Chronic Inflammatory Demyelinating Polyradiculoneuropathy Follow-up
- Author: Richard A Lewis, MD; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE more...
Further Outpatient Care
Outpatient care consists of visits to specialists such as neurologists and physiatrists and of treatment visits for IVIg infusions or to the plasma exchange unit.
Further Inpatient Care
Most care is delivered on an outpatient basis, although patients may have to be admitted for a short stay for the initiation of plasma exchange or IVIg treatment, because of complications of chronic inflammatory demyelinating polyradiculoneuropathy or treatment, or for inpatient physical therapy.
Inpatient & Outpatient Medications
Most medications are administered on an outpatient basis. IVIg can be administered as a home infusion or during an outpatient visit. An exception is plasma exchange, which requires visits to a specialized pheresis center.
See the list below:
- If the disease becomes severe, swallowing and breathing functions can be affected. Aspiration pneumonia, atelectasis, and respiratory failure can occur.
- If autonomic function is involved, GI motility and bladder function can be abnormal. Orthostatic hypotension and cardiac conduction defects can occur.
- As already discussed, complications of treatment also must be considered.
Some have suggested that patients with the relapsing disease have a better prognosis than patients with the chronic progressive course. Approximately 70% of patients are said to make relatively good recovery from their relapses, and close to 90% of patients respond to initial immunosuppressive therapy. Some patients do not respond to the usual treatments and accumulate significant disability. Some patients have only a short treatment effect and become treatment dependent. A useful way of understanding the clinical status of patients is to use the CIDP activity status (CDAS). This approach has been useful for both clinical research and for clinical practice.
Refer to physical and occupational therapists and to a physiatrist for optimal outpatient therapy, orthotic devices, and adaptation at home.
Rajabally YA, Simpson BS, Beri S, Bankart J, Gosalakkal JA. Epidemiologic variability of chronic inflammatory demyelinating polyneuropathy with different diagnostic criteria: study of a UK population. Muscle Nerve. 2009 Apr. 39(4):432-8. [Medline].
Press R, Hiew FL, Rajabally YA. Steroids for chronic inflammatory demyelinating polyradiculoneuropathy: evidence base and clinical practice. Acta Neurol Scand. 2016 Apr. 133 (4):228-38. [Medline].
Hughes RA, Donofrio P, Bril V, et al. Intravenous immune globulin (10% caprylate-chromatography purified) for the treatment of chronic inflammatory demyelinating polyradiculoneuropathy (ICE study): a randomised placebo-controlled trial. Lancet Neurol. 2008 Feb. 7(2):136-44. [Medline].
Gorson KC, van Schaik IN, Merkies IS, et al. Chronic inflammatory demyelinating polyneuropathy disease activity status: recommendations for clinical research standards and use in clinical practice. J Peripher Nerv Syst. 2010 Dec. 15(4):326-33. [Medline].
Eftimov F, Vermeulen M, van Doorn PA, Brusse E, van Schaik IN. Long-term remission of CIDP after pulsed dexamethasone or short-term prednisolone treatment. Neurology. 2012 Apr 3. 78(14):1079-84. [Medline].
Barnett MH, Pollard JD, Davies L, McLeod JG. Cyclosporin A in resistant chronic inflammatory demyelinating polyradiculoneuropathy. Muscle Nerve. 1998 Apr. 21(4):454-60. [Medline].
Barohn RJ, Kissel JT, Warmolts JR, Mendell JR. Chronic inflammatory demyelinating polyradiculoneuropathy. Clinical characteristics, course, and recommendations for diagnostic criteria. Arch Neurol. 1989 Aug. 46(8):878-84. [Medline].
Barohn RJ, Saperstein DS. Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy. Semin Neurol. 1998. 18(1):49-61. [Medline].
Bouchard C, Lacroix C, Plante V, et al. Clinicopathologic findings and prognosis of chronic inflammatory demyelinating polyneuropathy. Neurology. 1999 Feb. 52(3):498-503. [Medline].
Bromberg MB. Comparison of electrodiagnostic criteria for primary demyelination in chronic polyneuropathy. Muscle Nerve. 1991 Oct. 14(10):968-76. [Medline].
Chassande B, Leger JM, Younes-Chennoufi AB, et al. Peripheral neuropathy associated with IgM monoclonal gammopathy: correlations between M-protein antibody activity and clinical/electrophysiological features in 40 cases. Muscle Nerve. 1998 Jan. 21(1):55-62. [Medline].
Chaudhry V. Multifocal motor neuropathy. Semin Neurol. 1998. 18(1):73-81. [Medline].
Dalakas MC, Quarles RH, Farrer RG, et al. A controlled study of intravenous immunoglobulin in demyelinating neuropathy with IgM gammopathy. Ann Neurol. 1996 Nov. 40(5):792-5. [Medline].
Donofrio PD. Chronic inflammatory demyelinating polyradiculoneuropathy: new views and guidelines. J Peripher Nerv Syst. 2005 Sep. 10(3):217-9. [Medline].
Dyck PJ, Daube J, O'Brien P, et al. Plasma exchange in chronic inflammatory demyelinating polyradiculoneuropathy. N Engl J Med. 1986 Feb 20. 314(8):461-5. [Medline].
Dyck PJ, Lais AC, Ohta M, Bastron JA, Okazaki H, Groover RV. Chronic inflammatory polyradiculoneuropathy. Mayo Clin Proc. 1975 Nov. 50(11):621-37. [Medline].
Dyck PJ, Litchy WJ, Kratz KM, et al. A plasma exchange versus immune globulin infusion trial in chronic inflammatory demyelinating polyradiculoneuropathy. Ann Neurol. 1994 Dec. 36(6):838-45. [Medline].
Erdmann PG, van Meeteren NL, Kalmijn S, Wokke JH, Helders PJ, van den Berg LH. Functional health status of patients with chronic inflammatory neuropathies. J Peripher Nerv Syst. 2005 Jun. 10(2):181-9. [Medline].
European Federation of Neurological Societies/Peripheral Nerve Society Guideline on management of chronic inflammatory demyelinating polyradiculoneuropathy. Report of a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society. J Peripher Nerv Syst. 2005 Sep. 10(3):220-8. [Medline].
Good JL, Chehrenama M, Mayer RF, Koski CL. Pulse cyclophosphamide therapy in chronic inflammatory demyelinating polyneuropathy. Neurology. 1998 Dec. 51(6):1735-8. [Medline].
Gorson KC, Allam G, Ropper AH. Chronic inflammatory demyelinating polyneuropathy: clinical features and response to treatment in 67 consecutive patients with and without a monoclonal gammopathy. Neurology. 1997 Feb. 48(2):321-8. [Medline].
Hadden RD, Hughes RA. Treatment of immune-mediated inflammatory neuropathies. Curr Opin Neurol. 1999 Oct. 12(5):573-9. [Medline].
Hobson-Webb LD, Donofrio PD. Inflammatory neuropathies: an update on evaluation and treatment. Curr Rheumatol Rep. 2005 Oct. 7(5):348-55. [Medline].
Jann S, Beretta S, Bramerio MA. Different types of chronic inflammatory demyelinating polyneuropathy have a different clinical course and response to treatment. Muscle Nerve. 2005 Sep. 32(3):351-6. [Medline].
Korinthenberg R. Chronic inflammatory demyelinating polyradiculoneuropathy in children and their response to treatment. Neuropediatrics. 1999 Aug. 30(4):190-6. [Medline].
Léger JM, Behin A. Multifocal motor neuropathy. Curr Opin Neurol. 2005 Oct. 18(5):567-73. [Medline].
Mahattanakul W, Crawford TO, Griffin JW, Goldstein JM, Cornblath DR. Treatment of chronic inflammatory demyelinating polyneuropathy with cyclosporin-A. J Neurol Neurosurg Psychiatry. 1996 Feb. 60(2):185-7. [Medline]. [Full Text].
Markvardsen LH, Debost JC, Harbo T, Sindrup SH, Andersen H, Christiansen I, et al. Subcutaneous immunoglobulin in responders to intravenous therapy with chronic inflammatory demyelinating polyradiculoneuropathy. Eur J Neurol. 2013 Jan 7. [Medline].
Mendell JR, Barohn RJ, Freimer ML, et al. Randomized controlled trial of IVIg in untreated chronic inflammatory demyelinating polyradiculoneuropathy. Neurology. 2001 Feb 27. 56(4):445-9. [Medline].
Notermans NC, Franssen H, Eurelings M, Van der Graaf Y, Wokke JH. Diagnostic criteria for demyelinating polyneuropathy associated with monoclonal gammopathy. Muscle Nerve. 2000 Jan. 23(1):73-9. [Medline].
Rotta FT, Sussman AT, Bradley WG, Ram Ayyar D, Sharma KR, Shebert RT. The spectrum of chronic inflammatory demyelinating polyneuropathy. J Neurol Sci. 2000 Feb 15. 173(2):129-39. [Medline].
Saperstein DS, Amato AA, Wolfe GI, et al. Multifocal acquired demyelinating sensory and motor neuropathy: the Lewis-Sumner syndrome. Muscle Nerve. 1999 May. 22(5):560-6. [Medline].
Saperstein DS, Katz JS, Amato AA, Barohn RJ. Clinical spectrum of chronic acquired demyelinating polyneuropathies. Muscle Nerve. 2001 Mar. 24(3):311-24. [Medline].
Stamboulis E, Katsaros N, Koutsis G, Iakovidou H, Giannakopoulou A, Simintzi I. Clinical and subclinical autonomic dysfunction in chronic inflammatory demyelinating polyradiculoneuropathy. Muscle Nerve. 2006 Jan. 33(1):78-84. [Medline].
Uncini A, De Angelis MV, Di Muzio A, et al. Chronic inflammatory demyelinating polyneuropathy in diabetics: motor conductions are important in the differential diagnosis with diabetic polyneuropathy. Clin Neurophysiol. 1999 Apr. 110(4):705-11. [Medline].
Visudtibhan A, Chiemchanya S, Visudhiphan P. Cyclosporine in chronic inflammatory demyelinating polyradiculoneuropathy. Pediatr Neurol. 2005 Nov. 33(5):368-72. [Medline].