1、Department of Neurology,Fujian Provincial HospitalXingyong Chen IntroductionTraditionally,chronic inflammatory demyelinating polyradiculoneuropathy(CIDP)has been considered a heterogeneous disorder including a broad spectrum of clinical phenotypes.T h e Eu ro p e a n Fe d e ra t i o n o f Ne u ro l
2、o g i c a l Societies/Peripheral Nerve Society(EFNS/PNS)CIDP treatment guideline has defined several clinical pictures as atypical CIDP phenotypes,additional to the classical(typical)picture of CIDPprevalence of around 6 cases per 100,000 predominantly affect males,and typically occur in middle to o
3、ld ageCIDP can also occur in children.The incidence of CIDP increases with age,rising to 1.5 times the overall average in people over 65 years of ageClinical presentationClassic CIDP is characterized by the occurrence of symmetrical weakness in both proximal and distal muscles,impaired sensation and
4、 parasthesia and absent or diminished tendon reflexesThe disease evolves over more than 8 weeks,thus distinguishing the condition from GBS which has an acute onset.The time course maybe relapsing,chronic progressive,monophasic or GBS like onset.Newly recognised clinical features in CIDPAcute onset o
5、f CIDP may occur in up to 18%of CIDP patients,resembling the GBSdiagnosis was changed to CIDP in 5%of GBS patientsFatigue can be the main complaint in CIDP patients(75%)Activity-induced weaknessSevere pain is present in only a minority of CIDP patients;Tremor can be a disabling symptom in CIDP(50%)a
6、 higher incidence of almost 40%of restless legs syndrome in patients with CIDPAutonomic symptoms:23%,of which gastrointestinal and genitourinary symptoms were most frequent(mild)severe autonomic dysfunction should be regarded as a red flag when considering the diagnosis of CIDP.CIDP PHENOTYPESThe cl
7、inical presentation of CIDP is variabledetermined by the number and distribution of the demyelinating peripheral nerve lesionsSM:sensory and motor.PE:plasma exchange;RR:relapsingremitting;CS:corticosteroids;Atypical CIDPDistal paresthesia and hypesthesia are the most frequent symptoms,followed by pr
8、oprioceptive ataxiaDADSP(distal acquired demyelinating symmetric polyneuropathy):distal or predominantly sensory large fibre neuropathy length dependent axonal neuropathy.DML:distal motor latencyThe LewisSumner syndrome(LSS),or multifocal acquired demyelinating sensory and motor neuropathy(MADSAM),h
9、as been reported in up to 15%of patients fulfilling the EFNS/PNS criteria for CIDPThe combination of symmetric pattern of weakness without bulbar involvement clinically distinguishes this phenotype from lower motor neuron disease,but distinction can be difficult,especially if electrophysiological cr
10、iteria of demyelination are not met completely.Focal CIDP is defined as involvement of the brachial or lumbosacral plexus or of one or more peripheral nerves in one upper or lower limb(EFNS).Associated conditionsCIDP may be associated with various diseases,such as infection with the human immunodefi
11、ciency virus or hepatitis C,Sjgrens syndrome,inflammatory bowel disease,melanoma,lymphoma,diabetes mellitus,and IgM,IgG,or IgA monoclonal gammopathy of unknown significance.The pathogenetic relevance of such concurrent diseases is unclearupdateAnti-neurofascin(神经束蛋白)IgG4 antibodies were associated w
12、ith a subgroup of patients with CIDP showing a younger age at onset,ataxia,tremor,CNS demyelination,and a poor response to IV immunoglobulinDiffusion-weighted images in patient 10 showed signal abnormalities in the splenium of the corpus callosum(胼胝体压部).Fluid-attenuated inversion recovery images in
13、patients 10 and 31 showed multiple sclerosislike lesions in the juxtaventricular（脑室旁）regions.Therapeutic options for CIDPThe acquired chronic demyelinating neuropathies include：chronic inflammatory demyelinating polyneuropathy(CIDP)neuropathy associated with monoclonal IgM antibodies to myelin-assoc
14、iated glycoprotein(MAG;anti-MAG neuropathy)multifocal motor neuropathy(MMN)POEMS syndrome.They have characteristic-though overlapping-clinical presentations,are mediated by distinct immune mechanisms,and respond to different therapies.Figure 1|A suggested diagnostic pathway for chronic acquired demy
15、elinating polyneuropathies.Differential diagnosis is based on electrodiagnostic studies,biopsies,serum biomarkers and antibodies.Abbreviations:CIDP,chronic inflammatory demyelinating polyneuropathy;IFE,immunofixation electrophoresis;MAG,myelin-associated glycoprotein;VEGF,vascular endothelial growth factor.THANKS
