Minimal and asymptomatic chronic inflammatory demyelinating polyneuropathy

Objectives: Show the chronic inflammatory demyelinating polyneuropathy (CID P) is not only clinically heterogeneous but extremely variable in severity. Methods: Three patients were referred for mild distal paresthesiae lasting mole than 6 months and one for inguinal and thigh pain later ascribed to co xarthrosis. Strength was normal in all patients and tactile sensation reduc ed distally only in one. Tendon jerks were absent, except the knee jerks in one patient, reduced in lower limbs in two and normal in one. Results: Electrophysiology showed a demyelinating neuropathy without motor conduction block. CSF protein content was increased in all patients. Nerve biopsies showed de-remyelination with varying degrees of axonal loss. Genet ic studies excluded a demyelinating neuropathy associated with duplication or deletion of the 17p.11.2 segment. Conclusions: CIDP patients with pure sensory clinical presentation have bee n described but are generally more severely impaired. However. because of t he mildness of symptoms and the unequivocal electrophysiological involvemen t of motor fibers, we think that in these cases the term minimal CIDP is mo re appropriate than sensory CIDP. These cases represent the most benign end of the CIDP spectrum. In our series minimal or even asymptomatic CIDP enco mpasses 8% of cases. (C) 1999 Elsevier Science Ireland Ltd. All rights rese rved.