Diagnosing CIDP

Opinion
Video

Dr Lewis discusses diagnosis of CIDP, the broad differential diagnosis to keep in mind and common misdiagnosis.

This is a video synopsis/summary of a panel discussion involving Richard Lewis, MD.

The transcript discusses the diagnostic criteria for chronic inflammatory demyelinating polyneuropathy (CIDP). It emphasizes the importance of a clinical presentation fitting the CIDP syndrome, including reflex loss or diminished reflexes. The nerve conduction component is crucial, and new guidelines detail specific criteria for conduction changes, such as motor nerve fibers needing to conduct at least 30 meters per second. The guidelines outline the necessary slowing of 70% below the lower limits of normal, indicating CIDP.

Sensory abnormalities in at least 2 nerves and supportive criteria, including elevated spinal fluid protein and an objective response to treatments like corticosteroids, intravenous immunoglobulin, or plasma exchange, are discussed. The transcript underscores the significance of objective evidence, not subjective reports, in evaluating treatment efficacy. The revised guidelines eliminate the "probable" category, distinguishing between definite CIDP and possible CIDP. The speaker acknowledges the vast differential diagnoses, particularly in different variants of CIDP, emphasizing the need to differentiate nerve disorders from muscle disorders. Additionally, caution is advised in interpreting spinal fluid protein increases, considering age and potential influences from other disorders or surgeries. The transcript concludes with a mention of POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal plasma cell disorder, skin changes) syndrome and the importance of testing for vascular endothelial growth factor, with a note on potential limitations when patients are on steroids during testing.

Video synopsis is AI-generated and reviewed by NeurologyLive editorial staff.

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