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Chronic Inflammatory Demyelinating Polyneuropathy — SCE Neurology MCQ

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HardPeripheral Neuropathy & NeuromuscularChronic Inflammatory Demyelinating PolyneuropathySCE Neurology

A patient has progressive symmetrical proximal and distal weakness, sensory loss and areflexia over six months. Nerve conduction meets CIDP demyelination criteria and mimics have been excluded. Which first-line approach is appropriate?

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Correct answer: B — Offer IVIg or corticosteroids, selecting between them by contraindications, tempo and patient preference; use plasma exchange

The best answer is “Offer IVIg or corticosteroids, selecting between them by contraindications, tempo and patient preference; use plasma exchange”. The EAN/PNS guideline strongly recommends IVIg or corticosteroids initially; plasma exchange is also effective but commonly reserved for selected circumstances. “Use cyclophosphamide before established first-line treatment” is a credible alternative elsewhere, but it fails the decisive discriminator in this case. “Treat with pyridostigmine for a junction disorder” is a credible alternative elsewhere, but it fails the decisive discriminator in this case. “Give levodopa for bradykinesia” is a credible alternative elsewhere, but it fails the decisive discriminator in this case. “Observe without treatment despite progressive disability” is a credible alternative elsewhere, but it fails the decisive discriminator in this case.

Reference: EAN/PNS CIDP guideline: https://pubmed.ncbi.nlm.nih.gov/34085743/