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A randomized trial (ICE trial) in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) demonstrated significantly more improvement with intravenous immunoglobulin (Gamunex®, Talecris Biotherapeutics, Inc., Research Triangle Park, NC) than placebo. To understand the relationship between CIDP impairments, activity and participation restrictions, and quality of life (QoL) in this trial, we investigated the association between scales representing these outcome levels. Gamunex or placebo was given every 3 weeks for up to 24 weeks to 117 patients in an initial treatment period after which treatment failures were crossed over (alternative treatment). We assessed impairments, activity and participation, and SF-36 component mental (MCS) and physical summaries (PCS). Regression analyses of baseline data were performed (all subjects) and change from baseline to endpoint (Gamunex-treated group only) to determine correlations between outcomes. Grip strength, medical research council (MRC) sum score, and inflammatory neuropathy cause and treatment (INCAT) sensory sum score were the strongest explanatory variables of disability (at baseline: r2 = 0.46; change from baseline: r2 = 0.66). Only up to half of the variance in QoL scores (PCS at baseline: r2 = 0.30; change from baseline: r2 = 0.41; MCS: at baseline: r2 = 0.10; change from baseline: r2 = 0.24) was explained by impairment and activity and participation measures. Future studies are required to elucidate the impact of CIDP on disability and QoL changes, because the obtained correlations provide only partial explanation. [ABSTRACT FROM AUTHOR]

Six patients with chronic acquired demyelinating neuropathy (CADP) were treated with autologous peripheral blood stem cell transplantation (PBSCT). Two with polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes (POEMS) syndrome improved–improvement was sustained in one but relapsed and required repeat transplant in the other. Two of the three with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and one with an IgM paraprotein and antibodies to nerve improved–of the responders, one relapsed after 18 months and the other was in remission after 6 months. Four developed neutropenic septicemia and pneumonia. The role of PBSCT in CADP refractory to other treatment deserves further investigation but the serious adverse events and lack of sustained response in some patients emphasize the need for caution. [ABSTRACT FROM AUTHOR]

Inflammatory neuropathies are uncommon but important to diagnose because they are treatable. This review summarizes the clinical approach to diagnosis and treatment of Guillain-Barré syndrome (GBS), chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), and related neuropathies which are thought to be caused by direct autoimmune attack on peripheral nerves. Features that suggest that a neuropathy is likely to be inflammatory include loss of reflexes without muscle wasting, elevated cerebrospinal fluid (CSF) protein, positive sensory symptoms such as pain or tingling, asymmetry, and proximal weakness. Nerve conduction studies show features of demyelination, especially motor nerve conduction block and temporal dispersion. Inflammatory neuropathy has been arbitrarily classified according to the time from symptom onset until maximal severity, where "acute" is less than four weeks and "chronic" is more than eight weeks, with a rare intermediate "subacute" group. Assessing the efficacy of potential treatments is difficult because the natural history is variable and may include spontaneous improvement. However, some progress has been made in conducting the randomized trials and systematic reviews as a basis for management decisions. [ABSTRACT FROM AUTHOR]

Presents a review to explain how general practitioners can approach the first level of diagnosis of peripheral neuropathy and warn patients about what lies ahead after referral to a specialist. Diagnosis of neuropathy due to diabetes mellitus and alcohol misuse in primary care; Treatability of demyelinating neuropathies; Causes of axonal neuropathies.

The Inflammatory Neuropathy Consortium held its first scientific meeting in Paris on 4–6 July 2008. The consortium is a special interest group of the Peripheral Nerve Society. The meeting included 10 plenary lectures and over 60 abstracts. A meeting summary is provided. [ABSTRACT FROM AUTHOR]

Assesses the achievements of the Cochrane Neuromuscular Disease Review Group in the field of peripheral nerve disorders. Symptomatic benefit with corticosteroid injection; Number of trials included in the review of plasma exchange; Setbacks in the review of interventions for chronic idiopathic axonal neuropathy.