Diabetes Cipd

ABSTRACT: This retrospective analysis was undertaken to determine whether a subset of diabetic patients with demyelinating polyneuropathy were similar to patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Ten patients meeting the clinical criteria for idiopathic CIDP were compared to nine patients with diabetes and demyelinating polyneuropathy. The diabetic patientswith demyelinating polyneuropathy displayed clinical, electrophysiologic, and histologic features that were similar to those in CIDP patients. All six patients with diabetes and demyelinating polyneuropathy who were treated with immunomodulatory therapy showed a favorable response. Our study highlights the importance of investigating diabetic patients with polyneuropathy in an attempt to identifypatients with demyelinating polyneuropathy, because of the likelihood of benefit in these patients from immunomodulatory treatment.
Muscle Nerve 27: 465– 470, 2003

CHRONIC INFLAMMATORY DEMYELINATING POLYRADICULONEUROPATHY IN DIABETIC PATIENTS
RIZWAN U. HAQ, MD,1 WILLIAM W. PENDLEBURY, MD1,2 TIMOTHY J. FRIES, MD,1 and RUP TANDAN, MD, FRCP1
1

Department of Neurology, C 225 Given Building,University of Vermont College of Medicine, Burlington, Vermont 05405, USA 2 Department of Pathology (Section of Neuropathology), University of Vermont College of Medicine, Burlington, Vermont, USA Accepted 17 December 2002

mellitus is the most common cause of peripheral neuropathy in industrialized countries. Diabetic peripheral neuropathies have been categorized into a number of different clinicaltypes.9,34 The proposed pathophysiologic factors are nerve ischemia,30,32,35 metabolic derangements of nerves,10,23 and immune and inflammatory mechanisms.31 Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an immune-mediated disorder for which specific clinical,1,15,16 cerebrospinal fluid (CSF),1,16 electrophysiologic,1,3,5 and histologic criteria1 have been proposed. AlthoughCIDP in diabetic patients has been described previously,17,20,28,29,33 there is controversy over whether the clinical,17 CSF,18,19 electrodiagnostic,6,11,33 and histologic33 features distinguish between CIDP and diabetic polyneuropathy.
Abbreviations: AAN, American Academy of Neurology; CIDP, chronic inflammatory demyelinating polyradiculoneuropathy; CMAP, compound muscle action potential; CSF,cerebrospinal fluid Key words: chronic inflammatory demyelinating polyradiculoneuropathy; diabetes; electrophysiology; immunomodulatory therapy; nerve biopsy Correspondence to: R. Tandan; e-mail: Rup.Tandan@uvm.edu © 2003 Wiley Periodicals, Inc.

Diabetes

We performed a retrospective analysis of patients with CIDP and diabetic patients with demyelinating polyneuropathy. The objective of this studywas to determine whether a subset of diabetic patients with demyelinating polyneuropathy were similar to patients with CIDP employing proposed electrodiagnostic and histologic criteria for CIDP. The electrodiagnostic criteria were those of Albers and Kelly,3 the Ad Hoc Subcommittee of the American Academy of Neurology AIDS Task Force (AAN),l and Barohn et al.,5 and the histologic criteria werethose of the AAN.1 Identification of a subset of diabetic patients with demyelinating polyneuropathy showing features of CIDP would isolate a subgroup of patients who might benefit from immunomodulatory therapy.
MATERIALS AND METHODS Patient Selection.

We undertook a medical record review of all patients with a clinical and electrophysiologic diagnosis of polyneuropathy at our medical center between1983 and 1997. From this group, we identified 10 patients (group 1) who met the clinical criteria for the diagnosis of CIDP and fulfilled at least one set of proposed electrodiagnostic criteria

CIDP in Diabetes

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for demyelination.1,3,5 The clinical criteria for the diagnosis were a modification of those of Dyck et al.,15 and included symmetrical distal...