Prednisone improves chronic inflammatory demyelinating polyradiculoneuropathy more than no treatment

Dyck, Peter J.; O’Brien, Peter C.; Oviatt, Karen F.; Dinapoli, Robert P.; Daube, Jasper R.; Bartleson, J. D.; Mokri, Bahram; Swift, Thomas R.; Low, Phillip A.; Windebank, Anthony J.

doi:10.1002/ana.410110205

Cited by 438 publications

(176 citation statements)

References 15 publications

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“…In one case (6), there were complaints of numbness in the left T8-10 dermatomes. In one case (10), unsteadiness was the chief complaint at the time of first evaluation because of sensory ataxia.…”

Section: Resultsmentioning

confidence: 99%

"Chronic sensory demyelinating neuropathy": chronic inflammatory demyelinating polyneuropathy presenting as a pure sensory neuropathy.

Joy

Kuruoğlu

1992

Journal of Neurology, Neurosurgery & Psychiatry

183

103

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The clinical electrophysiological and histological features of 10 cases of "chronic sensory demyelinating neuropathy" (CSDN) are reported. This entity is characterised by: 1) subacute or chronic progression; 2) pure sensory neuropathy; 3) high spinal fluid protein in the majority of cases; 4) electrophysiological evidence of demyelination affecting motor as well as sensory nerve fibres; 5) demyelination on sural nerve biopsy and 6) good response to immunotherapy in progressive phase. It is believed that this entity represents chronic inflammatory demyelinating polyneuropathy (CIDP) presenting as pure sensory neuropathy. (7 Neurol Neurosurg Psychiatry 1992;55:677-680) the distal value (fig 1). Abnormal temporal dispersion was considered to be present when the CMAP shape was abnormal with multiple phases (more than four) and total duration longer than three standard deviations above the normal mean value (fig 1).3 In five patients, the plantar nerves were studied using the nearnerve needle sensory nerve conduction technique.4 Needle EMG examination was carried out in all cases.Sural nerve biopsy was performed in eight cases. Frozen sections were stained with modified trichrome, cresyl-fast violet, hematoxylin and eosin, and crystal violet stains. Paraffin sections were stained with hematoxylin and eosin and congo-red stains. Semithin EM sections in three cases were stained with toluidine blue. Teased nerve preparations were studied in four cases.To compare the degree of sensory impair-

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Section: Resultsmentioning

confidence: 99%

"Chronic sensory demyelinating neuropathy": chronic inflammatory demyelinating polyneuropathy presenting as a pure sensory neuropathy.

Joy

Kuruoğlu

1992

Journal of Neurology, Neurosurgery & Psychiatry

183

103

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“…5,15,16 There is a need, therefore, to develop new treatments. A positive treatment effect with prednisone in chronic inflammatory demyelinating polyneuropathy, a closely related illness to GBS, has been established, 17,18 and the results of a pilot study 19 on the effect of high-dose intravenous methylprednisolone when given as an add-on therapy to standard treatment with IVIg indicate a beneficial effect of this combination of drugs in patients with GBS, as measured with the GBS disability score. We therefore decided to further assess whether combination treatment with methylprednisolone and IVIg improves outcome in patients with GBS to a greater extent than does IVIg alone.…”

Section: Introductionmentioning

confidence: 98%

Effect of methylprednisolone when added to standard treatment with intravenous immunoglobulin for Guillain-Barré syndrome: randomised trial

Koningsveld¹,

Schmitz²,

Meché³

et al. 2004

The Lancet

324

191

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SummaryBackground Despite available treatment with intravenous immunoglobulin (IVIg), morbidity and mortality are considerable in patients with Guillain-Barré syndrome (GBS). Our aim was to assess whether methylprednisolone, when taken with IVIg, improves outcome when compared with IVIg alone.Methods We did a double-blind, placebo-controlled, multicentre, randomised study, to which we enrolled patients who were unable to walk independently and who had been treated within 14 days after onset of weakness with IVIg (0·4 g/kg bodyweight per day) for 5 days. We assigned 233 individuals to receive either intravenous methylprednisolone (500 mg per day; n=116) or placebo (n=117) for 5 days within 48 h of administration of first dose of IVIg. Because age is an important prognostic factor, we split treatment groups into two age-groups-ie, younger than age 50 years, or 50 years and older. Our primary outcome was an improvement from baseline in GBS disability score of one or more grades 4 weeks after randomisation. Analysis was by intention to treat.Findings We analysed 225 patients. GBS disability scores increased by one grade or more in 68% (76 of 112) of patients in the methylprednisolone group and in 56% (63 of 113) of controls (odds ratio [OR] 1·68, 95% CI 0·97-2·88; p=0·06). After adjustment for age and degree of disability at entry, treatment OR was 1·89 (95% CI 1·07-3·35; p=0·03). Side-effects did not differ greatly between groups.Interpretation We noted no significant difference between treatment with methylprednisolone and IVIg and IVIg alone. Because of the relevance of prognostic factors and the limited side-effects of methylprednisolone, the potential importance of combination treatment with the drug and IVIg, however, warrants further investigation.

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“…It is characterised by slow onset of weakness and reduced sensation. It is a prolonged illness that has been shown to respond to a number of treatment regimes including intravenous immunoglobulin (IVIg), corticosteroids and plasma exchange [3][4][5][6][7][8]. Each of these interventions appears to be efficacious in the short term but little is known about the long-term effects.…”

Section: Introductionmentioning

confidence: 99%

Cost–utility analysis of intravenous immunoglobulin and prednisolone for chronic inflammatory demyelinating polyradiculoneuropathy

McCrone

Chisholm

Knapp

et al. 2003

Euro J of Neurology

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There is a paucity of economic evidence relating to interventions for peripheral nerve disorders and the aim of this study was to illustrate the application of economic evaluation in this area by making a comparison of the cost-effectiveness of intravenous immunoglobulin and prednisolone treatment for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Patients (n=32) were recruited to a double-blind randomised cross-over trial from nine European centres and received either prednisolone or intravenous immunoglobulin during the first six-week treatment period, followed by a four-week washout period after which the other treatment was received.Service use, quality of life and physical disability were measured at baseline and at the end of both treatment periods. Cost and outcome data were available for 25 patients who completed the first arm of the study but for only 16 who completed both arms.Therefore, the focus of the economic evaluation was on the initial treatment period.Baseline costs were controlled for using a bootstrapped multiple regression model. The cost difference between the two treatments was estimated to be £1608 for the initial six

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Prednisone improves chronic inflammatory demyelinating polyradiculoneuropathy more than no treatment

Cited by 438 publications

References 15 publications

"Chronic sensory demyelinating neuropathy": chronic inflammatory demyelinating polyneuropathy presenting as a pure sensory neuropathy.

"Chronic sensory demyelinating neuropathy": chronic inflammatory demyelinating polyneuropathy presenting as a pure sensory neuropathy.

Effect of methylprednisolone when added to standard treatment with intravenous immunoglobulin for Guillain-Barré syndrome: randomised trial

Cost–utility analysis of intravenous immunoglobulin and prednisolone for chronic inflammatory demyelinating polyradiculoneuropathy

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