Demyelinating Neuropathy

CIDP Symptoms Diagnosis and Treatment at Ohio State

One of the other conditions that I have a particular interest in is CIDP and associated mimickers. CIDP stands for chronic inflammatory demyelinating polyradiculoneuropathy. And it’s a disease where the immune system targets the nerves and nerve roots and can be diagnosed via EMG or electromyography nerve conduction studies, a spinal tap and also sometimes using imaging of the a a cervical and lumbar nerve roots to look for enlargement. This is an interesting condition because it’s very treatable and also happens to have a lot of other diseases that can mimic it so part of what we do here at Ohio State when patients come to see us is to exclude other potential mimickers of that condition. Typical symptoms of CIDP will.

Include instability of gate, inexplicable weakness typically higher up in the legs in in the pelvic girdle and also in the shoulder girdle area, clumsiness with hands, inexplicable numbness or burning of the hands and feet or I should say inexplicable numbness more so than than burning, as well as EMG or nerve conduction findings that show what we typically describe as a demyelinating disease process where the coating of the nerves is damaged and leads to very slow conduction. So one analogy for example is that CIDP is kind of like the MS but of the peripheral nervous system. For CIDP one of the first line treatments is IVIG, which consists of immune globulin, pulled immune globulin from many contributing.

Patients and typically it is infused over the course of five days at the first time the patient receives it. And then this infusion can then be repeated on a monthly or once per threeweek basis until patients attain a plateau or emission of disease. One of the other common cond treatments of course, is steroids, which can be given either on a daily basis or on a pulsed monthly basis, infusion wise as well. And then there are other forms of treatment which have less robust evidence but which can still be used, immunosuppressant therapies for example. CIDP is a condition that typically requires a prolonged course of therapy, sometimes as far out as two years but typically no less than a year especially.

If patients are at risk of remission or relapse, I should say. But some patients actually who have very mild disease never even require treatment. So we first evaluate patients and see the severity of disease and on that basis decide what treatment therapy would be most appropriate and with the least side effect profile for those patients.

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