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Neurology (Expert Forum)
CIDP
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CIDP
by Nathan Hale, Aug 31, 1999 12:00AM
Is it possible to receive a diagnosis of CIDP without much in the way of sensory symptoms? Would delayed nerve conduction velocities on an EMG point to a CIDP diagnosis as well? How important is an elevated protein level in CSF to this diagnosis?
I have increased systemic weakness and mild atrophy of my hands in addition to voice and swallowing problems over a three month period. My CSF was normal and I have not lost my reflexes. I have not been officially diagnosed but my neurologist is leading toward treatment as if it is CIDP. Does this make sense? Thanks for your help.
I have increased systemic weakness and mild atrophy of my hands in addition to voice and swallowing problems over a three month period. My CSF was normal and I have not lost my reflexes. I have not been officially diagnosed but my neurologist is leading toward treatment as if it is CIDP. Does this make sense? Thanks for your help.
Doctor's Answer
by CCF Neuro[P] MD, RPS, Aug 31, 1999 12:00AM
Dear Mr. Hale:
CIDP is a chronic disorder that can be episodic in nature. There is usually muscle weakness, delayed conduction velocities (due to the demyelination) and the disorder is patchy on EMG studies. CIDP can present without sensory problems but also can have some sensory component. Usually the sensory component is much less in nature compared to the motor component. However, one of the diagnostic tools in this disorder is an elevated protein in the spinal fluid. One does not have to lose reflexes to have CIDP, although this is the norm.
Did the EMG indicate a demyelination pattern? There should be slowing. Were there any suggestions of muscle problems such as fibrillations? The EMG should have indicated a demyelination problem. If not, then I would get a second opinion. This would be especially true if the spinal fluid did not show increased protein. There are other things that can affect swallowing and have muscle weakness and atrophy associated with them.
I would make sure of the diagnosis before starting treatment. Treatment often masks symptoms, even is treatment is for the wrong disease.
Sincerely,
CCF Neuro MD
CIDP is a chronic disorder that can be episodic in nature. There is usually muscle weakness, delayed conduction velocities (due to the demyelination) and the disorder is patchy on EMG studies. CIDP can present without sensory problems but also can have some sensory component. Usually the sensory component is much less in nature compared to the motor component. However, one of the diagnostic tools in this disorder is an elevated protein in the spinal fluid. One does not have to lose reflexes to have CIDP, although this is the norm.
Did the EMG indicate a demyelination pattern? There should be slowing. Were there any suggestions of muscle problems such as fibrillations? The EMG should have indicated a demyelination problem. If not, then I would get a second opinion. This would be especially true if the spinal fluid did not show increased protein. There are other things that can affect swallowing and have muscle weakness and atrophy associated with them.
I would make sure of the diagnosis before starting treatment. Treatment often masks symptoms, even is treatment is for the wrong disease.
Sincerely,
CCF Neuro MD
Another EMG? Thank you for your time.
Sounds like somethings are not coming together. I would see your neurologist and have him/her evaluate the situation. Based on your physicial exam and the abnormal EMG something is going on. If there is doubt then maybe another LP but I would talk it over first. The EMG should have been more positive for CIDP.
Sincerely,
CCF Neuro MD
CIDP or chronic inflammatory demyelinating polyneuropathy is a disorder where your body's immune system attacks the myelin that surround your peripheral nerves. It is manifested by muscle weakness. There can be a sensory component or paraesthesias but these are usually not prominent. There is elevated protein in the CSF and always an abnormal EMG that shows patchy demyelination.
I hope this helps.
CCF Neuro MD