Chronic inflammatory demyelinating polyneuropathy. Findings in 30 patients.

Chronic demyelinating inflammatory polineuropathy (CIDP) is a disease which was recognized several years ago. However, the mechanism underlying its pa thogenesis remains poorly understood. Nevertheless, there are some clues wh ich strongly suggest that it constitutes an autoimmune disease. Since 1992 we have studied 30 cases. All them were clinically assessed and submitted t o laboratory investigations encompassing nerve conduction studies, sera pro teins immunoelectrophoresis, spinal fluid analysis and sural nerve biopsies . Upon clinical examination the usual findings were weakness, muscle atroph y, absence or diminished tendon jerks, paresthesias and hyposthesias. Elect rophysiological studies disclosed marked slowing of the nerve conduction ve locities, suggesting demyelination. Sera immunoelectrophoresis detected mon oclonal gammopathy in 17% of the studied patients, which was not associated with lymphoproliferative illnesses. Of the patients 79% had increased leve ls of spinal fluid proteins. Seventeen patients gave their consent for perf orming a sural nerve biopsy; all the samples showed demyelination. In concl ussion, we think that CDIP is a disease which can be recognized when the cl inical assessment, the nerve conduction studies and the spinal fluid findin gs suggest the diagnosis. Although nerve biopsy may be strongly suppporting , we believe that it has to be performed only if doubts arise from the clin ical, electrophysiological or spinal fluid observations. It is worth noting that its early detection may benefit the patient through the administratio n of the right therapy precluding the eventual sequelae of the disease.