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Chronic inflammatory polyneuropathy

Definition

Chronic inflammatory polyneuropathy is nerve inflammation that results in loss of movement or sensation.

Alternative Names

Polyneuropathy - chronic inflammatory; CIDP; Chronic inflammatory demyelinating polyneuropathy

Causes, incidence, and risk factors

Chronic inflammatory polyneuropathy is a common type of damage to nerves outside the brain or spinal cord (peripheral neuropathy). Polyneuropathy means there are several nerves involved. Polyneuropathy usually affects both sides of the body equally.

The cause of chronic inflammatory polyneuropathy is an abnormal immune response. The specific processes and triggering factors vary and, in many cases, are unknown.

Guillain-Barre syndrome is an acute form of chronic inflammatory polyneuropathy.

It may occur in association with other conditions such as HIV, inflammatory bowel disease, lupus erythematosus, chronic active hepatitis, and blood cell abnormalities.

Symptoms

• Weakness, usually in the arms and hands or legs and feet
• Facial weakness
• Difficulty walking
• Difficulty using the arms and hands or legs and feet
• Sensation changes (usually of the arms and hands or legs and feet)
  • Pain, burning, tingling, or other abnormal sensations
  • Numbness or decreased sensation

Additional symptoms that may be associated with this disease:

• Swallowing difficulty
• Speech impairment
• Loss of function or feeling in the muscles
• Muscle contractions
• Muscle atrophy
• Uncoordinated movement
• Dysfunctional movement
• Joint pain
• Hoarseness or changing voice
• Fatigue
• Facial paralysis
• Bowel or bladder dysfunction
• Breathing difficulty

Signs and tests

A neurological exam shows sensory problems and weakness. Sensation problems usually occur on both sides of the body, and move from the arms and legs to the center of the body.

Reflexes are usually absent. Muscle weakness, paralysis, and loss of muscle mass may be seen. A nerve biopsy may be needed to find the cause of inflammation and rule out other nerve diseases.

A spinal tap may show high levels CSF total protein. EMG and nerve conduction tests may show that there is a loss of the myelin sheath or a wearing away of part of the nerve cell.

The selection of other tests depends on the suspected cause of the condition and may include various x-rays, imaging scans, and blood tests.

Treatment

The goal of treatment is control of symptoms. Treatment depends on how severe the symptoms are, among other things. The most aggressive treatment is usually only given if there is difficulty walking or if symptoms interfere with the ability to perform self-care or work functions.

Corticosteroids may help reduce inflammation and relieve symptoms. Other medications that suppress the immune system may also be used for some severe cases.

Plasmapheresis may benefit some patients. In this procedure, the fluid part of the blood (plasma) containing antibodies is removed from the body, and replaced with fluids or donated plasma that is antibody-free. Intravenous immune globulin (IVIg) is another effective option.

Expectations (prognosis)

The outcome varies. The disorder may be prolonged, or there may be repeated episodes of symptoms. Complete recovery is possible, but permanent loss of nerve function may also occur.

Complications

• Permanent weakness or paralysis of areas of the body
• Permanent decrease or loss of sensation in areas of the body
• Repeated or unnoticed injury to an area of the body
• Side effects of medications used to treat the disorder (see the specific medication)
• Pain

Calling your health care provider

Call your health care provider if loss of movement or sensation in any area of the body occurs. Progressive symptoms are particularly worrisome.

Review Date:9/10/2006
Reviewed By:Daniel Kantor, M.D., Director of the Comprehensive MS Center, Neuroscience Institute, University of Florida Health Science Center, Jacksonville, FL. Review provided by VeriMed Healthcare Network.

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