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Diabetic Demyelinating Polyneuropathy Responsive to Intravenous Immunoglobulin Therapy
Khema R. Sharma, MD;
John Cross, MD;
D. Ram Ayyar, MD;
Alberto Martinez-Arizala, MD;
Walter G. Bradley, DM, FRCP
Arch Neurol. 2002;59:751-757.
Background There is growing evidence that idiopathic chronic inflammatory demyelinating
polyneuropathy (CIDP) and polyneuropathy in patients with diabetes mellitus
(DM) that meets the electrophysiological criteria for CIDP (DM-CIDP) have
many similarities.
Objective To evaluate whether DM-CIDP responds to intravenous immunoglobulin (IVIG)
therapy.
Patients and Methods Twenty-six patients (mean [SD] age, 64 [8.9] years; age range, 40-80
years) with type 2 DM (n = 25), who met the electrophysiological criteria
for CIDP, were given IVIG therapy (400 mg/kg body weight per day for 5 days)
in a prospective open-label pilot study. All patients had quantitative evaluation
using the Neuropathy Impairment Score at baseline and at the end of 4 weeks
from the initiation of IVIG therapy.
Results The mean Neuropathy Impairment Score improved significantly from baseline
(mean [SD], 61.5 [26.0] points) to the end of the fourth week (33 [29.6] points; P<.00l). This clinically significant improvement occurred
in 21 (80.8%) of the 26 patients. Conduction block occurred in 11 (42.3%)
of the 26 patients; improvement in the Neuropathy Impairment Score was more
frequent in patients who had a conduction block (11 of 11 patients) than in
those who did not (10/15 [66.7%]; P = .03). Adverse
reactions to IVIG included reversible renal dysfunction in 3 patients, flulike
symptoms in 5, headache in 5, and chest pain and shortness of breath in 1.
Conclusion Although IVIG therapy seemed to improve DM-CIDP in this uncontrolled
trial, a controlled trial is required for confirmation of our findings.
From the Department of Neurology, University of Miami School of Medicine,
Miami, Fla.
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