How Common Is CIDP Misdiagnosis?
How Common Is CIDP Misdiagnosis?
These findings support the investigators' conclusion that misdiagnosis of CIDP is common despite some limitations of the study, including its retrospective design and reliance on medical record review. Diagnostic pitfalls often resulting in misdiagnosis of CIDP include overreliance on subjective patient-reported improvement with treatment, liberal electrophysiologic interpretation of demyelination, and relying too extensively on mild or moderate cytoalbuminologic dissociation. Fatigue, pain, and other nonspecific symptoms may be prominent in CIDP, but improvement only of these symptoms after immunotherapy without improvement in the clinical hallmarks of CIDP may lead to the incorrect diagnosis of CIDP and subject the patient to an unnecessarily long course of corticosteroids or intravenous immunoglobulin (IVIg). In this small sample, patients received a combined 32 years of treatment with IVIg and 13 years of treatment with corticosteroids for presumed CIDP, which they did not have.
Additional research is needed to determine the source of electrophysiologic errors, whether in technique or interpretation, and to clarify how these errors can be reduced. Following established EFNS/PNS criteria and using clear, objective markers of treatment efficacy may facilitate informed treatment decisions.
Abstract
Viewpoint
These findings support the investigators' conclusion that misdiagnosis of CIDP is common despite some limitations of the study, including its retrospective design and reliance on medical record review. Diagnostic pitfalls often resulting in misdiagnosis of CIDP include overreliance on subjective patient-reported improvement with treatment, liberal electrophysiologic interpretation of demyelination, and relying too extensively on mild or moderate cytoalbuminologic dissociation. Fatigue, pain, and other nonspecific symptoms may be prominent in CIDP, but improvement only of these symptoms after immunotherapy without improvement in the clinical hallmarks of CIDP may lead to the incorrect diagnosis of CIDP and subject the patient to an unnecessarily long course of corticosteroids or intravenous immunoglobulin (IVIg). In this small sample, patients received a combined 32 years of treatment with IVIg and 13 years of treatment with corticosteroids for presumed CIDP, which they did not have.
Additional research is needed to determine the source of electrophysiologic errors, whether in technique or interpretation, and to clarify how these errors can be reduced. Following established EFNS/PNS criteria and using clear, objective markers of treatment efficacy may facilitate informed treatment decisions.
Abstract