Chronic inflammatory demyelinating polyradiculoneuropathy

Last reviewed: 27 Dec 2022
Last updated: 08 Feb 2019



History and exam

Key diagnostic factors

  • disease progression
  • weakness
  • altered sensation
  • decreased deep tendon reflexes
More key diagnostic factors

Other diagnostic factors

  • incoordination
  • age 40 to 60 years
  • preceding infection
  • absence of exposure to neuropathy-causing drugs
  • dyspnoea
  • facial weakness
  • dysarthria
  • dysphagia
  • urinary incontinence
  • urinary urgency or hesitancy
  • impotence
  • orthostatic hypotension
  • papilloedema
  • vision loss
  • spasticity
  • ataxia
Other diagnostic factors

Risk factors

  • male sex
  • autoimmune diseases
  • diabetes
  • infection
  • monoclonal gammopathy of undetermined significance (MGUS)
More risk factors

Diagnostic investigations

1st investigations to order

  • nerve conduction studies (NCS)
  • cerebrospinal fluid (CSF) evaluation
More 1st investigations to order

Investigations to consider

  • nerve biopsy
  • MRI spine
  • nerve ultrasound
  • enzyme-linked immunosorbent assay (ELISA) or Western blot to detect auto-antibodies
  • clinical trial of immunosuppressant
More investigations to consider

Treatment algorithm


no significant impact on function and quality of life

significant impact on function and quality of life

partial or no response to initial monotherapy

refractory to combination therapy with 2 initial agents


response to treatment

no response to treatment



Glenn Lopate, MD
Glenn Lopate

Professor of Neurology

Department of Neurology

Washington University School of Medicine

St. Louis



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.

Peer reviewers

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


CHU Dupuytren

Service et Laboratoire de Neurologie




Not disclosed.

  • Differentials

    • Guillain-Barre syndrome (GBS)
    • Hereditary motor and sensory neuropathy (HMSN)
    • Anti-myelin-associated glycoprotein (anti-MAG) neuropathy
    More Differentials
  • Guidelines

    • Guideline on management of chronic inflammatory demyelinating polyradiculoneuropathy
    • Recommendations on diagnostic strategies for chronic inflammatory demyelinating polyradiculoneuropathy
    More Guidelines
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