The primary goal of treatment for chronic inflammatory demyelinating polyradiculoneuropathy, or CIDP, is to reduce weakness and other symptoms and improve functioning. There is currently no cure for the disease.

A few patients recover from CIDP without treatment. Of the remaining patients, most respond to some form of treatment. However, no single treatment works for every patient. Your doctor may prescribe or combine several different therapies before arriving at the optimum treatment program for you.

Several treatments target the CIDP disease process itself. The goal of these treatments is to slow or stop the destruction of myelin and underlying nerve cells by the patient's own antibodies. This is accomplished by decreasing the production of antibodies and by directly removing antibodies from the blood.

Medications. Corticosteroids and immunosuppressive drugs decrease the activity of the immune system so that fewer antibodies are produced.

Prednisone (Deltasone®, Orasone®) is the corticosteroid that is most commonly used for treating CIDP. Most patients respond to treatment with prednisone. Long-term use of high doses of prednisone can cause serious health problems, but side effects can be managed. To reduce the risk of these disorders, prednisone is usually given in high doses for only a short time and then tapered off. Use of other immunosuppressive drugs can decrease the amount of prednisone needed to control symptoms. Improvement usually begins within three to six weeks. (For more information on prednisone and side effects, see CIDP Medications).

Immunosuppressive agents used in treating CIDP include azathioprine (Imuran®) and cyclosporine (Sandimmune®, Neoral®). It usually takes four to eight months for the effect of azathioprine to be felt. Symptoms of CIDP usually improve within one to two months after cyclosporine is started, with the maximum effect reached within six months. Because of the high cost and risk of side effects, cyclosporine is usually administered only when patients have not responded to other treatments.

The most common side effects of cyclosporine include hypertension, headache, painful or swollen gums, nausea, vomiting, increased hair growth, and breast enlargement. Let your doctor know if these symptoms don't go away or if they are severe. Call your doctor immediately if you experience any of the following symptoms: tremors, sore throat, fever, chills, unusual bleeding or bruising, yellow eyes or skin, weight gain, changes in vision, confusion, lack of control over body movement, seizures, decreased urination, and swelling of the feet, ankles, lower legs, and torso.

Another important fact to know about cyclosporine is that it makes you more vulnerable to infections, so you should avoid people with contagious illnesses like the flu and seek medical help if you are injured or develop any signs of infection. You should call the doctor if you've been exposed to checken pox, measles, or tuberculosis (TB); in addition, you should not have a vaccination, immunization, or skin test before checking with your doctor. (For more information on azathioprine, cyclosporine, and potential side effects, see CIDP Medications. )

IVIg. IVIg is pooled human gamma globulin. This product is derived from a pool of donated blood that has been screened to prevent viruses, such as HIV, from being added to the pool. The blood is further processed to inactivate any viruses that may be present.

IVIg is injected into a vein over the course of several hours. Many patients undergo a series of treatments, usually in a medical setting. Unfortunately, this is an enormously expensive treatment option. IVIg is believed to decrease the production of antibodies but the way it works is not understood.

Plasma exchange (plasmapheresis). Plasma exchange is a process that removes antibodies from the blood. Most patients have significant improvement in symptoms after each treatment, but the effects often last only three to four months. When the treatment is combined with drugs that suppress the immune system, the effects may last longer.

Physical therapy may be used to help you manage problems due to muscle weakness. As CIDP symptoms decrease, therapy and exercise can also help you regain muscle strength.

In some cases, patients may need supportive devices such as an ankle brace or mobility aids such as a walker or wheelchair. A physical therapist can help identify the appropriate equipment and provide training to help the patient use the equipment as effectively as possible.

A Home Safety and Durable Medical Equipment evaluation examines the home for anything that might increase the risk of injury. The evaluator will observes your regular activities to determine if special equipment is needed.

Prednisone can affect the health of the eye, so eye exams are usually recommended each year if you're using prednisone on a regular basis.

First published April 1, 2000
Copyright © 2000 Accordant Health Services, Inc. All Rights Reserved.

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