What is Chronic Inflammatory Demyelinating Polyneuropathy?
Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)
Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare disorder of the nervous system in which the immune system attacks the peripheral nerves.
For reasons that are still not well understood, the immune system mistakenly attacks myelin, the protective coating that insulates nerve fibers. When myelin is damaged, signals between the body and the brain slow down or break down, causing both movement and sensory symptoms.
Without treatment, CIDP can cause permanent nerve damage. If you develop weakness that worsens quickly over days, or any trouble breathing or swallowing, seek emergency care right away.
How Common Is CIDP?
CIDP is rare, affecting an estimated 1.9 to 7.7 people per 100,000. It can affect anyone, but it is most common after age 50 and about twice as common in men as in women (28).
What Causes CIDP?
Healthy peripheral nerve fibers are wrapped in myelin. This insulation lets electrical signals travel quickly and efficiently along the nerve. Myelin also helps protect the nerve. When myelin breaks down, the nerve fibers underneath become more vulnerable to damage.
CIDP is an autoimmune condition, meaning the immune system mistakenly treats myelin as something foreign and attacks it. Several different conditions that disrupt the immune system can trigger CIDP. Over time, the immune attack on myelin can also damage the nerve fibers themselves.
The most common nerve problem in people with diabetes is diabetic peripheral neuropathy. However, people with diabetes can also develop inflammatory neuropathies, and CIDP is the most common and most treatable of these. Whether diabetes raises the risk of CIDP is still debated.
What Are the Symptoms of CIDP?
CIDP can cause gradually worsening weakness and loss of feeling in the arms and legs. It often affects muscles both close to the body, like the hips and shoulders, and farther away, like the hands and feet. Reflexes are often reduced or absent in all four limbs. Other symptoms can include numbness and tingling that start in the toes and fingers, and ongoing fatigue.
CIDP may come and go in episodes, but it is often progressive and can spread to involve more of the body. Walking and balance can become difficult, and some people living with CIDP become disabled. CIDP can significantly affect quality of life (27).
How Is CIDP Diagnosed?
CIDP is diagnosed by a neurologist based on symptoms and testing. Symptoms may include numbness, loss of sensation, tingling or pain, along with reduced reflexes, limb weakness, trouble walking or foot drop.
Nerve conduction studies are considered essential for a definite diagnosis, and electromyography usually shows a pattern of myelin damage. Nerve ultrasound and MRI can also help. A spinal fluid test often shows elevated protein with a normal cell count, and blood and urine tests help rule out other causes of neuropathy. Typical CIDP is relatively easy to diagnose, but less common forms can be a challenge (7).
How Does CIDP Affect the Brain?
Research shows that CIDP is not always limited to the peripheral nerves. Visual and auditory evoked potential tests measure how quickly signals from the eyes and ears travel through the brain. Studies have found these signals can be delayed in CIDP, and the delay tends to be greater in people with more peripheral nerve damage (8).
In some people with CIDP, the immune attack can also affect myelin in the brain and spinal cord, similar to what happens in multiple sclerosis (MS). Brain lesions like those seen in MS have been reported in some patients with CIDP, and these areas of damage can affect many types of brain function (4).
In one study of people with suspected combined central and peripheral demyelinating disease, 74% had signs of peripheral nerve demyelination, and 46% had brain MRI findings that met criteria for MS. This suggests that current diagnostic criteria for MS and CIDP may not capture the full range of these conditions (9).
How Is CIDP Usually Treated?
Early diagnosis and treatment, before severe nerve damage occurs, make a major difference in CIDP. Unfortunately, many people aren’t diagnosed until symptoms have been present for weeks to months, when significant nerve damage may already have happened.
CIDP is treated with therapies that calm the immune attack, such as corticosteroids, intravenous immunoglobulin (IVIG) and plasma exchange. These are effective, but many people need maintenance treatment for years, with doses carefully monitored and adjusted by their neurologist (7). The earlier treatment begins, the better the outcome tends to be.
How the NeuroRescue Program Can Help
Our first priority is your safety. When we evaluate people with peripheral neuropathy, we look for signs that could point to CIDP. If we suspect CIDP, we’ll refer you promptly for diagnostic testing and coordinate with your care team so that treatment can begin as quickly as possible. Research shows that early immune-modulating treatment can be very effective in CIDP (2).
Many people with CIDP need long-term medication to control their immune system. These medications are essential, and our care is never meant to replace them. Please don’t change any medication without talking with your neurologist.
Supporting overall health. Alongside your medical treatment, we may look at other factors that can affect immune health. Vitamin D status appears to matter in autoimmune neuropathies (11), and researchers are studying the roles of diet (10), gut health (12) and the antioxidant glutathione (13) in autoimmune disease. Early research, mostly in the lab and in animals, has also explored compounds like curcumin (14), resveratrol (15) and other plant flavonoids (16) for calming immune responses. When appropriate, we may recommend diet changes or supplements, and we’ll coordinate any recommendations with your neurologist.
Balance and fall prevention. Once your immune system is stable, we address both the peripheral and central effects of CIDP. Loss of nerve function can make walking and balance difficult. Studies show that people with CIDP tend to spend more time on both feet while walking, take shorter steps, and walk less consistently, which can make them unsteady and more likely to fall (17). People with other types of neuropathy often slow down and reduce trunk sway to stay stable, but people with CIDP may not be able to use this strategy as well, likely because of greater damage to motor nerves (18).
Balance depends not only on the nerves in your legs, but also on your inner ear and vision. Studies have found reduced vestibular function in some people with CIDP, sometimes severely (19). When CIDP also affects the brain and spinal cord, visual pathways can be affected too (20). This means several of the systems your brain uses to keep you balanced may be affected at the same time. When testing shows problems in these systems, your program will include vestibular rehabilitation, visual exercises and gait training, with the goal of improving your balance and mobility and lowering your risk of falls (25).
Electrical stimulation. Your program may include one or more forms of electrical stimulation, applied through the skin, such as somatosensory stimulation, which uses repeated electrical pulses to activate peripheral nerves, or the Rebuilder, a device that stimulates the full sensory area of a nerve. TENS has also been shown to help reduce painful neuropathy symptoms (3). We choose the type based on the details of your case.
Laser therapy. Studies in diabetic neuropathy suggest that both low-level and high-intensity laser therapy can help reduce nerve pain (21, 22).
Transcranial magnetic stimulation. TMS has been studied for reducing neuropathic pain (23). At our clinic, TMS is provided by our psychiatric mental health nurse practitioner, who will evaluate whether it’s appropriate for you.
Nutritional support. Some research supports antioxidants like alpha-lipoic acid for neuropathy symptoms, and earlier research has explored plant compounds like luteolin and quercetin (26).
Recovery between sessions. Some programs include mild hyperbaric therapy as a structured recovery option between more demanding therapy sessions.
Every nervous system is different, so every NeuroRescue Program is different too. Your plan is based on your test results and the specific factors of your case.
How the NeuroRescue Program Works
Your NeuroRescue Program begins with your Discovery Day. We start with a detailed history of your condition and your life on a timeline. This helps us understand the factors that may have contributed to where you are now, and identify related conditions that may be making it harder to move forward.
Because CIDP can sometimes affect the brain and spinal cord as well as the peripheral nerves, we also evaluate your central nervous system. We measure how your visual, vestibular and balance systems are working through computerized analysis of your eye movements, inner ear reflexes and balance under different conditions.
Our testing includes videonystagmography and saccadometry to measure several types of eye movements, the video head impulse test to measure inner ear reflexes, and CAPS computerized posturography to assess your balance under different sensory conditions. We also use NeuroSensoryMotor Integration testing to evaluate hand-eye coordination and cognition, and Virtualis testing to assess dynamic eye tracking and your perception of vertical in a virtual reality environment.
We combine this with a thorough physical and neurological exam of your sensory, motor, autonomic and cognitive systems. We also review any relevant lab work, imaging and prior testing, and integrate it with our findings.
Together, this helps us understand which parts of your nervous system are working well, which are struggling, and how quickly they tire. We use that information to design your personal NeuroRescue Program, aimed at improving energy, endurance and function in the systems that need support. Our testing also helps us decide when to push and when to let you rest.
We can’t bring back nerve cells that have been lost. What we can do is work with the pathways that remain, helping them work more efficiently and work better together. Our goal is to help you improve your balance and function, stay safer on your feet, and enjoy more of your life.
Your Next Step
Living with CIDP can be challenging, but there is hope for improving function. To find out if the NeuroRescue Program is right for you, contact one of our patient care coordinators to schedule your Discovery Day.
It’s never too late to take the next step.
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