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            Welcome to the treatment section of the CIDPUSA web site.               Global site for those who are seeking the Light.

                     Look at our E-BOOK to stay healthy permanently  
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     The treatment for all the autoimmune diseases is similar. These diseases are caused by inflammation, triggered by bacteria or viruses or chemicals. You have to reduce inflammation. You can do that with many drugs or non drugs (herbal, homeopathic or holistic) treatments. The cornerstone for treatment has in the past has been steroids which are fast going out the door due to their side effect profile. However if use steroids on alternate days and in small doses they still can provide adequate treatment.

             One should always begin treatment with diet modifications described in the diet chapter. The next step will be to avoid toxins. If the disease was caused by exposure to diesel fumes then the patient should avoid them.  Avoid pesticides if you are a farmer in New Zealand  spraying your field and you can smell the toxin. A farmer in Bangladesh and Northern India is exposed to high Arsenic exposure in the ground water. The high arsenic is brought about by excessive pesticide usage. This will cause and trigger many autoimmune diseases. The farmers in Vietnam are exposed to the deadly agent orange used in the Vietnam Era wars. After denying benefits to the poor US veterans who were suffering from agent orange associated CIDP, skin and lung disorders the VA administration finally agreed to pay them restitution as a service connected disability. That was a great victory for the VA administration doctors who had been trying to help these veterans.

             The next step in medications is supplements like vitamin B-12, Folate, B-6 they are usually available in a sublingual  tablet. If you read our e-book you see we recommend foods as alternative to these vitamins.

              For specific therapy of autoimmune diseases please read our E-BOOK. This will also help us and support this foundation and your personnel health. If you can afford then please donate through one of the buttons on the services page. Please read the miracle treatments in the Lahore page. CIDPUSA has  published the autoimmune diseases E-BOOK which we have named ,"The Flame Within". The Book  contains treatment of alzheimers, CIDP, neuropathies, Pemphigus, acne, alopecia , every type of arthritis and many more by simple antibiotics. Save your money and purchase this book online today 24 hour delivery to your email. Check this offer on our home page.  Hundreds of satisfied patients worldwide. Remember this is true research by university doctors and not the research that you see in the news supported by Big Pharma. We figured out that bugs cause autoimmune diseases and eliminating these bugs will stop the progression of autoimmune diseases.

          Intravenous immune globulin (IVIG) has also been found to be beneficial. in CIDP treatment. IVIG is usually given in divided doses over 4 or 5 consecutive days at a  total dose of 2g/kg. Dr. Dalakas has shown that if the total infusion can be given in two large doses it works better for the patient. He also recommends that for all the neurological disorders the dose of IVIg should be 2gm/kg.

            Maintenance doses are often needed at monthly intervals to maintain clinical response. Serious side effects of IVIG treatment incude, (fatal anaphylaxis in IgA-deficient patients seen in {In patients who have anti IgA  antibodies}.  We recommend that before the infusion the total IgA level be measured. If the level is below 58 then anti IgA ANTIBODIES NEED TO BE MEASURED. However a case has been reported with IgA LEVEL of 58 who later developed IgA reaction. So a careful history should be taken of all patients first starting IVIg. If the lab reports IgA <20 IT MAY BE SAFE TO ASSUME THAT IT IS ZERO. Not Always. Check the patients history! ( Who is your IVIg PROVIDER)? Learn to give IVIg safely, learn the secret!

 Potential nephrotoxicity (renal failure) risk from IVIg exists, especially in patients with pre-existing renal disease. FDA issued this advisory when lots of patients developed nephrotoxicity. FDA also issued recalls after Hepatitis was induced after the use of IVIg. This led to a nationwide IVIg shortage. A nurse from a prominent IVIg company contacted us and informed us that when she was administering IVIg she noticed a yellowish discoloration , she said that she did not want to infuse the product however she did. The patient spent 6 days in the hospital with a terrible headache. Then her physical condition was weak. The risk is there and there are simpler ways to treat Multiple Sclerosis so please read our e-book and follow the treatment protocols.

For those patients that are resistant to IVIg therapy one needs to check if the dose being given is correct. If the dose has been 2g/kg then one can consider adding steroids to the IVIg. If that does not work then Cyclophosphamide, Rituxan, Cyclosporin can be considered.

IVIg is used as a rescue therapy or first line agent and then a second line agent is started like cyclosporin. In time this becomes the agent of choice for chronic maintenance.

For very simple treatment of your autoimmmune disorder which can be done with a oral course of medication available any part of planet earth please purchase our E-BOOK .

Do not forget about supplements we recommend in our E-BOOK .

Have any questions or need help then please contact us.

                             

 
Neurology. 1998 Dec;51(6 Suppl 5):S16-21.  

Treatment of chronic inflammatory demyelinating polyneuropathy with intravenous immunoglobulin.

Hahn AF.

Department of Clinical Neurological Sciences, University of Western Ontario, London Health Sciences Centre, Canada.

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a defined clinical entity with a chronic progressive or chronic relapsing course, lasting months to years. It causes variable but often severe chronic disability. CIDP is considered an autoimmune disorder caused by both cellular and humoral immune processes. Various immunomodulatory therapies, i.e., IVIg, therapeutic plasma exchange (PE), and prednisone, are of proven benefit. Comparative studies indicate that IVIg and PE confer equal short-term benefit. Efficacy of IVIg is maintained; regularly timed pulse treatments may stabilize relapsing CIDP. The combination of IVIg and prednisone may be advantageous in long-term management. Despite the high cost, IVIg is considered the preferred first treatment. The safety profile is similar to that reported for other conditions; close monitoring during the infusion is recommended. The precise mechanisms of IVIg action in CIDP are not known. Anti-idiotypic neutralization of autoantibodies, binding of complement, and blockade of macrophages may prevent the ongoing inflammatory demyelination.
 
Neurology. 2002 Dec 24;59(12 Suppl 6):S33-40.  
 
Intravenous gammaglobulin (IVIg) for treatment of CIDP and related immune-mediated neuropathies.

Brannagan TH 3rd.

Peripheral Neuropathy Center, Department of Neurology and Neuroscience, Weill Medical College of Cornell University, New York, NY 10021, USA.

Intravenous immune globulin (IVIg) is considered an effective and safe treatment for autoimmune neuropathies, especially in comparison to the alternative treatments such as corticosteroids, chemotherapy, and plasmapheresis. Patients are frequently given a standard induction dose of 2 g/kg, which may be followed by maintenance therapy as needed. Mild infusion-related reactions are frequent but these can often be controlled by slowing the infusion rate or by symptomatic medications. Serious adverse effects are rare and can include thromboembolic events, renal failure, anaphylaxis, or septic meningitis. Patients with IgA deficiency are at risk for anaphylaxis. Immobility, increased serum viscosity, and preexisting vascular disease can increase the risk for thromboembolic events. Preexisting renal insufficiency or the use of sucrose-containing IVIg preparations can increase the risk for renal failure, and patients with migraine are at risk for development of aseptic meningitis. Screening patients for risk factors that predispose to development of adverse events may reduce the incidence of complications.
 

For those with multi-focal neuropathy with conduction block the rules for treatment are different. Those patients get worse with steroids and do not do very well with plasma exchange, but do respond well to IVIg.

Some patients with CIDP have a para-protein in the blood, which is an abnormal protein produced by the bone marrow. These patients may respond to CIDP treatments, but may also require treatment for the excess para-protein.

To conclude, CIDP is a very variable condition. It is auto-immune and is treatable. It is exceptional for CIDP not to respond to at least one of the available drugs. The first choice of treatment is either prednisolone or IVIg. The diagnosis is difficult, much less so than GBS, depending critically on the nerve conduction studies and neuro-physiologies. Trials for immuno-suppression have shown promise. ..........

 
Brain. 1996 Aug;119 ( Pt 4):1067-77. , Links

Intravenous immunoglobulin treatment in chronic inflammatory demyelinating polyneuropathy. A double-blind, placebo-controlled, cross-over study.

Hahn AF, Bolton CF, Zochodne D, Feasby TE.

University of Western Ontario, London, Canada.

Thirty patients with definite or probable chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) of chronic progressive (16 patients) or relapsing (14 patients) course were randomly assigned to receive intravenous immunoglobulin (IvIg) 0.4 g per kg body weight or a placebo treatment on 5 consecutive days in a double-blind, cross-over trial. Neurological function was monitored by serial quantitative assessments [neurological disability score (NDS); clinical grade (CG) and grip strength (GS) measurements] and by electrophysiological studies before and after each treatment period. Twenty-five patients completed both treatment periods. A comparison of the observed changes in clinical outcome measures revealed statistically significant differences in favour of IvIg, with (mean +/- SD) improvements in NDS by 24.4 +/- 5.4 points (P < 0.002) in CG by 1 +/- 0.3 points (P < 0.001) in GS by +6.3 +/- 1.7 kg (P < 0.005), whereas scores were unchanged or worse with placebo. A secondary two-groups analysis of the first trial period included all 30 patients; 16 patients had been randomly assigned to IvIg and 14 to placebo treatments. Again significant differences in favour of IvIg were observed in all the clinical end-points: improvement in NDS was 35.6 +/- 25 points (P < 0.0001), in CG it was 1.3 +/- 1.9 points (P < 0.002) and in GS +9.8 +/- 7.7 kg (P < 0.001), whereas all scores worsened with placebo. Of the 30 patients, 19 (63%) improved with IvIg treatments; nine out of 16 patients (56%) with chronic progressive CIDP, and 10 out of 14 patients (71%) with relapsing CIDP (differences were not statistically significant). A placebo response was seen in five patients. Comparison of paired electrophysiological measurements before and 4 weeks after IvIg treatments revealed statistically significant improvements in the summed motor conduction velocities (sigma MCV; P < -0.0001) and in the summed compound muscle action potentials (CMAP) evoked with proximal stimulation (sigma proximal CMAP, P < 0.03) of median, ulnar, peroneal and tibial nerves. Eight of nine IvIg responders with chronic progressive CIDP improved gradually to normal function with a single 5 day course of IvIg; in five of these, small doses of prednisone were prescribed during follow-up. In 10 IvIg responders with relapsing CIDP, improvements lasted a median 6 weeks (range 3-22 weeks) and was reproducible with open label treatments. All 10 patients have been maintained and stabilized with IvIg pulse therapy of 1 g per kg body weight or less, given as a single infusion prior to the expected relapse. A beneficial response to IvIg was found to be most likely in patients with acute relapse or with disease of one year or less. Patients with predominantly sensory signs did not improve.
 
J Neurol Neurosurg Psychiatry. 2005 Aug;76(8):1115-20.  

Intractable chronic inflammatory demyelinating polyneuropathy treated successfully with ciclosporin.

Odaka M, Tatsumoto M, Susuki K, Hirata K, Yuki N.

Department of Neurology, Dokkyo University School of Medicine, Kitakobayashi 880, Mibu, Shimotsuga, Tochigi 321-0293, Japan. m-odaka@dokkyomed.ac.jp.

BACKGROUND: Chronic inflammatory demyelinating polyneuropathy (CIDP) is a heterogeneous disorder and both clinical course and response to treatment vary widely. Because of the propensity for relapse, CIDP requires maintenance therapy after the initial response to treatment. There is no consensus regarding this in the published literature.Present report: A patient with CIDP was treated with oral prednisolone and cyclophosphamide pulse therapy but required repeated plasma exchange and intravenous immunoglobulin (IVIg). Treatment with ciclosporin freed the patient from repeated IVIg administration. Therapeutic responses in 14 subsequent cases including three patients who showed improvement with ciclosporin are also presented along with an algorithm of the authors' suggested protocol for treatment. CONCLUSION: Ciclosporin should be considered for patients with intractable CIDP who require repeated IVIg.

PMID: 16024890 [PubMed - in process]

 

 
J Neurol Neurosurg Psychiatry. 2006 Apr;77(4):544-7. Links

Treatment of chronic inflammatory demyelinating polyradiculoneuropathy with methotrexate.

Fialho D, Chan YC, Allen DC, Reilly MM, Hughes RA.

Department of Molecular Neuroscience, Institute of Neurology, Queen Square, London WC1N 3BG, UK. doreen@doctors.org.uk.

We discovered many reports of other immunosuppressive drugs being used in adults with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) but none of methotrexate. As weekly low dose oral methotrexate is safe, effective, and well tolerated in other diseases, we treated 10 patients with otherwise treatment resistant CIDP. Seven showed improvement in strength by at least two points on the MRC sum score and three worsened. Only two showed an improvement in disability and both were also receiving corticosteroids. We discuss the difficulty of detecting an improvement in treatment resistant CIDP and propose methotrexate as a suitable agent for testing in a randomised trial.

PMID: 16543541 [PubMed - in process]
 
Expert Rev Neurother. 2006 Mar;6(3):365-79. Related Articles, Links

Chronic inflammatory demyelinating polyneuropathy: a treatment protocol proposal.

Odaka M.

Department of Neurology, Dokkyo University School of Medicine, Kitakobayashi 880, Mibu, Shimotsuga, Tochigi 321-0293, Japan. m-odaka@dokkyomed.ac.jp

Guidelines for diagnostic criteria and treatment of chronic inflammatory demyelinating polyneuropathy (CIDP) have been proposed by a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society, based on available evidence and expert consensus. These should prove practical for the clinical management of CIDP. Intravenous immunoglobulin followed by corticosteroids should be considered as the initial treatment, however no clear second drug of choice for patients who do not respond to the initial treatment is given. The author reports the long-term therapeutic efficacy of ciclosporin for patients with CIDP who did not show sustained improvement under steroid therapy. Ciclosporin should be tried for patients with intractable CIDP who require repeated intravenous immunoglobulin. An adequate initial dose of ciclosporin is 3 mg/kg/day, with plasma trough concentrations between 100 and 150 ng/ml. If patients respond to ciclosporin, remission can be maintained for 2 years, after which the dose can be slowly reduced over 1 year. Eventual withdrawal should be considered. This review proposes a treatment strategy that includes long-term maintenance therapy for CIDP based on published clinical trials and the author's clinical experience. Current concepts concerning the clinical spectrum of CIDP and diagnostic approaches are also considered.

PMID: 16533141 [PubMed - in process]
 


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