Chronic inflammatory polyneuropathy
Chronic inflammatory polyneuropathy involves nerve swelling and irritation (inflammation) that leads to a loss of strength or sensation.
Polyneuropathy - chronic inflammatory; CIDP; Chronic inflammatory demyelinating polyneuropathy
Chronic inflammatory polyneuropathy is one cause of damage to nerves outside the brain or spinal cord (peripheral neuropathy). Polyneuropathy means several nerves are involved. It usually affects both sides of the body equally.
Chronic inflammatory demyelinating polyneuropathy (CIDP) is the most common chronic neuropathy caused by an abnormal immune response. CIDP occurs when the immune system attacks the myelin cover of the nerves.
The cause of chronic inflammatory polyneuropathy is an abnormal immune response. The specific triggers vary. In many cases, the cause cannot be identified.
It may occur with other conditions, such as:
- Autoimmune disorders
- Chronic hepatitis
- Inflammatory bowel disease
- Systemic lupus erythematosus
- Paraneoplastic syndrome
- Side effects of medicines to treat cancer or HIV
- Difficulty walking due to weakness or trouble feeling your feet
- Difficulty using the arms and hands or legs and feet due to weakness
- Sensation changes, such as numbness or decreased sensation, pain, burning, tingling, or other abnormal sensations (usually affects the feet first, then the arms and hands)
- Weakness, usually in the arms and hands or legs and feet
Other symptoms that can occur with this disease:
- Abnormal movement
- Breathing difficulty
- Hoarseness or changing voice
- Loss of function or feeling in the muscles
- Muscle atrophy
- Muscle contractions
- Speech impairment
- Swallowing difficulty
- Uncoordinated movement
Exams and Tests
The doctor will examine you and ask questions about your medical history. The physical exam shows:
- Loss of muscle mass
- No reflexes
- Muscle weakness or paralysis
- Sensation problems on both sides of the body
Tests may include:
- Electromyography (EMG)
- Nerve conduction tests
- Nerve biopsy
- Spinal tap
- Blood tests may be done to look for specific proteins that are causing the immune attack on the nerves
Which other tests are done depends on the suspected cause of the condition. Tests may include x-rays, imaging scans, and blood tests.
The goal of treatment is to reverse the attack on the nerves. In some cases, nerves can heal and their function can be restored. In other cases, nerves are badly damaged and cannot heal, so treatment is aimed at preventing the disease from getting worse.
Which treatment is given depends on how severe the symptoms are, among other things. The most aggressive treatment is usually only given if you have difficulty walking or if symptoms interfere with your ability to care for yourself or perform work functions.
Treatments may include:
- Corticosteroids to help reduce inflammation and relieve symptoms
- Other medications that suppress the immune system (for some severe cases)
- Plasmapheresis or plasma exchange to remove antibodies from the blood
- Intravenous immune globulin (IVIg), which involves adding large numbers of antibodies to the blood plasma to reduce the effect of the antibodies that are causing the problem
The outcome varies. The disorder may continue long term, or you may have repeated episodes of symptoms. Complete recovery is possible, but permanent loss of nerve function is not uncommon.
- Permanent decrease or loss of sensation in areas of the body
- Permanent weakness or paralysis in areas of the body
- Repeated or unnoticed injury to an area of the body
- Side effects of medications used to treat the disorder
When to Contact a Medical Professional
Call your health care provider if you have a loss of movement or sensation in any area of the body, especially if your symptoms get worse.
Katirji B, Koontz D. Disorders of peripheral nerves. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 76.
Shy ME. Peripheral neuropathies. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 428.
Reviewed By: Joseph V. Campellone, MD, Department of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.