Welcome to the diagnosis page of CIDPUSA 

 Diagnosis of autoimmune diseases is simple. These diseases present with complaints of fatigue, tiredness, weakness, pain, stress, anger which often comes in cycles (remits and relapses) or (waxes and wanes). If your disease comes in cycles which are days, weeks, months apart then you have a autoimmune disease process.  The autoimmune diseases are associated  with a  elevated SED rate or ESR. (Sed Rate is a simple blood test which measures inflammation). C-reactive protein (CRP) is a more sophisticated blood test which also is used to measure inflammation, CRP will also be elevated in autoimmune diseases. However in my personnel experience sedimentation rate is a cost effective test as compared to CRP for mass screening and disease follow up.

 Some Fibromyalgia patients will present with pain only on the left side of the body and in a similar way early Parkinson will only affect the left side of the body. All the diseases are immune mediated and if you follow the disease pattern you can diagnose and treat the disease on the first visit without any tests or procedures.

The human body is the most sensitive machine and I can just see and diagnose most diseases. To me it looks like the diagnosis is written on the face of the patient. I sense the disease, you can too if you try. Don't depend on diagnostic tests. Most diseases will not show up on the tests. Lets take the case of Fibromyalgia, the only test I have seen come back positive in this diseases is IgG sub class deficiency. But in reality the diagnosis can be seen as a anxious look on the patients face who is begging for a diagnosis. Feel with your fingers and feel the pain, if the patient has a headache then feel the scalp and if the scalp is tender then two things should come to mind either it is a vasculitis like Temporal arteritis or it is a case of Myofacial pain/ Fibromyalgia.

I see patients from USA and UK who have seen a orthopedic surgeons for their weak knees and have had several endoscopies, MRI, CT scans, yet their disease  remains a mystery. I frequently ask them did the doctor examine the knee with is hands, you can feel the swelling, the warmth and the speed bumps of myofacial pain.  The most common cause of knee pain is Statins.

CIDPUSA  has published its extensive research in the autoimmune diseases E-BOOK which contains treatment of Alzheimer's, CIDP, neuropathies, Pemphigus, acne, alopecia , every type of arthritis, psychiatric disorders and many more by simple antibiotics. Save your money and purchase this book online today 24 hour delivery to your email. Check this offer on our home page.  Hundreds of satisfied patients worldwide. Remember this is true research by university doctors and not the research that you see in the news supported by Big Pharma.

 In CIDP, patients usually present with a history of weakness, numbness, pain and difficulty in walking. Some patients may have a sudden onset of back pain or neck pain radiating down the extremities. This pain is usually diagnosed as radicular pain (radiating pain or going down). The symptoms of CIDP are usually progressive and may come and go. The patients have difficulty climbing stairs and use their hands to pull themselves upstairs.

On examination the patients may have weakness in hips and shoulders, loss of  deep tendon reflexes (rarely increased or normal).

There may be atrophy (shrinkage) of muscles, fasciculation's (twitching) and loss of sensation in the feet and hands.

Some patients present with  ALS (Lou Gehrig's Disease ) like clinical picture. Who have MMF (Multi-Focal Motor neuropathy. As these patients have no sensory loss, but just weakness. These conditions are fully reversible.

The patients may present with a single cranial nerve or peripheral nerve dysfunction. For example, double vision, loss of hearing, ringing in the ear, face dropping on one side, hoarseness, facial pain. They can have weak hand grip, numbness in the hands or feet. Pain in the neck or back .

They may present with abdominal pains, fainting spells while standing up. Burning pain in extremities.

Laboratory findings for CIDP or Polyneuropathy

The major laboratory tests for CIDP are electrophysiologic studies, CSF examination, and nerve biopsy.

Electrophysiological Tests consist of two parts.

• EMG  or Electro-Myo-Graphy is  a test where a electrical needle is placed in a muscle to record its electrical activity. It is used to differentiate other causes of muscle weakness, such as myopathy (inflammation of muscle), axonal neuropathies (Dysfunction in the center of the nerve) and disorders of neuromuscular transmission (dysfunction at the place where a nerve connects to a muscle) seen in Myasthenia.

   NCV  is a Nerve-conduction-Velocity is the second part of the Electrophysiological Test. In NCV a nerve is shocked by a electrical current  and the time this current takes to reach a second point is measured. If the speed of this measured electrical conduction is slow, then the nerve conduction studies show demyelination or CIDP. If the speed is slightly slow then a axonal neuropathy is considered which may be due to vitamin deficiency.

  Some of the NCV findings include: (see this link for EMG findings in CIDP)

  (a) a slowing in the nerve conduction velocities ; (meaning that the Myelin around a nerve is damaged or rarely the axon is affected)

  (b) the presence of conduction block or abnormal temporal dispersion in at least one motor nerve (meaning no or little electrical current is transmitted in the nerve). Is seen in Mutli Focal Motor Neuropathy.

  (c) prolonged distal latencies in at least two nerves; (means that it takes a long time for the current to get past the ends of the shocked nerve) This portion is a good way to measure for carpal tunnel syndrome. At CIDPUSA we believe CTS is due to the inflammation of a nerve and does not need surgery.

  (d) This F wave is a stimulation of the nerve in the opposite direction, towards the spin and the distance from the spine back to the nerve is measured. F wave will be absent in Diabetic Amyotrophy or swelling of the spinal discs causing inflammation on the nerve. Absent F waves or prolonged minimum F wave latencies in at least two motor nerves is a rule in CIDP diagnosis. Or that a F wave is not seen in these patients.

  (In some case EMG/NCV can be normal). EMG does not tell what is the cause of your disease, it can only locate the site of the damage.

   

• CSF Examination:  Cerebro Spinal Fuid is the fluid that bathes your brain and spinal cord. Cytoalbuminologic dissociation (means elevated CSF protein >45 in the absence of a high cell count <10) is characteristic of CIDP & GBS. CSF pleocytosis (excess of white cells) is rare except in HIV-associated CIDP. An elevated IgG index and IgG synthesis rate is consistent with the immune-related nature of CIDP.

                        Dr. Imran Khan Nanotech Neurology Lahore

Not all the patients will have lab abnormalities. In many the EMG/NCV findings will not show that they have CIDP yet they will still have the disease.

The clinical profile of chronic inflammatory demyelinating polyneuropathy (CIDP) is variable. Nerve conduction studies are essential for the diagnosis of CIDP; however, current electrophysiologic criteria for CIDP may not be sensitive. These authors analyzed results of nerve conduction studies and nerve biopsies in 8 patients with CIDP who did not fulfill standard electrophysiologic criteria (of 44 patients with CIDP confirmed by nerve histology). Two standard electrophysiologic criteria were used: one proposed by an ad hoc committee of the AAN (Neurology 1991; 41:617) and another by the Inflammatory Neuropathy Cause and Treatment Group (Ann Neurol 2001; 50:195).

The main electrophysiologic abnormalities were those of simple axonopathy in 7 patients; the other patient had almost normal electrophysiologic results. In contrast, examination of nerve biopsies in all 8 patients revealed substantial loss of myelinated fibers; in addition, frequent histologic findings were naked axons, thinly myelinated fibers, and various degrees of onion bulbs. These histology findings were identical to those of the 36 other CIDP patients. The authors conclude that many patients with unrecognized CIDP are erroneously classified by electrodiagnosis as having chronic axonal neuropathy and that nerve biopsy should be considered to further investigate a chronic idiopathic neuropathy.

    Click to view different size nerve fibers.

                                   Pathalogy in CIDP and autoimmune diseases