High arched feet with shrinkage of muscles in the lower leg
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Current standards to diagnose CIDP do not recommend a nerve biopsy: As the skip lesions of CIDP may or may not be seen in Sural nerve biopsy. After biopsy the patient may have a sensory deficit. Which may be worse then the original disease. I have seen people who are worse off due to nerve biopsy. Dr. Katz in San Francisco has said that Leprosy may be the only reason to do a nerve biopsy.
Finding of inflammation in the nerve biopsy, is rare, definitely will confirm the diagnosis of CIDP. However, the absence of inflammation does not rule out CIDP. Findings of demyelination (loss of myelin around the nerve) on the nerve biopsy can be used to confirm the clinical presentation and suggest a diagnosis of CIDP. We find the nerve biopsy unnecessary.
For those in whom this procedure has to be done. The best technique is described by aAustrian team. Where they only remove a 10mm piece of the Sural nerve and reattach the stumps by microsurgical repair. They claim none of their patients had any complaints of pain or sensory loss.
However Massachusetts General Hospital has come off with a novel idea of doing a skin biopsy instead of a nerve biopsy. This provides more information in small fiber neuropathies and is less invasive. In the old days GBS patients were in bed for 6 months, today patients improve in a few days, due to modern treatments.
According to Dr. Jonathan Katz the best test for CIDP is to give treatment and see if the patient responds to the treatment. (This saves time and money.) Howard W. Sander, MD and Norman Latov, MD PhD have said , "although patients may not meet the diagnostic criteria for inclusion in clinical trials of CIDP, they may still benefit from current and future treatments used in CIDP". So doctors, Please, Don't follow guidelines of ANA.
If you are following ANA guidelines you will miss most of the patients with CIDP.
For long term treatment, (interferon, Cellcept, Cyclosporine, Cyclophosphamide, Methotrexate are used ) These drugs suppress the immune system. Severe immune suppression can lead to other problems (cancer). IVIg and Cyclosporine combination is described successfully in several reports. Steroids are only used for short term benefits. Some Centers are using Avonex, Enbrel, Remicade and Rituxan. From early reports all of these drugs works well, recently a novel pharmaceutical has been seen to help CIDP! These cheap drugs help many autoimmune diseases. (answer in our e-book). Many CIDP patients have healed no IVIg, no medications chronic medications. Ditto for alzheimers, ITP , arthritis, kidney disease.
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Read about misdiagnosis of CIDP
The diagnosis page provides a one minute guide how to diagnose a autoimmune disease.
The Diet page provides a easy to follow anti-inflammatory diet.
This page is about information on chronic inflammatory neuropathy.