From the Research
The workup for Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) should include a comprehensive neurological examination, nerve conduction studies, cerebrospinal fluid analysis, and blood tests, as outlined in the most recent study 1. The neurological examination typically reveals symmetric weakness, diminished or absent reflexes, and sensory abnormalities. Nerve conduction studies are essential and should demonstrate demyelination with features like conduction block, temporal dispersion, prolonged distal latencies, and slowed conduction velocities in multiple nerves. Some key points to consider in the workup include:
- Cerebrospinal fluid analysis often shows elevated protein levels (>45 mg/dL) with normal cell counts, known as albuminocytologic dissociation.
- Blood tests should include complete blood count, comprehensive metabolic panel, HbA1c, thyroid function, vitamin B12, serum protein electrophoresis, immunofixation, and tests for HIV, hepatitis, and Lyme disease to rule out other causes.
- In some cases, nerve biopsy may be necessary, showing demyelination with inflammatory infiltrates.
- MRI of the spinal roots, plexus, or peripheral nerves may show enhancement or enlargement. This comprehensive approach is necessary because CIDP is primarily a diagnosis of exclusion, requiring demonstration of both clinical and electrophysiological evidence of demyelination while ruling out other conditions that can mimic CIDP, as discussed in 2 and 1. It's also important to note that CIDP can present as various subtypes, and the diagnosis relies on a combination of clinical suspicion, clinical findings, and the demonstration of demyelinating changes on electrodiagnostic testing and nerve pathology, as outlined in 3 and 4. The treatment approach for CIDP includes immunosuppressive or immunomodulatory therapies, such as intravenous immunoglobulin, corticosteroids, and plasma exchange, as discussed in 1 and 5.