title: Triple-stimulation technique improves the diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy.
abstract: BACKGROUND
  A difficult clinical situation occurs when a chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) patient does not fulfill any of the diagnostic criteria. Moreover, nerve conduction studies (NCS) can be consistent with axonal neuropathy and lead to misdiagnosis.
  
  
  METHODS
  We aimed to assess the usefulness of the triple-stimulation technique (TST) for detection of proximal conduction blocks (CBs) in patients with axonal-like CIDP. Four patients with axonal-like CIDP were studied and compared with 10 typical CIDP patients. In the axonal-like group, NCS showed a decrease in compound muscle action potential amplitude without features of demyelination, but nerve biopsy showed features of demyelination in all 4.
  
  
  RESULTS
  Twelve nerves were tested with TST, and 8 CBs were detected between the root emergence and the Erb point in the 4 patients, all of whom improved after treatment with intravenous immunoglobulin.
  
  
  CONCLUSIONS
  TST can identify very proximal CBs in CIDP. The sensitivity of nerve conduction studies may be improved by TST in CIDP.
authors.affiliation: Reference Centre for Neuromuscular Diseases and ALS, Department of Neurology and Neuromuscular Diseases, Centre Hospitalier Universitaire La Timone, 264 rue Saint-Pierre, 13385, Marseille, France; Inserm UMR_S 910 Medical Genetics and Functional Genomics, Aix-Marseille University, Marseilles, France.
authors.forename: Shahram
authors.initials: S
authors.lastname: Attarian
authors.forename: Jérôme
authors.initials: J
authors.lastname: Franques
authors.forename: Jouve
authors.initials: J
authors.lastname: Elisabeth
authors.forename: Agnes
authors.initials: A
authors.lastname: Trébuchon
authors.forename: Yann
authors.initials: Y
authors.lastname: Duclos
authors.forename: Délphine
authors.initials: D
authors.lastname: Wybrecht
authors.forename: Annie
authors.initials: A
authors.lastname: Verschueren
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Salort-Campana
authors.forename: Jean
authors.initials: J
authors.lastname: Pouget
mesh_terms: D001369:Axons / Q000473:pathology / Q000502:physiology*; D004558:Electric Stimulation / Q000379:methods; D005260:Female; D006801:Humans; D007249:Inflammation / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction / Q000502:physiology*; D020277:Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome
keywords: CIDP; conduction block; demyelinating neuropathy; transcranial magnetic stimulation; triple-stimulation technique