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Abstract Details

Chronic Inflammatory Demyelinating Polyneuropathy: Diagnostic Pitfalls in a Medically Underserved Community
Neuromuscular and Clinical Neurophysiology (EMG)
P12 - Poster Session 12 (12:00 PM-1:00 PM)
1-014
We aim to explore the pitfalls that frequently lead to misdiagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP).
Misdiagnosis of CIDP is common in outpatient neurology. This leads to unnecessary immunomodulatory treatments that subject patients to potential side effects and increased healthcare spending without much benefit.
We analysed seven cases of supposed CIDP referred to our center over a period of seven months. A second opinion was sought by the referring providers. Analysis and interpretation were based on clinical examination, ancillary tests and European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) criteria.
Majority of patients (5/7) failed to meet the diagnostic criteria for CIDP. CSF studies pursued in (3/7) cases showed only mild protein elevation in two cases diagnosed as CIDP. Interestingly, proteins were also mildly elevated in the third case which was deemed not to have CIDP. Electrodiagnostic studies were much more forthcoming towards a correct diagnosis. Nerve conduction studies in patients without CIDP were either normal or showed a variety of heterogeneous findings including length dependent axonal polyneuropathy or a cervical or lumbar polyradiculopathy. Features of demyelination noted in some cases were better explained by an etiology other than CIDP like DM. We noted frequent mismatch between perceived subjective improvements by the patient in absence of any objective signs of improvement on examination. Absent or depressed reflexes in some cases were attributed to alternate etiologies like axonal neuropathy or prior spine surgery rather than CIDP. 
Propagation of incorrect prior chart diagnosis, reliance on subjective rather than objective parameters for treatment responsiveness, errors and technical artifacts in nerve conduction studies, confounding sural nerve biopsy results and over-reliance on mild CSF albuminocytological dissociation are some of the common pitfalls in misdiagnosis of CIDP. Our study helps to understand, address and improve upon this quality gap for better patient care. 
Authors/Disclosures
Saurabh G. Shukla, MD (Lone Star Neurology)
PRESENTER 		Dr. Shukla has nothing to disclose.