CIDP

[Nathan Hale]

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.

[RankinBranch]

A related discussion, CIDP? was started.

[Boatbuilder]

A related discussion, Diagnosing was started.

[Becky]

Nathan and Jim, I have a hereditary type of peripheral neuropathy called Charcot-Marie-Tooth, (CMT) type 2-c, which involves the phrenic nerves, I have the same symptoms as you describe, swallowing, voice, atrophy of legs, feet and hands. CMT type 2, shows only a mild slowing on the EMG and or NCV tests. CIDP and CMT are both forms of peripheral neuropathy. Any other members of your family, perhaps aunts uncles great grandfathers etc, have any neuromuscular problems? Do you have high arches?  Its a long shot, but worth investigating.

[CCF Neuro[P] MD, RPS]

Thanks for your comments.

[Jim]

Can someone explain to me what CIPD is?  I have had same symptoms with negative EMG's over past four years.  Have been afraid of ALS.  Thank you.

[CCF Neuro[P] MD, RPS]

Dear Jim:

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

[CCF Neuro[P] MD, RPS]

Dear Mr. Hale:

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

[Kathy]

I've just been diagnosed with CIDP thru a Sural Nerve Biopsy. My hands and feet have also lost subcuteanous fat from this form of PN.

[Nathan Hale]

Sounds like I could use a second opinion. I've had two EMG's. First was normal while second (1 month later) was indicative of a demyelinating neuropathy. My lumbar puncture was taken shortly after my normal EMG when I continued to experience increased weakness. Do you think another lumbar puncture would be in order?
Another EMG? Thank you for your time.

[CCF Neuro[P] MD, RPS]

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