Further Outpatient Care

Generally, all patients in whom AIDP is suspected should be admitted for further monitoring and treatment.

Patients who present with mild neurologic impairment after already reaching a plateau can be treated as outpatients with close supervision.

Upon discharge, patients require several follow-up visits to ensure that relapses do not occur and to help coordinate home-health services if necessary. Physical and occupational therapy, either in a long-term rehabilitation unit or at home, help many patients return more rapidly to their baseline level of activity.

Relapses occur (10%–20%) following completion of plasma exchange, and these relapses frequently respond to a second course of treatment. Similarly, relapses that follow IVIG therapy also respond to a second course.

Further Inpatient Care

Based on the severity of symptoms, patients with acute inflammatory demyelinating polyradiculoneuropathy (AIDP) may require further inpatient services.

Patients should have cardiac monitoring to confirm and treat arrhythmias.
Pulmonary function tests such as FVC and negative inspiratory pressure should be performed 3–4 times a day until a patient has reached a plateau for several days.
Transfer to an ICU is recommended for patients with worsening respiratory effort (ie, FVC < 20 mL/kg) or cardiac arrhythmias.
Physical therapy should be initiated early to help increase patient activity and mobility. Patients who do not recover quickly benefit by transfer to an inpatient rehabilitation center before returning home.

Transfer

Transfer patients to the ICU when respiratory failure is impending or when cardiac arrhythmias are occurring.

Transfer patients to regional or tertiary hospitals if a community hospital does not have an ICU or is unable to provide IVIg or plasmapheresis therapy.

Questions

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Author

Emad R Noor, MBChB Assistant Professor of Neurology and Clinical Neurophysiology, Hackensack Meridian School of Medicine; Attending Neurologist/Clinical Neurophysiologist, Neuroscience Institute at JFK Medical Center

Emad R Noor, MBChB is a member of the following medical societies: American Academy of Neurology, American Medical Association, Egyptian Society of Neurology, Psychiatry, and Neurosurgery

Disclosure: Nothing to disclose.

Coauthor(s)

Mahsa Mohajery, MD Chief Resident Physician, Department of Neurology, JFK University Medical Center, Hackensack Meridian School of Medicine

Mahsa Mohajery, MD is a member of the following medical societies: American Academy of Neurology, American Medical Association, Iranian American Medical Association, Medical Council of Islamic Republic of Iran

Disclosure: Nothing to disclose.

Hasnain Arshad, MD Resident Physician, Department of Neurology, JFK University Medical Center, Hackensack Meridian School of Medicine

Hasnain Arshad, MD is a member of the following medical societies: Pakistan Medical and Dental Council

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Glenn Lopate, MD Associate Professor, Department of Neurology, Division of Neuromuscular Diseases, Washington University in St Louis School of Medicine; Consulting Staff, Department of Neurology, Barnes-Jewish Hospital

Glenn Lopate, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

Nicholas Lorenzo, MD, CPE, MHCM, FAAPL Co-Founder and Former Chief Publishing Officer, eMedicine and eMedicine Health, Founding Editor-in-Chief, eMedicine Neurology; Founder and Former Chairman and CEO, Pearlsreview; Founder and CEO/CMO, PHLT Consultants; Former Chief Medical Officer, MeMD Inc

Nicholas Lorenzo, MD, CPE, MHCM, FAAPL is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Association for Physician Leadership

Disclosure: Nothing to disclose.

Additional Contributors

Richard A Sater, MD, PhD Neurologist, High Point Neurology Associates

Richard A Sater, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Medical Association, American Society of Neuroradiology

Disclosure: Nothing to disclose.

Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS † Professor Emeritus of Neurology and Psychiatry, Clinical Professor of Medicine, Clinical Professor of Family Medicine, Clinical Professor of Neurosurgery, State University of New York Upstate Medical University; Neuroscience Director, Department of Neurology, Crouse Irving Memorial Hospital

Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, American College of Forensic Examiners Institute, American College of International Physicians, American College of Physicians, American Heart Association, American Stroke Association, National Association of Managed Care Physicians, Royal College of Physicians, Royal College of Physicians and Surgeons of Canada, Royal College of Surgeons of England, Royal Society of Medicine

Disclosure: Nothing to disclose.

Sections Acute Inflammatory Demyelinating Polyradiculoneuropathy
Overview
Presentation
DDx
Workup
Treatment
Medication
Follow-up
Questions & Answers
References

Acute Inflammatory Demyelinating Polyradiculoneuropathy Follow-up

Further Outpatient Care

Further Inpatient Care

Transfer

References

Tables

Contributor Information and Disclosures

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