Early identification of 'acute-onset' chronic inflammatory demyelinating polyneuropathy

Jia Ying Sung, Jowy Tani, Susanna B. Park, Matthew C. Kiernan, Cindy Shin Yi Lin

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Distinguishing patients with acute-onset chronic inflammatory demyelinating polyneuropathy from acute inflammatory demyelinating polyneuropathy prior to relapse is often challenging at the onset of their clinical presentation. In the present study, nerve excitability tests were used in conjunction with the clinical phenotype and disease staging, to differentiate between patients with acute-onset chronic inflammatory demyelinating polyneuropathy and patients with acute inflammatory demyelinating polyneuropathy at an early stage, with the aim to better guide treatment. Clinical assessment, staging and nerve excitability tests were undertaken on patients initially fulfilling the diagnostic criteria of acute inflammatory demyelinating polyneuropathy soon after symptom onset and their initial presentation. Patients were subsequently followed up for minimum of 12 months to determine if their clinical presentations were more consistent with acute-onset chronic inflammatory demyelinating polyneuropathy. Clinical severity as evaluated by Medical Research Council sum score and Hughes functional grading scale were not significantly different between the two cohorts. There was no difference between the time of onset of initial symptoms and nerve excitability test assessment between the two cohorts nor were there significant differences in conventional nerve conduction study parameters. However, nerve excitability test profiles obtained from patients with acute inflammatory demyelinating polyneuropathy demonstrated abnormalities in the recovery cycle of excitability, including significantly reduced superexcitability (P <0.001) and prolonged relative refractory period (P <0.01), without changes in threshold electrotonus. In contrast, in patients with acute-onset chronic inflammatory demyelinating polyneuropathy, a different pattern occurred with the recovery cycle shifted downward (increased superexcitability, P <0.05; decreased subexcitability, P <0.05) and increased threshold change in threshold electrotonus in both hyperpolarizing and depolarizing directions [depolarizing threshold electrotonus (90-100 ms) P <0.005, hyperpolarizing threshold electrotonus (10-20 ms), P <0.01, hyperpolarizing threshold electrotonus (90-100 ms), P <0.05], perhaps suggesting early hyperpolarization. In addition, using excitability parameters superexcitability, subexcitability and hyperpolarizing threshold electrotonus (10-20 ms), the patients with acute inflammatory demyelinating polyneuropathy and acute-onset chronic inflammatory demyelinating polyneuropathy could be clearly separated into two non-overlapping groups. Studies of nerve excitability may be able to differentiate acute from acute-onset chronic inflammatory demyelinating polyneuropathy at an early stage. Characteristic nerve excitability parameter changes occur in early acute-onset chronic inflammatory demyelinating polyneuropathy, to match the clinical phenotype. Importantly, this pattern of change was strikingly different to that shown by patients with acute inflammatory demyelinating polyneuropathy, suggesting that nerve excitability techniques may be useful in distinguishing acute-onset chronic inflammatory demyelinating polyneuropathy from acute inflammatory demyelinating polyneuropathy at the initial stage.

Original languageEnglish
Pages (from-to)2155-2163
Number of pages9
JournalBrain
Volume137
Issue number8
DOIs
Publication statusPublished - 2014

Fingerprint

Chronic Inflammatory Demyelinating Polyradiculoneuropathy
Guillain-Barre Syndrome
Phenotype
Onset
Early Identification
Neural Conduction
Nerve
Biomedical Research
Recurrence

Keywords

  • acute inflammatory demyelinating polyneuropathy (AIDP)
  • chronic inflammatory demyelinating polyneuropathy (CIDP)
  • Guillain-Barré syndrome
  • immunotherapy
  • nerve excitability

ASJC Scopus subject areas

  • Clinical Neurology
  • Arts and Humanities (miscellaneous)

Cite this

Early identification of 'acute-onset' chronic inflammatory demyelinating polyneuropathy. / Sung, Jia Ying; Tani, Jowy; Park, Susanna B.; Kiernan, Matthew C.; Lin, Cindy Shin Yi.

In: Brain, Vol. 137, No. 8, 2014, p. 2155-2163.

Research output: Contribution to journalArticle

Sung, Jia Ying ; Tani, Jowy ; Park, Susanna B. ; Kiernan, Matthew C. ; Lin, Cindy Shin Yi. / Early identification of 'acute-onset' chronic inflammatory demyelinating polyneuropathy. In: Brain. 2014 ; Vol. 137, No. 8. pp. 2155-2163.
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