Minimal chronic inflammatory demyelinating polyneuropathy

Chronic inflammatory demyelinating polyneuropathy (CIDP) is clinically heterogeneous and the spectrum of severity is not well defined. Three patients were referred for mild distal paresthesias lasting more than 2 months and one for lumbar pain. Strength was normal in all pts and tactile sensation reduced distally only in 1. Tendon jerks were absent in 2 pts, reduced in lower limbs in 1, normal in 1. There was no ataxia or tremor. Electrophysiological examination was indicative of a demyelinating neuropathy, CSF protein content was increased and nerve biopsy showed de-remyelination in all pts. Search for deletion or duplication of the 17pll.2 segment was negative. Paresthesias disappeared in 2 pts with steroids and in 1 spontaneously. In our prospective study 8% of patients, although fulfilling all the diagnostic laboratory criteria for CIDP (Neurology 1991; 41:617), present with only minimal sensory symptoms or even are an occasional discovery. This broadens the clinical spectrum of CIDP.