Isolated unilateral adduction deficit and ptosis as the presenting features of chronic inflammatory demyelinating polyradiculoneuropathy.
Pieh C, Rossillion B, Heritier-Barras AC, Chofflon M, Landis T,
Safran AB.
Ophthalmology Clinic, Department of Clinical Neurosciences, Geneva University Hospitals, Switzerland.
A patient with chronic inflammatory demyelinating polyneuropathy (CIDP) presented with an isolated unilateral adduction deficit and
ptosis. Investigations were negative until the onset of limb weakness and fatigue 2 years later. At that time, electroneuromyography, cerebrospinal fluid examination, and magnetic
resonance imaging confirmed the diagnosis of CIDP. Thus, ophthalmic signs can precede extremity and bulbar signs with a long latency in
CIDP.
Intravenous immunoglobulin as first treatment in diabetics with concomitant distal symmetric axonal polyneuropathy
and CIDP.
Cocito D, Ciaramitaro P, Isoardo G, Barbero P, Migliaretti G, Pipieri A, Proto G, Quadri R, Bergamasco B, Durelli L.
U. O. A. D. U. Neurologia I, Dipartimento di Neuroscienze, Universita di Torino, Via Cherasco 15, 10126 Turin, Italy. dariococito@yahoo.it
The authors investigated the impact of IVIg as first line treatment of diabetic patients suffering from chronic inflammatory demyelinating
polyneuropathy (CIDP) concomitant with distal symmetric axonal polyneuropathy. Nine patients with these clinical and
electrophysiological features were treated with IVIg (0.4 g/Kg/day for 5 days). Clinical and electrophysiological evaluations were
performed before and after treatment. Following IVIg treatment there was no significant improvement in clinical deficit. However, there
was a significant and persistent decrease in the Rankin scale score and an improvement in the demyelinating feature on nerve conduction
studies. Our findings suggest that IVIg had small but detectable beneficial effects on diabetic patients with CIDP and a high degree
of axonal damage.
Arch Neurol. 2002 May;59(5):758-65.
Demyelinating neuropathy in diabetes mellitus.
Sharma KR, Cross J, Farronay O, Ayyar DR, Shebert RT, Bradley WG.
Department of Neurology, University of Miami School of Medicine
(M740), 1150 NW 14th St, Room 603, Miami, FL 33136, USA. ksharma@med.miami.edu
BACKGROUND: Recent studies have reported that patients with diabetes mellitus (DM) have a predisposition to develop chronic inflammatory
demyelinating polyneuropathy (CIDP). OBJECTIVES: To determine whether patients with DM have a polyneuropathy fulfilling electrophysiologic criteria for CIDP, and whether CIDP is more
frequent in patients with type 1 than in patients with type 2 DM. METHODS: We prospectively studied the frequency of
electrophysiologic changes meeting the criteria for CIDP in patients with DM seen in our electrophysiology laboratory during a 51-month
period (period 1). To evaluate the relationship between DM and CIDP, we prospectively determined during a 14-month period (period 2) the
frequency of DM in patients seen in our electrophysiology laboratory with other neuromuscular diseases, and the frequency of idiopathic
CIDP. RESULTS: During period 1, 120 patients with DM met the electrophysiologic criteria for CIDP (DM-CIDP). The most frequent clinical features of DM-CIDP were those of a predominantly
large-fiber sensorimotor neuropathy, with recent motor deterioration and a moderately increased cerebrospinal fluid protein
concentration. Twenty-six of the 120 patients were given intravenous immunoglobulin (400 mg/kg per day for 5 days), and 21 patients
(80.8%) had significant improvement in the neurologic deficit at the end of 4 weeks of therapy. The DM-CIDP occurred equally in type 1 and type 2 DM. During period 2, 1127 patients were seen. Of these,
189 (16.8%) had DM with various neurologic disorders, including 32 patients (16.9%) with DM-CIDP. Among the remaining 938 patients
without DM, 17 (1.8%) had idiopathic CIDP. The odds of occurrence of DM-CIDP was 11 times higher among diabetic than nondiabetic patients
(P<.001). CONCLUSIONS: Demyelinating neuropathy meeting the electrophysiologic criteria for CIDP occurred in both types of DM, and its occurrence was significantly higher in diabetic than in
nondiabetic patients.
www.cidpusa.org/P/ivig.htm
http://www.cidpusa.org/disease.html