Comparison of sensitivity and specificity among 15 criteria for chronic inflammatory demyelinating polyneuropathy

Breiner, Ari; Brannagan, Thomas H.

doi:10.1002/mus.24088

Cited by 90 publications

(90 citation statements)

References 53 publications

(101 reference statements)

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“…The AAN criteria are considered most specific but are less sensitive presumably due to requirement of electrophysiological evidence of a minimum of 5 or 6 demyelinating findings in 2 nerves, and of abnormalities in cerebrospinal fluid and/or nerve biopsy studies for a diagnosis of definite CIDP [6,[46][47][48]. Overall, EFNS/PNS criteria have a higher sensitivity, likely because in contrast to the AAN criteria, only 1 or 2 demyelinating findings are required to diagnose CIDP, with or without additional testing, but are still highly specific presumably due to the higher thresholds for demyelinating features [6,[46][47][48][49]. The higher specificity and lower sensitivity of de AAN criteria seem to explain the reason behind the lower incidence and prevalence rates when using the AAN criteria.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Prevalence of Chronic Inflammatory Demyelinating Polyradiculoneuropathy: A Systematic Review and Meta-Analysis

et al. 2019

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Background: Prevalence and incidence rates of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) are required to determine the impact of CIDP on society. We aimed to estimate the prevalence and incidence of CIDP worldwide and to determine the effect of diagnostic criteria on prevalence and incidence. Method: A systematic review was conducted for all published incidence and prevalence studies on CIDP until May 18, 2017. Methodological quality was assessed using the Methodological Evaluation of Observational Research checklist. We performed a random effect meta-analysis to estimate pooled prevalence and incidence rates. Results: Of the 907 studies, 11 were included in the systematic review, 5 in the meta-analysis of incidence (818 cases; 220,513,514 person-years) and 9 in the meta-analysis of prevalence (3,160 cases; 160,765,325 population). These studies had a moderate quality. The pooled crude incidence rate was 0.33 per 100,000 person-years (95% CI 0.21–0.53; I² = 95.7%) and the pooled prevalence rate was 2.81 per 100,000 (95% CI 1.58–4.39; I² = 99.1%). Substantial heterogeneity in incidence and prevalence across studies seems to be partly explained by using different diagnostic criteria. Conclusion: These findings provide a starting point to estimate the social burden of CIDP and demonstrate the need to reach consensus on diagnostic criteria for CIDP.

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Section: Discussionmentioning

confidence: 99%

Incidence and Prevalence of Chronic Inflammatory Demyelinating Polyradiculoneuropathy: A Systematic Review and Meta-Analysis

et al. 2019

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“…Despite established criteria to diagnose chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), there is significant clinical heterogeneity in relation to clinical course and response to treatment 3. In atypical cases, CIDP can be difficult to diagnose and a significant number of patients with CIDP remain unrecognized 4…”

Section: Introductionmentioning

confidence: 99%

Corneal confocal microscopy in chronic inflammatory demyelinating polyneuropathy

Stettner

Hinrichs

Guthoff

et al. 2015

Ann Clin Transl Neurol

105

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ObjectiveThere is an unmet need for better diagnostic tools to further delineate clinical subsets of heterogeneous chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and multifocal motor neuropathy (MMN) to facilitate treatment decisions. Corneal confocal microscopy (CCM) is a noninvasive and reproducible nerve imaging technique. This study evaluates the potential of CCM as a diagnostic surrogate in CIDP and MMN.MethodsIn a cross‐sectional prospective approach, 182 patients and healthy controls were studied using CCM to quantify corneal nerve damage and immune cell infiltration.ResultsPatients with CIDP and MMN had a reduction in corneal nerve fiber (CNF) measures and an increase in corneal immune cell infiltrates. In CIDP, CNF parameters decreased with increasing duration of disease. The number of dendritic cells in proximity to CNFs was increased in patients with early disease and correlated with the degree of motor affection. A further reduction in CNF parameters and an increase in nondendritic cells were observed in patients with painful neuropathy. In CIDP patients with antineuronal antibodies the number of nondendritic cells was increased.InterpretationOur findings suggest that CNF loss may reflect severity of neuropathy and quantification of distinct cells around the CNF plexus may help in stratifying CIDP subtypes, clinical course, and disease activity. However, further longitudinal studies are required before CCM can be considered as a valid surrogate endpoint for patients with CIDP and MMN.

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“…We have since recently proposed new electrophysiological criteria for Guillain-Barré syndrome (GBS) subtypes [4]. These were based on stricter demyelinating cut-offs [5], whose reliability have since been confirmed in multiple populations with chronic inflammatory demyelinating polyneuropathy (CIDP) [6,7]. We in addition utilized new data on axonal GBS subtypes to add parameters in order to increase the detection of this subcategory of patients.…”

Section: Introductionmentioning

confidence: 99%

Influence of timing on electrodiagnosis of Guillain–Barré syndrome in the first six weeks: A retrospective study

Rajabally

Hiew

Winer

2015

Journal of the Neurological Sciences

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The effect of timing is uncertain on the electrophysiology of Guillain-Barré syndrome (GBS). On this may however depend the usefulness of systematic serial studies performed at specific time intervals. We retrospectively analyzed records of 118 consecutive patients with GBS from Birmingham, U.K. (2001-2012), studied between 0-14days, or, 15-42days post-onset using new criteria which we recently proposed [4]. Rates of acute inflammatory demyelinating polyneuropathy (AIDP) (p=0.45), axonal GBS (p=0.32) and equivocal forms (p=0.46) were similar for both timings. Similarly, no significant differences between timings were observed using Hadden et al.'s criteria. Proportions were comparable to published serial studies for both timings, for AIDP (p=0.25; p=0.10) and axonal GBS (p=0.73; p=0.56) but were higher than with serial studies for equivocal forms in patients studied on days 0-14 (p=0.012), although not in those studied on days 15-42 (p=0.17). This suggests that over the initial 6weeks post-onset, timing fails to influence subtype proportions in a large GBS cohort, irrespective of criteria used. Repeat studies appear therefore unlikely to be helpful when systematically performed within this time frame, except in equivocal cases. The benefit of repeat studies remains possible at other times but may need to be individualized, and requires future prospective evaluation.

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Comparison of sensitivity and specificity among 15 criteria for chronic inflammatory demyelinating polyneuropathy

Abstract: In our patient population, the EFNS and Neuropathy Association criteria stand out due to high sensitivity and specificity.

Cited by 90 publications

References 53 publications

Incidence and Prevalence of Chronic Inflammatory Demyelinating Polyradiculoneuropathy: A Systematic Review and Meta-Analysis

Incidence and Prevalence of Chronic Inflammatory Demyelinating Polyradiculoneuropathy: A Systematic Review and Meta-Analysis

Corneal confocal microscopy in chronic inflammatory demyelinating polyneuropathy

Influence of timing on electrodiagnosis of Guillain–Barré syndrome in the first six weeks: A retrospective study

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