because corticosteroids may worsen patients with GBS.
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an acquired demyelinating peripheral neuropathy of presumed autoimmune aetiology. The course is usually either chronic progressive (over >8 weeks) or relapsing and remitting. The clinical phenotype consists of proximal and distal symmetrical weakness, distal sensory loss, and absent reflexes.
History and exam
- age 40 to 60 years
- preceding infection
- absence of exposure to neuropathy-causing drugs
- facial weakness
- urinary incontinence
- urinary urgency or hesitancy
- orthostatic hypotension
- vision loss
Glenn Lopate, MD
Professor of Neurology
Department of Neurology
Washington University School of Medicine
GL is on the medical advisory board for Alnylam Pharmaceuticals and a consultant for Gerson Lehrman Group. GL is an author of a reference cited in this monograph.
Todd Levine, MD
Phoenix Neurological Associates Ltd
TL declares that he has no competing interests.
Richard A.C. Hughes, MD, FRCP, FMedSci
Cochrane Neuromuscular Disease Group
MRC Centre for Neuromuscular Disease
National Hospital for Neurology and Neurosurgery
RACH has held or holds consultancies with companies that produce intravenous immunoglobulin (CSL Behring, LFB, Octapharma, Kedrion, and Talecris) and with other companies that produce immunomodulatory drugs (Biogen-Idec and Ares-Serono). RACH has received grants from the UK Department of Health for the Cochrane Neuromuscular Disease Review Group, Sandoz (now Novartis), and Ares-Serono. RACH is an author of a number of references cited in this monograph.
Jean-Michel Vallat, MD
Service et Laboratoire de Neurologie
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