Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) Management

Sensory Deficit Patterns

CIDP commonly presents with a predominant sensory axonal neuropathy, though motor and autonomic involvement can occur, affecting large sensory nerve fibers and leading to symmetrical length-dependent "dying back axonopathy" 1
Sensory symptoms typically include acral pain, paraesthesia, dysaesthesia, allodynia, and hyperalgesia, with sensory loss appearing in a "glove and stocking type" distribution with impaired perception of light touch, vibration sense, pin prick, and proprioception 1
Small fiber neuropathy may also be present, affecting nerve terminals involved in temperature and pain perception, leading to painful burning sensations in feet and/or hands, and lancinating pain 1

Early detection is crucial for adequate management and preventing irreversible neuropathy, with baseline and ongoing clinical evaluation of physical function being critical 1
Neurological consultation is recommended if there is uncertainty in the clinical presentation 1
Conventional neurophysiological methods, such as EMG with nerve conduction studies, provide complementary information to clinical assessment, with axonal degeneration evident as progressive reduction of sensory nerve action potential amplitude 1
MRI of the brachial or lumbosacral plexus can help identify focal or diffuse peripheral nerve abnormalities in CIDP variants 2

Corticosteroid administration, such as daily oral or pulse therapies, may be effective for both induction and maintenance, with methylprednisolone (2-4 mg/kg/day) followed by slow steroid taper being a reasonable approach 3