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Vialatte de Pémille C, Noël N, Adam C, Labeyrie C, Not A, Beaudonnet G, Echaniz-Laguna A, Adams D, Cauquil C. Red Flags for Chronic Inflammatory Demyelinating Polyradiculoneuropathy Associated with Sarcoidosis or Connective Tissue Diseases. J Clin Med 2023; 12:jcm12093281. [PMID: 37176720 PMCID: PMC10179067 DOI: 10.3390/jcm12093281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/21/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023] Open
Abstract
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a rare autoimmune disorder of the peripheral nervous system. Diagnosis relies on clinical and electrophysiological criteria. Various disorders requiring specific treatment regimens may be associated with CIDP, including sarcoidosis (SAR-CIDP) and connective tissue disease (CTD-CIDP). Therefore, it is important to distinguish between CIDP, SAR-CIDP and CTD-CIDP. In this retrospective monocentric study, we analyzed 16 patients with SAR-CIDP and 11 with CTD-CIDP and compared them with a group of 17 patients with idiopathic CIDP. SAR-CIDP patients had a frequently acute or subacute CIDP onset. CTD-CIDPs were mostly Sjögren's syndrome and lupus, and patients had a chronic onset. An older age at onset (64.5 vs. 54 years, p = 0.04), more atypical presentation (19/25 (76%) vs. 6/17 (35%), p = 0.008), acute/subacute onset of symptoms (15/25 (60%) vs. 1/17 (6%), p = 0.0004) and more frequent weight loss (7/16 (44%) vs. 0/17 (0%), p = 0.017) were identified SAR-CIDP and CTD-CIDP groups. Response to intravenous immunoglobulin therapy was lower in the combined SAR-CIDP and CTD-CIDP group (44% versus 82%, p = 0.005). As sarcoidosis and CTDs might be associated with CIDP and require specific management, the "red flags" mentioned above should be kept in mind by clinicians managing patients with CIDP.
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Affiliation(s)
| | - Nicolas Noël
- Internal Medicine Departement, CHU de Bicêtre, 78 Rue du General Leclerc, 94270 Le Kremlin Bicetre, France
- Faculty of Medicine, Paris Saclay University, 63 Rue Gabriel Peri, 94270 Le Kremlin Bicetre, France
| | - Clovis Adam
- Pathology Laboratory, CHU de Bicêtre, 78 Rue du General Leclerc, 94270 Le Kremlin Bicetre, France
| | - Céline Labeyrie
- Neurology Department, AP-HP, CHU de Bicêtre, 78 Rue du General Leclerc, 94270 Le Kremlin Bicetre, France
- French National Reference Center for Rare Neuropathies (NNERF), CHU de Bicêtre, 78 Rue du General Leclerc, 94275 Le Kremlin Bicetre, France
| | - Adeline Not
- Neurology Department, AP-HP, CHU de Bicêtre, 78 Rue du General Leclerc, 94270 Le Kremlin Bicetre, France
- French National Reference Center for Rare Neuropathies (NNERF), CHU de Bicêtre, 78 Rue du General Leclerc, 94275 Le Kremlin Bicetre, France
| | - Guillemette Beaudonnet
- Neurology Department, AP-HP, CHU de Bicêtre, 78 Rue du General Leclerc, 94270 Le Kremlin Bicetre, France
- French National Reference Center for Rare Neuropathies (NNERF), CHU de Bicêtre, 78 Rue du General Leclerc, 94275 Le Kremlin Bicetre, France
- Neurophysiology Department, AP-HP, CHU de Bicêtre, 78 Rue du General Leclerc, 94270 Le Kremlin Bicetre, France
| | - Andoni Echaniz-Laguna
- Neurology Department, AP-HP, CHU de Bicêtre, 78 Rue du General Leclerc, 94270 Le Kremlin Bicetre, France
- Faculty of Medicine, Paris Saclay University, 63 Rue Gabriel Peri, 94270 Le Kremlin Bicetre, France
- French National Reference Center for Rare Neuropathies (NNERF), CHU de Bicêtre, 78 Rue du General Leclerc, 94275 Le Kremlin Bicetre, France
- INSERM U1195, Paris Saclay University, 94276 Le Kremlin Bicetre, France
| | - David Adams
- Neurology Department, AP-HP, CHU de Bicêtre, 78 Rue du General Leclerc, 94270 Le Kremlin Bicetre, France
- Faculty of Medicine, Paris Saclay University, 63 Rue Gabriel Peri, 94270 Le Kremlin Bicetre, France
- French National Reference Center for Rare Neuropathies (NNERF), CHU de Bicêtre, 78 Rue du General Leclerc, 94275 Le Kremlin Bicetre, France
- INSERM U1195, Paris Saclay University, 94276 Le Kremlin Bicetre, France
| | - Cécile Cauquil
- Neurology Department, AP-HP, CHU de Bicêtre, 78 Rue du General Leclerc, 94270 Le Kremlin Bicetre, France
- French National Reference Center for Rare Neuropathies (NNERF), CHU de Bicêtre, 78 Rue du General Leclerc, 94275 Le Kremlin Bicetre, France
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Recommendations on diagnostic strategies for chronic inflammatory demyelinating polyradiculoneuropathy. J Neurol Neurosurg Psychiatry 2008; 84:378-81. [PMID: 18202204 DOI: 10.1136/jnnp.2006.109785] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an immune mediated treatable peripheral neuropathy, the diagnosis of which is straightforward in more than half of cases. Numerous sets of electrophysiological criteria have been published. However, in some cases, electrophysiological data are not sufficient and patients that may benefit from treatment escape accurate diagnosis. OBJECTIVE To describe a step by step diagnostic procedure for neurologists facing a peripheral neuropathy of undetermined cause, to help make an accurate diagnosis of CIDP. METHODS A group of French experts was established, neurologists and neurophysiologists being recruited on the basis of personal experience with patients suffering from CIDP and also on publications in the field. A full literature review was conducted on the topic of diagnostic criteria and procedures for the diagnosis of CIDP, and meetings were scheduled to reach a consensus on the best diagnostic workup in different clinical situations. RESULTS Six meetings were conducted and a consensus was reached, based on the available literature and experience in the management of such patients. Discussions resulted in defining five clinical situations in which a diagnosis of CIDP may be considered, and procedures were detailed in each case, including the location of nerve biopsy and use of non-conventional electrophysiological testing and imaging procedures. CONCLUSION The guidelines in the diagnostic procedure reported here result from a consensus of French experts in the field of peripheral neuropathy and allow a diagnosis of CIDP to be made in the most frequently encountered situations. These recommendations may be of value for physicians as they rely on the rational use of available techniques in typical clinical situations.
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Servioli L, Pérez C, Consani S, Suárez A, Sehabiaga G, Collazo C, Catalá G. Prevalence and characteristics of immunomediated neuropathies in a group of patients with autoimmune diseases. J Clin Neuromuscul Dis 2007; 9:285-290. [PMID: 18090680 DOI: 10.1097/cnd.0b013e318157614b] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To determine the prevalence and the clinical-neurophysiological characteristics of immunomediated peripheral neuropathies (PN) in a group of patients with systemic autoimmune diseases. METHOD Fifty-nine patients with proved systemic autoimmune diseases were included. Patients underwent clinical examination and nerve conduction studies to diagnose the PN. RESULTS Immune PNs were detected in 18 patients (30.5%). Out of the total number of PNs (18), 39% were sensory-motor polyneuropathies, 33% mononeuritis multiplex, 11% pure sensory polyneuropathies, 11% cranial neuropathies, and 6% proximal motor neuropathies, such as the Guillain-Barré syndrome. Nine PNs (50%) appeared at the onset of the connective tissue disorders, and the rest of the cases appeared during the course of the disease. Of the total of PNs detected in this study, only 45% had a previous diagnosis. Vasculitis was the disease that presented more associated PNs. Systemic lupus erythematosus showed the widest range of PN clinical varieties. CONCLUSIONS The first national prevalence rate of PNs in patients with systemic autoimmune diseases was provided: 30.5%. No comparative data were found in the international bibliography. Sensory-motor polyneuropathy was the most frequently observed form of PN, followed by mononeuritis multiplex. The NPs appeared with the same frequency both at the onset and during the course of the diseases under study; these predominated at the onset of vasculitis and primary Sjögren syndrome. The compromise of the peripheral nervous system is underdiagnosed.
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Affiliation(s)
- Luisa Servioli
- Autoimmune Diseases Unit, Department of Internal Medicine, Medical Clinic "1", Montevideo, Uruguay.
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Antoine JC, Azulay JP, Bouche P, Créange A, Fournier E, Gallouedec G, Lagueny A, Lefaucheur JP, Léger JM, Magy L, Maisonobe T, Nicolas G, Pouget J, Soichot P, Stojkovic T, Vallat JM, Verschueren A, Vial C, Viala K. Polyradiculonévrites inflammatoires démyélinisantes chroniques : stratégie diagnostique. Rev Neurol (Paris) 2005; 161:988-96. [PMID: 16365632 DOI: 10.1016/s0035-3787(05)85166-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) comprises a group of dysimmune neuropathies easily diagnosed in more than half of the patients. Diagnosis is based on clinical, electrophysiological and biological clues. In some patients, diagnosis is unclear because of the debated value of the available clues. In such circumstances, dysimmune neuropathies may not be diagnosed, leading to insufficient treatment. This is an important category of patients because immunomodulatory drugs have proven efficacy. The CIDP spectrum includes a relatively wide range of diseases. Besides the easily recognized classic forms, there are many clinical variants, sometimes with a paucisymptomatic presentation leading to uncertain diagnosis. The French CIDP study group has established guidelines for diagnostic strategy in CIDP patients. The first part of this paper is devoted to the clinical aspects of the disease, classical forms and variants. In the second part, the results of electrophysiological studies are reported. In a third chapter, complementary examinations useful for diagnosis are discussed. The fourth chapter deals with the diagnostic strategy, discussed in relation to the different situations which may be encountered in clinical practice. details the technical modalities of appropriate electrophysiological studies and presents normal results together with those indicating demyelinating neuropathy. Nerve biopsy technique and results are given in appendix II.
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Affiliation(s)
- J C Antoine
- Service et Laboratoire de Neurologie, CHU Dupuytren, Limoges
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