TY - JOUR
T1 - Atypical CIDP: Diagnostic criteria, progression and treatment response. Data from the Italian CIDP Database
AU - Doneddu, Pietro Emiliano
AU - Cocito, Dario
AU - Manganelli, Fiore
AU - Fazio, Raffaella
AU - Briani, Chiara
AU - Filosto, Massimiliano
AU - Benedetti, Luana
AU - Mazzeo, Anna
AU - Marfia, Girolama Alessandra
AU - Cortese, Andrea
AU - Fierro, Brigida
AU - Jann, Stefano
AU - Beghi, Ettore
AU - Clerici, Angelo Maurizio
AU - Carpo, Marinella
AU - Schenone, Angelo
AU - Luigetti, Marco
AU - Lauria, Giuseppe
AU - Antonini, Giovanni
AU - Rosso, Tiziana
AU - Siciliano, Gabriele
AU - Cavaletti, Guido
AU - Liberatore, Giuseppe
AU - Santoro, Lucio
AU - Peci, Erdita
AU - Tronci, Stefano
AU - Ruiz, Marta
AU - Cotti Piccinelli, Stefano
AU - Toscano, Antonio
AU - Mataluni, Giorgia
AU - Piccolo, Laura
AU - Cosentino, Giuseppe
AU - Sabatelli, Mario
AU - Nobile-Orazio, Eduardo
PY - 2019
Y1 - 2019
N2 - Objectives A few variants of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) have been described, but their frequency and evolution to typical CIDP remain unclear. To determine the frequency and characteristics of the CIDP variants, their possible evolution to typical CIDP, and treatment response. Methods We applied a set of diagnostic criteria to 460 patients included in a database of Italian patients with CIDP. Clinical characteristics and treatment response were reviewed for each patient. The Kaplan-Meier curve was used to estimate the progression rate from atypical to typical CIDP. Results At the time of inclusion, 376 (82%) patients had a diagnosis of typical CIDP while 84 (18%) had atypical CIDP, including 34 (7%) with distal acquired demyelinating symmetric neuropathy (DADS), 17 (4%) with purely motor, 17 (4%) with Lewis-Sumner syndrome (LSS) and 16 (3.5%) with purely sensory CIDP. Based on retrospective review of the symptoms and signs present at onset and for at least 1 year, 180 (39%) patients had an initial diagnosis compatible with atypical CIDP that in 96 (53%) patients evolved to typical CIDP. Mean disease duration was longer in patients evolving to typical CIDP than in those not evolving (p=0.0016). Patients with DADS and LSS had a less frequent response to immunoglobulin than those with typical CIDP, while patients with purely motor and sensory CIDP had a similar treatment response. Conclusions The proportion of patients with atypical CIDP varies during the disease course. DADS and LSS have a less frequent response to intravenous immunoglobulin compared with typical CIDP, raising the possibility of a different underlying pathogenetic mechanism.
AB - Objectives A few variants of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) have been described, but their frequency and evolution to typical CIDP remain unclear. To determine the frequency and characteristics of the CIDP variants, their possible evolution to typical CIDP, and treatment response. Methods We applied a set of diagnostic criteria to 460 patients included in a database of Italian patients with CIDP. Clinical characteristics and treatment response were reviewed for each patient. The Kaplan-Meier curve was used to estimate the progression rate from atypical to typical CIDP. Results At the time of inclusion, 376 (82%) patients had a diagnosis of typical CIDP while 84 (18%) had atypical CIDP, including 34 (7%) with distal acquired demyelinating symmetric neuropathy (DADS), 17 (4%) with purely motor, 17 (4%) with Lewis-Sumner syndrome (LSS) and 16 (3.5%) with purely sensory CIDP. Based on retrospective review of the symptoms and signs present at onset and for at least 1 year, 180 (39%) patients had an initial diagnosis compatible with atypical CIDP that in 96 (53%) patients evolved to typical CIDP. Mean disease duration was longer in patients evolving to typical CIDP than in those not evolving (p=0.0016). Patients with DADS and LSS had a less frequent response to immunoglobulin than those with typical CIDP, while patients with purely motor and sensory CIDP had a similar treatment response. Conclusions The proportion of patients with atypical CIDP varies during the disease course. DADS and LSS have a less frequent response to intravenous immunoglobulin compared with typical CIDP, raising the possibility of a different underlying pathogenetic mechanism.
KW - CIDP
KW - Neurology (clinical)
KW - Psychiatry and Mental Health
KW - Surgery
KW - chronic inflammatory demyelinating polyradiculoneuropathy
KW - diagnostic criteria
KW - distal acquired demyelinating symmetric neuropathy
KW - lewis-sumner syndrome
KW - CIDP
KW - Neurology (clinical)
KW - Psychiatry and Mental Health
KW - Surgery
KW - chronic inflammatory demyelinating polyradiculoneuropathy
KW - diagnostic criteria
KW - distal acquired demyelinating symmetric neuropathy
KW - lewis-sumner syndrome
UR - http://hdl.handle.net/10807/130826
UR - http://jnnp.bmj.com/
U2 - 10.1136/jnnp-2018-318714
DO - 10.1136/jnnp-2018-318714
M3 - Article
SN - 0022-3050
VL - 90
SP - 125
EP - 132
JO - Journal of Neurology, Neurosurgery and Psychiatry
JF - Journal of Neurology, Neurosurgery and Psychiatry
ER -