Les limites cliniques du concept de polyradiculonévrite chronique

[Management and treatment of chronic inflammatory demyelinating polyradiculoneuropathy: Results of a French national opinion survey]

AIM

To assess the clinical and epidemiological characteristics of chronic inflammatory demyelinating polyneuropathy (CIDP) in a French population opinion survey.

METHODS

A national and multicentric metropolitan French opinion survey was conducted by TNS Healthcare Sofres from October to December 2006. Five thousand and thirty three hospital or private practice physicians were contacted by mail. A specific questionnaire (38 questions) was designed for the survey to evaluate epidemiology, diagnosis and treatment of CIDP.

RESULTS

Four hundred and forty one responses were obtained, 430 were analyzed, 11 being excluded. Only 172 physicians were caring for patients with CIDP, the others feeling that they were not competent for this management (only 34% of the physicians cared for at least one patient during the study). Treatment was managed by only 28% of the physicians and mainly by neurologists working in public hospitals. The percentage of treated patients was 84%, the others were not treated because the impairment was too mild. IVIg were the first intention treatment for 63.2% of the patients and steroids for 30.8% of them. The choice was mainly based on the good tolerance profile of IVIg, both treatments being considered as efficacious.

CONCLUSION

This survey has shown a higher incidence and prevalence of CIDP than expected but a methodological bias may have led to an overestimation (a same patient being included twice). Treatment complied with recommendations and guidelines while the diagnosis may be improved.

Dixièmes Journées des Maladies du Système Nerveux Périphérique Diagnostic des polyneuropathies axonales chroniques : les polyradiculonévrites chroniques méconnues

Chronic inflammatory demyelinating polyradiculoneuropathy is an autoimmune disease that target myelin sheats of peripheral nerves. Its diagnosis is often difficult to make, and a number of cases are probably not identified because of the clinical and electrophysiological heterogeneity. Typical cases associate progressive or relapsing-remitting motor and sensory deficit with increased CSF protein content and electrophysiological features of demyelination. In some cases electrophysiological studies fail to show evidence of demyelination, conventional electrophysiological diagnostic criteria are not filled yet the patient may respond to immunomodulatory treatments. In such cases, presence of clinical characteristics suggestive of CIDP (that means not compatible with a length-dependent axonal process) are critical justifying fully investigations including sural nerve biopsy. The main clinical characteristic are: a symmetric proximal and distal motor weakness predominantly affecting the lower limbs, a diffuse areflexia, a sensory deficit characterized by a preferential involvement of large fibers, an evolution which may be either chronic progressive or recurrent. Usual therapeutic agents (corticosteroids, intravenous immunoglobulins, plasma exchanges) seem to have the same efficacy whatever the electrophysiologic profile.