Abstract
Objective:The purpose of this study is to evaluate the autonomic disturbance in patients with chronic inflammatory demyelinating polyneuropathy.Methods:Thirty-eight patients who fit into the AAN criteria of diagnosis of CIDP were studied. Five standard cardiovascular autonomic Ewing tests were performed for every patient in addition to the assessment of autonomic symptoms.Results: The study includes 32 males and 6 females their age ranged from 10 to 69 years. In this study we have seen one child with CIDP whose age was ten years and he had PST impairment. Sexual disturbance was the majorautonomic symptom seen in the males [40.6%], while urinary disturbance 2was the major autonomic disturbance encountered in females [66.6%]. Autonomic function tests [AFT] showed that one quarter of males and half of the females had abnormal AFT. In patients aged between 50-59 years, [40%] having normal autonomic function test, [40%] had PST impairment, while the others have mixed impairment [20%]. None of the patients had pure sympathetic impairment. Regarding the types of CIDP the largest percent [84.2%] of patients have classic type of CIDP while 7.8%, 5.2% and 2.6% had DADS, MADSAM and MMN respectively.Conclusions: Autonomic dysfunction was common in Iraqi CIDP patients. PST impairment is a major pattern of dysautonomia in CIDP. Sexual disturbance in males while urinary disturbance in females were the most common autonomic symptoms encountered. VM, HR response to standing allow an early detection of autonomic dysfunction even in asymptomatic individuals.
Highlights
The term chronic inflammatory demyelinating polyradiculoneuropathy [CIDP] has been used to identify patients with a chronically progressive or relapsing symmetric sensorimotor disorder with cytoalbuminologic dissociation and interstitial and perivascular endoneurial infiltration by lymphocytes and macrophages
In POEMS syndrome, the M protein is typically immunoglobulin G [IgG]. -Systemic lupus erythematosus. -Inflammatory bowel disease: CIDP has been described in association with Crohn disease and other inflammatory bowel conditions, no direct correlation between the 2 afflictions is known. -Diabetes mellitus: Increasing evidence supports the suggestion that some patients with diabetes who have severe neuropathy or unusually progressive neuropathy may have CIDP superimposed on their diabetic disorder. [28, 29] -Occasionally, chronic inflammatory demyelinating polyneuropathy may develop in a setting of another polyneuropathy, even one with ahereditary basis, such as Charcot–Marie–Tooth disease. [30]
This is the first study investigating in details the autonomic dysfunction in Iraqi CIDP patients
Summary
The term chronic inflammatory demyelinating polyradiculoneuropathy [CIDP] has been used to identify patients with a chronically progressive or relapsing symmetric sensorimotor disorder with cytoalbuminologic dissociation and interstitial and perivascular endoneurial infiltration by lymphocytes and macrophages. CIDP can be considered the chronic equivalent of acute inflammatory demyelinating polyradiculoneuropathy [AIDP], the most common form of Guillain-Barré syndrome [GBS]. [1]
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