[Can sural nerve biopsy be used to orientate the treatment of chronic inflammatory demyelinating polyneuropathy?].
BACKGROUND
Chronic inflammatory demyelinating polyneuropathy (CIDP) is an acquired neuropathy characterized by demyelination of the peripheral nerves and roots. The course of the illness is progressively chronic or of relapses and remissions. Biopsy of the sural nerve is not essential for diagnosis. It is therefore not necessary to carry it out on all occasions, but probably permits a more rational approach to treatment.


OBJECTIVE
To show whether biopsy of the sural nerve is useful for orientation of the treatment required in cases of CIDP.


METHODS
We studied a total of 16 patients admitted to hospital with a diagnosis of CIDP. They had neurophysiological studies, sural nerve biopsy and other studies to rule out other diagnoses. The patients were assigned to the therapeutic protocols recommended. During 8 years of follow up we compared the response to treatment with intacglobin/plamapheresis, steroids and cytostatic drugs.


RESULTS
It was highly significant (p< 0.001) that the patients with axon lesions on sural nerve biopsy did not respond to treatment with intac globin/plasmapheresis or steroids but did respond to cyclophosphamide, without any serious adverse effects being seen.


CONCLUSIONS
Axonal histopathological lesions of CIDP at the onset of the disease may require cytostatic treatment since they do not usually improve on standard treatment. Sural biopsy is usually invaluable in such cases.
Andrade
R
R
Hospital Universitario Arnaldo Milián Castro. Hosp. Municipal de Remedios, Santa Clara. Villa Clara, Cuba. neurol@medscape.com
González
I
I
Machado
A
A
García
A
A
D000328:Adult; D000368:Aged; D001706:Biopsy; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D020277:Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D013497:Sural Nerve / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D003520:Cyclophosphamide
Puede la biopsia de nervio sural orientar el tratamiento en la polineuropatía desmielinizante crónica inflamatoria?