A comparative study of chronic inflammatory demyelinating polyradiculoneuropathy with and without diabetes mellitus

Abstract

Diabetes mellitus (DM) is occasionally associated with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) raising the question of coexistence or etiological link. The study compares, neurophysiological and outcome of CIDP patients with and without DM. Consecutive CIDP patients were subjected to detailed clinical evaluation, haematology, serum chemistry, vasculitis profile, paraproteins, myeloma screening and cerebrospinal fluid (CSF) examination. Electrodiagnostic (EDx) tests included motor and sensory conduction and F-wave studies. The patients were treated with oral prednisolone 1 mg/kg/day with or without azathioprine 1-2 mg/kg and followed up for 6 months. The clinical and EDx finding in CIDP with and without DM were compared. Thirty-five CIDP patients were included and nine had DM. CIDP with diabetes (CIDP-D) had higher frequency of autonomic dysfunction. In CIDP-D, motor (38.9% vs. 16.7%) and sensory (40.7% vs. 14.1%) nerve conductions were more frequently unrecordable or had reduced compound muscle action potential (CMAP) amplitude. F-waves were also more frequently unrecordable in CIDP-D (28.8% vs. 12.8%) compared with idiopathic CIDP (I-CIDP). The degree of conduction block was more in I-CIDP. At 6-month follow up, I-CIDP patients improved better than CIDP-D. CIDP-D patients present with higher frequency of autonomic dysfunction, electrophysiological evidences of associated axonal loss and had a poorer outcome at 6 months compared with I-CIDP.

Chronic inflammatory demyelinating polyneuropathy in an adolescent with type 1 diabetes mellitus

“…Chronic inflammatory demyelinating polyneuropathy Alves et al diSCuSSion Chronic inflammatory demyelinating polyradiculopathy is an acquired neuropathy characterized by a chronic, rapidly progressive, proximal and distal symmetric weakness, associated with hyporeflexia and sensory symptoms 1 . It has an immunologic pathophysiology involving both the humoral and the cellular immunologic response, which supports the rationale to the immunotherapy 1,2 .…”

“…However, the distinction of diabetic somatic polyneuropathy from CIDP is not a simple task. While CIDP progresses in months, with relapses in a third of the cases, in the diabetic neuropathy the course is slower, progressing in years, and usually related to the length of diabetes [1][2][3][4]5 . In addition, the electromyography and nerve conduction studies reveal demyelination with nervous conduction abnormalities, contrary to the axonal pattern of diabetic neuropathy.…”

“…However, besides the classical presentation, CIDP encompasses a large set of phenotypes, including one with a normal CSF study. Therefore there is not a single diagnostic pattern which can cover every expression of the disease 1,2,4,7 . In this patient, the diagnosis of CIDP was based on: diagnosis of T1DM, progressive pattern of the neuropathy, and electromyography studies compatible with demyelinating polyneuropathy, without evidence of axonal lesion.…”

“…Chronic inflammatory demyelinating polyradiculopathy (CIDP) is an immune-mediated disorder for which specific clinical cerebrospinal fluid (CSF), electrophysiologic and histological criteria have been proposed 1 . CIPD is an uncommon cause of childhood polyneuropathy.…”

Chronic Inflammatory Demyelinating Polyneuropathy in Children: A Review of Clinical Characteristics and Recommendations for Treatment

“…Chronic inflammatory demyelinating polyradiculopathy (CIDP) is an acquired neuropathy, characterized by a chronic, rapidly progressive, proximal and distal symmetric weakness, accompanying with hyporeflexia and sensory symptoms (1). The most common complaint that brings children with CIDP to medical attention is gait disturbance and falling.…”