From the Guidelines
CIDP evaluation should include a comprehensive diagnostic workup with neurology consultation, MRI of spine, lumbar puncture, serum antiganglioside antibody tests, and electrodiagnostic studies to evaluate polyneuropathy. When evaluating CIDP, it is essential to consider the diagnostic workup recommended by recent guidelines, such as those outlined in the American Society of Clinical Oncology clinical practice guideline 1. The diagnostic workup should include:
- Neurology consultation to assess the patient's neurological function and determine the need for further testing
- MRI of spine with and without contrast to rule out compressive lesions and evaluate for nerve root enhancement or thickening
- Lumbar puncture to analyze cerebrospinal fluid (CSF) for elevated protein levels and white blood cell count, as well as to send cytology samples
- Serum antiganglioside antibody tests to diagnose Guillain-Barré syndrome (GBS) and its subtypes
- Electrodiagnostic studies, such as nerve conduction studies and electromyography, to evaluate polyneuropathy and detect evidence of demyelination. This comprehensive approach is crucial for accurate diagnosis and timely initiation of treatment, ultimately improving morbidity, mortality, and quality of life for patients with CIDP.
From the Research
CIDP Evaluation
- The diagnosis of Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP) relies on clinical suspicion, clinical findings, and the demonstration of demyelinating changes on electrodiagnostic (EDx) testing and nerve pathology 2.
- The clinical features of CIDP include weakness and sensory deficits that can lead to significant neurological disability 3.
- Recognizing CIDP and distinguishing it from other chronic polyneuropathies is important because many patients with CIDP are highly responsive to treatment with immunosuppressive or immunomodulatory therapies 3.
Treatment Options
- Evidence-based therapies for CIDP consist of corticosteroids, intravenous immunoglobulins (IVIg), and plasma exchange 4.
- Corticosteroids, IVIg, and plasma exchange are recommended as initial treatment options for typical CIDP and CIDP variants 5.
- Pulsed corticosteroids have been shown to have a higher potential in achieving therapy-free remission or longer remission-free periods compared with IVIg, as well as relatively low rates of serious side effects 4.
- The choice between IVIg and pulsed steroid treatment may depend on factors such as efficacy, relapse rate and time, and side effect profile 4.
Diagnostic Criteria
- The levels of diagnostic certainty for CIDP have been reduced from three (definite, probable, possible CIDP) to only two (CIDP and possible CIDP) 5.
- Good Practice Points have been formulated for supportive criteria and investigations to be considered to diagnose CIDP, including electrodiagnostic testing and nerve pathology 5.
- The diagnosis of CIDP should be based on a combination of clinical examination findings, electrodiagnostic studies, and other supportive evidence 3.