Abstract

The diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP) mainly relies on clinical presentation and traditional nerve conduction studies. However, diagnosing CIDP with an atypical presentation remains a challenge. Availability of an additional diagnostic utility, such as the nerve excitability test (NET), can improve clinicians' ability to diagnose CIDP. In this article, we present a review of published papers on the changes in nerve excitability parameters in CIDP. Among the nerve excitability parameters, a baseline increase of the threshold current in a stimulus-response curve, decreased strength-duration time constant, and "fanning-out" pattern of the threshold electrotonus are consistently noted. The recovery cycle might show increased superexcitability and the current-voltage relationship might show inward rectification, but these changes are less consistently noted. These parameters are compatible with membrane hyperpolarization in CIDP. On longitudinal follow-up, normalization of nerve excitability parameters is noted after intravenous immunoglobulin treatment. We also report a case of acute-onset focal CIDP with a longitudinal nerve excitability study, where nerve excitability changes consistent with previous studies have enabled early diagnosis. NET may be a useful tool for clinical neurophysiologists for early diagnosis and follow-up of CIDP.

Original languageEnglish
Pages (from-to)43-49
Number of pages7
JournalJournal of Experimental and Clinical Medicine(Taiwan)
Volume6
Issue number2
DOIs
Publication statusPublished - 2014

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Chronic Inflammatory Demyelinating Polyradiculoneuropathy
Biomarkers
Early Diagnosis
Intravenous Immunoglobulins
Neural Conduction
Membranes

Keywords

  • Chronic inflammatory demyelinating polyneuropathy
  • Clinical predictor
  • Immunotherapy
  • Nerve excitability

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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title = "Nerve excitability changes in chronic inflammatory demyelinating polyneuropathy: A new clinical diagnostic biomarker",
abstract = "The diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP) mainly relies on clinical presentation and traditional nerve conduction studies. However, diagnosing CIDP with an atypical presentation remains a challenge. Availability of an additional diagnostic utility, such as the nerve excitability test (NET), can improve clinicians' ability to diagnose CIDP. In this article, we present a review of published papers on the changes in nerve excitability parameters in CIDP. Among the nerve excitability parameters, a baseline increase of the threshold current in a stimulus-response curve, decreased strength-duration time constant, and {"}fanning-out{"} pattern of the threshold electrotonus are consistently noted. The recovery cycle might show increased superexcitability and the current-voltage relationship might show inward rectification, but these changes are less consistently noted. These parameters are compatible with membrane hyperpolarization in CIDP. On longitudinal follow-up, normalization of nerve excitability parameters is noted after intravenous immunoglobulin treatment. We also report a case of acute-onset focal CIDP with a longitudinal nerve excitability study, where nerve excitability changes consistent with previous studies have enabled early diagnosis. NET may be a useful tool for clinical neurophysiologists for early diagnosis and follow-up of CIDP.",
keywords = "Chronic inflammatory demyelinating polyneuropathy, Clinical predictor, Immunotherapy, Nerve excitability",
author = "Jowy Tani and Chen, {Chin I.} and Sung, {Jia Ying}",
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T2 - A new clinical diagnostic biomarker

AU - Tani, Jowy

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N2 - The diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP) mainly relies on clinical presentation and traditional nerve conduction studies. However, diagnosing CIDP with an atypical presentation remains a challenge. Availability of an additional diagnostic utility, such as the nerve excitability test (NET), can improve clinicians' ability to diagnose CIDP. In this article, we present a review of published papers on the changes in nerve excitability parameters in CIDP. Among the nerve excitability parameters, a baseline increase of the threshold current in a stimulus-response curve, decreased strength-duration time constant, and "fanning-out" pattern of the threshold electrotonus are consistently noted. The recovery cycle might show increased superexcitability and the current-voltage relationship might show inward rectification, but these changes are less consistently noted. These parameters are compatible with membrane hyperpolarization in CIDP. On longitudinal follow-up, normalization of nerve excitability parameters is noted after intravenous immunoglobulin treatment. We also report a case of acute-onset focal CIDP with a longitudinal nerve excitability study, where nerve excitability changes consistent with previous studies have enabled early diagnosis. NET may be a useful tool for clinical neurophysiologists for early diagnosis and follow-up of CIDP.

AB - The diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP) mainly relies on clinical presentation and traditional nerve conduction studies. However, diagnosing CIDP with an atypical presentation remains a challenge. Availability of an additional diagnostic utility, such as the nerve excitability test (NET), can improve clinicians' ability to diagnose CIDP. In this article, we present a review of published papers on the changes in nerve excitability parameters in CIDP. Among the nerve excitability parameters, a baseline increase of the threshold current in a stimulus-response curve, decreased strength-duration time constant, and "fanning-out" pattern of the threshold electrotonus are consistently noted. The recovery cycle might show increased superexcitability and the current-voltage relationship might show inward rectification, but these changes are less consistently noted. These parameters are compatible with membrane hyperpolarization in CIDP. On longitudinal follow-up, normalization of nerve excitability parameters is noted after intravenous immunoglobulin treatment. We also report a case of acute-onset focal CIDP with a longitudinal nerve excitability study, where nerve excitability changes consistent with previous studies have enabled early diagnosis. NET may be a useful tool for clinical neurophysiologists for early diagnosis and follow-up of CIDP.

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