Chronic inflammatory demyelinating polyradiculoneuropathy – a narrative review
DOI:
https://doi.org/10.11606/issn.1679-9836.v100i1p57-61Keywords:
Acute inflammatory demyelinating polyneuropathy, Physiotherapy, Guillain-Barre syndromeAbstract
Introduction: Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an autoimmune disease generated by cellular and humoral immune responses, that act in a synergistic way, will act against antigens of the peripheral nerves, generating a progressive clinical feature of sensorimotor weakness that will change the quality of life of this patient. Aim: Summarize the basic and actual concepts of CIDP, such as etiology, disease subtypes, clinical features, pathogenesis, pharmacological and non-pharmacological treatment. Material and Methods: This is a narrative systematic review. Medline (Pubmed), Embase and PEDro databases were used to summarize the review’ topics. The studies used in this review were selected by convenience. Results: CIDP can affect children and adults, and male gender is the most affected. The clinical picture of CIDP is composed of numbness, paresthesia, sensory changes, muscle weakness, hyporeflexia or areflexia, fatigue and balance changes, this picture has a progressive or relapsing character, symmetrical and with slow evolution. The disease has an autoimmune character generated by cellular and humoral immune responses, which will act against peripheral nerve antigens, generating demyelination and axonal degeneration. The treatment of CIDP aims to reduce or attenuate the evolution of symptoms. The main types of treatments are the intravenous of immunoglobulins, corticosteroid, and plasma transfer administration. Conclusion: Studies exploring more deeply the pathophysiological mechanisms of CIDP and optimization of diagnosis, are important points that should be investigated to improve care and assertiveness in the treatment of these patients.
Downloads
References
Dalakas MC. Advances in the diagnosis, pathogenesis and treatment of CIDP. Nat Rev Neurol. 2011;7:507-17. doi: https://doi.org/10.1038/nrneurol.2011.121.
Mathey EK, Park SB, Hughes RAC, et al. Chronic inflammatory demyelinating polyradiculoneuropathy: from pathology to phenotype. J Neurol Neurosurg Psychiatry. 2015;86:973-85. doi: https://doi.org/10.1136/jnnp-2014-309697.
Ruts L, Drenthen J, Jacobs BC, et al. Distinguishing acute-onset CIDP from fluctuating Guillain-Barré syndrome. Neurology. 2010;74;1680-6. doi: https://doi.org/10.1212/WNL.0b013e3181e07d14.
Latov N. Diagnosis and treatment of chronic acquired demyelinating polyneuropathies. Nat Rev Neurol. 2017;117:1-12. doi: https://doi.org/10.1038/nrneurol.2014.117.
Santos PL, Almeida-Ribeiro GAN, Silva DMD, Marques-Junior W, Barreira AA. Chronic inflammatory demyelinating polyneuropathy: quality of life, sociodemographic profile and physical complaints. Arq Neuropsiquiatr 2014;72(3):179-83. doi: https://doi.org/10.1590/0004-282X20130232.
Nobile-Orazio E. Chronic inflammatory demyelinating polyradiculoneuropathy and variants: where we are and where we should go. J Peripheral Nerv Syst. 2014;19:2–13. doi: https://doi.org/10.1111/jns5.12053.
Dimachkie MM, Barohn RJ. Chronic inflammatory demyelinating polyneuropathy. Curr Treat Options Neurol. 2013;15(3):350-66. doi: https://doi.org/10.1007/s11940-013-0229-6.
Alexandrescu R, Siegert RJ, Turner-Stokes L. Functional outcomes and efficiency of rehabilitation in a national cohort of patients with Guillain–Barré syndrome and other inflammatory polyneuropathies. PLoS One. 2014;9(11):e110532. doi: https://doi.org/10.1371/journal.pone.0110532.
Hahn A. Guillain-Barré syndrome. Lancet. 1998;
352(9128):635. doi: https://doi.org/10.1016/S0140-6736(97)12308-X.
Hughes RAC, Allen D, Makowska A, Gregson NA. Pathogenesis of chronic inflammatory demyelinating polyradiculoneuropathy. J Peripheral Nerv Syst. 2006;11:30-46. doi: https://doi.org/10.1111/j.1085-9489.2006.00061.x.
Rodríguez Y, Vattib N, Ramírez-Santana C, et al. Chronic inflammatory demyelinating polyneuropathy as autoimmune disease. J Autoimmunity. 2019;102:8-37. doi: https://doi.org/10.1016/j.jaut.2019.04.021.
Chi LJ, Xu WH, Zhang ZW, et al. Distribution of Th17 cells and Th1 cells in peripheral blood and cerebrospinal fluid in chronic inflammatory demyelinating polyradiculoneuropathy. J Peripheral Nerv Syst. 2010;15:345-56. doi: 10.1111/j.1529-8027.2010.00294.x.
Mei FJ, Ishizu T, Murai H, et al. Th1 shift in CIDP versus Th2 shift in vasculitic neuropathy in CSF. J Neurol Sci. 2005;208:75-85. doi: https://doi.org/10.1016/j.jns.2004.10.001.
Hu W, Mathey E, Hartung H, et al. Cyclo-oxygenases and prostaglandins in acute inflammatory demyelination of the peripheral nerve. Neurology. 2003;61:1774-9. doi: https://doi.org/10.1212/01.wnl.0000098884.75756.4d.
Palumbo S. Pathogenesis and progression of multiple sclerosis: the role of arachidonic acid–mediated Neuroinflammation. In: Zagon IS, McLaughlin PJ, editors. Multiple sclerosis: perspectives in treatment and pathogenesis. Brisbane: Codon Publications; 2017. Chap.7, p.111-23. doi: http://dx.doi.org/10.15586/codon.multiplesclerosis.2017.ch7.
Koller H, Kieseier B, Jander S, Hartung H. Chronic inflammatory demyelinating polyneuropathy. N Engl J Med. 2005;352:1343-56. doi: 10.1056/NEJMra041347.
Reynolds J, Sachs G, Stavros K. Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP): clinical features, diagnosis, and current treatment strategies. R I Med J. 2016;32-35. Available from: http://www.rimed.org/rimedicaljournal/2016/12/2016-12-32-autoimmune-reynolds.pdf.
Riekhoff AGM, Jadoul C, Mercelis R, Cras P, Ceulemans BPGM. Childhood chronic inflammatory demyelinating polyneuroradiculopathy - three cases and a review of the literature. Eur J Pediatr Neurol. 2012;(16):315-31. doi: https://doi.org/10.1016/j.ejpn.2011.12.003.
Gorson KC. An update on the management of chronic inflammatory demyelinating polyneuropathy. Ther Adv Neurol Disord. 2012;5(6):359-73. doi: https://doi.org/10.1177/1756285612457215.
Dyck PJ, et al. A plasma exchange versus immune globulin infusion trial in chronic inflammatory demyelinating polyradiculoneuropathy. Ann Neurol. 1994;36:838-45. doi: https://doi.org/10.1002/ana.410360607.
Hahn AF, et al. Plasma-exchange therapy in chronic inflammatory demyelinating polyneuropathy. A double-blind, sham-controlled, cross-over study. Brain. 1994;119:1055-66. doi: https://doi.org/10.1093/brain/119.4.1055.
van Schaik IN, et al. Pulsed high-dose dexamethasone versus standard prednisolone treatment for chronic inflammatory demyelinating polyradiculoneuropathy (PREDICT study): a double-blind, randomized, controlled trial. Lancet Neurol. 2010;9:245-53. doi: https://doi.org/10.1016/S1474-4422(10)70021-1.
Hahn AF, Bolton CF, Zochodne D, Feasby TE. Intravenous immunoglobulin treatment in chronic inflammatory demyelinating polyneuropathy. A double blind, placebo-controlled, cross-over study. Brain. 1996;119:1067-77. doi: https://doi.org/10.1093/brain/119.4.1067.
Hadden RDM, Hughes RAC. Management of inflammatory neuropathies. J Neurol Neurosurg Psychiatry. 2003;74(Suppl II):ii9–ii14. doi: https://doi.org/10.1136/jnnp.74.suppl_2.ii9.
Oaklander AL, Lunn MPT, Hughes RAC, et al. Treatments for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP): an overview of systematic reviews. Cochrane Database Syst Rev. 2017;;1(1):CD010369. doi: 10.1002/14651858.CD010369.pub2.
Garssen MPJ, Bussmann JBJ, Schmitz PIM, et al. Physical training and fatigue, fitness, and quality of life in Guillain–Barré syndrome and CIDP. Neurology. 2004;63:2393-5. doi: https://doi.org/10.1212/01.wnl.0000148589.87107.9c.
Bussmann JB, et al. Analysing the favourable effects of physical exercise: relationships between physical fitness, fatigue and functioning in Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy. J Rehabil Med. 2007;39:121-5. doi: https://doi.org/10.2340/16501977-0007.
Downloads
Published
Issue
Section
License
Copyright (c) 2021 Revista de Medicina
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
