Chronic Inflammatory Demyelinating Polyneuropathy CIDP PDF is a highly resistant polyneuropathy marked by symmetric weakening of the proximal and distal muscles, as well as a progression that lasts more than two months.
Chronic inflammatory demyelinating polyneuropathy (CIDP) has symptoms that are similar to Guillain-Barré syndrome. CIDP differs from Guillain-Barré syndrome, which is monophasic and self-limited, in that it progresses for more than two months. In 2 to 5% of patients initially diagnosed with Guillain-Barré syndrome, CIDP develops.
The cause is assumed to be autoimmune, with demyelination as a result.
Symptoms and Signs of CIDP
CIDP often starts slowly and worsens over time, or it may follow a pattern of relapses and recovery, with partial or complete recovery in between relapses. Flaccid weakness, particularly in the limbs, predominates in the majority of cases; it is frequently more evident than sensory impairments (eg, paresthesias of hands and feet). Deep tendon reflexes have stopped working.
In most patients, the autonomic function is affected less than in Guillain-Barré syndrome. Furthermore, unlike Guillain-Barré syndrome, weakness may be asymmetric and progress more slowly.
Diagnosis of CIDP
Analyses of the cerebrospinal fluid (CSF) and electrodiagnostic tests
CSF analysis and electrodiagnostic tests are among the diagnostics performed. Albuminocytologic dissociation (increased protein but normal white blood cell count) and demyelination, both confirmed by electrodiagnostic testing, are comparable to those seen in Guillain-Barré syndrome.
Nerve biopsy, which can reveal demyelination as well, is rarely required.
Treatment of CIDP
- IV immune globulin (IVIG)
- Plasma exchange
IVIG is generally given first to patients with chronic inflammatory demyelinating polyneuropathy, despite the fact that it is more expensive:
- It doesn’t have the same long-term side effects as corticosteroids.
- It’s less complicated to use than plasma exchange.
Recent research suggests, however, that pulsed corticosteroids may produce longer remissions and have a lower rate of significant side effects than IVIG.
Corticosteroids in pulses can be provided as follows:
For 6 cycles, dexamethasone 40 mg orally every day for 4 days in a row.
Dexamethasone is administered once a week for three months, with monthly dose modifications dependent on the patient’s clinical condition.
IV methylprednisolone 500 mg once a day for 6 months on up to four days
Some individuals can benefit from a combination of IVIG and corticosteroids.
Plasma exchange does not have the same long-term adverse effects as corticosteroids, but it does require an indwelling port and can produce hypotension due to the massive fluid shifts. Plasma exchange may be administered to patients who do not respond to IVIG or who have severe disease, but because it is intrusive and has hazards, it is usually used to de-escalate severe deterioration instead of as a long-term maintenance treatment.
SCIG, or subcutaneous immunoglobulin, could be just as effective as IVIG. Immunosuppressants (such as azathioprine) may be beneficial in reducing corticosteroid reliance. Treatment may be required for an extended period of time.