The characteristics of chronic inflammatory demyelinating polyneuropathy in patients with and without diabetes--an observational study.

<h4>Introduction</h4>We aimed to determine whether the clinical characteristics and electrodiagnostic classification of nerve injury, and response to treatment differed in patients diagnosed with chronic inflammatory demyelinating polyneuropathy (CIDP) with and without diabetes.<h4>...

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Autores principales: Samantha K Dunnigan, Hamid Ebadi, Ari Breiner, Hans D Katzberg, Carolina Barnett, Bruce A Perkins, Vera Bril
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Publicado: Public Library of Science (PLoS) 2014
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spelling oai:doaj.org-article:9dddba0e62ec478386ed43299b8473492021-11-18T08:31:56ZThe characteristics of chronic inflammatory demyelinating polyneuropathy in patients with and without diabetes--an observational study.1932-620310.1371/journal.pone.0089344https://doaj.org/article/9dddba0e62ec478386ed43299b8473492014-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24586703/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Introduction</h4>We aimed to determine whether the clinical characteristics and electrodiagnostic classification of nerve injury, and response to treatment differed in patients diagnosed with chronic inflammatory demyelinating polyneuropathy (CIDP) with and without diabetes.<h4>Methods</h4>CIDP patients with diabetes (CIDP+DM) (n = 67) and without diabetes (CIDP-DM) (n = 67) underwent clinical examination and nerve conduction studies (NCS). CIDP-DM patients were selected using age and gender matching with the existing CIDP+DM cohort. Patients treated with immunotherapies were classified as responders (R) (n = 46) or non-responders (NR) (n = 54) based on clinical response to treatment. The groups were compared using analysis of variance, contingency tables and Kruskal-Wallis analyses.<h4>Results</h4>CIDP+DM subjects had more severe neuropathy based on higher lower limb vibration potential thresholds (VPT)(p = 0.004), higher Toronto Clinical Neuropathy Score (TCNS) (p = 0.0009), more proximal weakness (p = 0.03), more gait abnormality (p = 0.03) and more abnormal NCS. CIDP+DM subjects had more abnormal sural NCS with lower sural sensory nerve action potential amplitudes (2.4±3.0 µV, 6.6±6.0 µV, p<0.0001) and slower sural nerve conduction velocities (38.6±5.4 m/s, 41.0±5.3 m/s, p = 0.04). CIDP-DM subjects were more likely to receive immune therapies (93% vs 57%, p = <0.0001), despite no significant differences in treatment responder rates (p = 0.71). Patients who responded to therapy had shorter duration of CIDP than non-responders (8.0±6.0 y vs 11.9±7.6 y, p = 0.004).<h4>Discussion</h4>The clinical phenotype and electrophysiological profile of CIDP patients differs according to the presence or absence of diabetes. Despite CIDP+DM patients having more severe clinical and electrophysiological neuropathy, they are less likely to receive disease-modifying/specific therapy, yet have similar response rates to treatment as those without diabetes. Specifically, the duration of neuropathy - not diabetes status - was associated with treatment response.Samantha K DunniganHamid EbadiAri BreinerHans D KatzbergCarolina BarnettBruce A PerkinsVera BrilPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 2, p e89344 (2014)
institution DOAJ
collection DOAJ
language EN
topic Medicine
R
Science
Q
spellingShingle Medicine
R
Science
Q
Samantha K Dunnigan
Hamid Ebadi
Ari Breiner
Hans D Katzberg
Carolina Barnett
Bruce A Perkins
Vera Bril
The characteristics of chronic inflammatory demyelinating polyneuropathy in patients with and without diabetes--an observational study.
description <h4>Introduction</h4>We aimed to determine whether the clinical characteristics and electrodiagnostic classification of nerve injury, and response to treatment differed in patients diagnosed with chronic inflammatory demyelinating polyneuropathy (CIDP) with and without diabetes.<h4>Methods</h4>CIDP patients with diabetes (CIDP+DM) (n = 67) and without diabetes (CIDP-DM) (n = 67) underwent clinical examination and nerve conduction studies (NCS). CIDP-DM patients were selected using age and gender matching with the existing CIDP+DM cohort. Patients treated with immunotherapies were classified as responders (R) (n = 46) or non-responders (NR) (n = 54) based on clinical response to treatment. The groups were compared using analysis of variance, contingency tables and Kruskal-Wallis analyses.<h4>Results</h4>CIDP+DM subjects had more severe neuropathy based on higher lower limb vibration potential thresholds (VPT)(p = 0.004), higher Toronto Clinical Neuropathy Score (TCNS) (p = 0.0009), more proximal weakness (p = 0.03), more gait abnormality (p = 0.03) and more abnormal NCS. CIDP+DM subjects had more abnormal sural NCS with lower sural sensory nerve action potential amplitudes (2.4±3.0 µV, 6.6±6.0 µV, p<0.0001) and slower sural nerve conduction velocities (38.6±5.4 m/s, 41.0±5.3 m/s, p = 0.04). CIDP-DM subjects were more likely to receive immune therapies (93% vs 57%, p = <0.0001), despite no significant differences in treatment responder rates (p = 0.71). Patients who responded to therapy had shorter duration of CIDP than non-responders (8.0±6.0 y vs 11.9±7.6 y, p = 0.004).<h4>Discussion</h4>The clinical phenotype and electrophysiological profile of CIDP patients differs according to the presence or absence of diabetes. Despite CIDP+DM patients having more severe clinical and electrophysiological neuropathy, they are less likely to receive disease-modifying/specific therapy, yet have similar response rates to treatment as those without diabetes. Specifically, the duration of neuropathy - not diabetes status - was associated with treatment response.
format article
author Samantha K Dunnigan
Hamid Ebadi
Ari Breiner
Hans D Katzberg
Carolina Barnett
Bruce A Perkins
Vera Bril
author_facet Samantha K Dunnigan
Hamid Ebadi
Ari Breiner
Hans D Katzberg
Carolina Barnett
Bruce A Perkins
Vera Bril
author_sort Samantha K Dunnigan
title The characteristics of chronic inflammatory demyelinating polyneuropathy in patients with and without diabetes--an observational study.
title_short The characteristics of chronic inflammatory demyelinating polyneuropathy in patients with and without diabetes--an observational study.
title_full The characteristics of chronic inflammatory demyelinating polyneuropathy in patients with and without diabetes--an observational study.
title_fullStr The characteristics of chronic inflammatory demyelinating polyneuropathy in patients with and without diabetes--an observational study.
title_full_unstemmed The characteristics of chronic inflammatory demyelinating polyneuropathy in patients with and without diabetes--an observational study.
title_sort characteristics of chronic inflammatory demyelinating polyneuropathy in patients with and without diabetes--an observational study.
publisher Public Library of Science (PLoS)
publishDate 2014
url https://doaj.org/article/9dddba0e62ec478386ed43299b847349
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