scholarly journals Chronic Inflammatory Demyelinating Polyradiculoneuropathy 101—Pitfalls and Pearls of Diagnosis and Treatment

US Neurology ◽  
2017 ◽  
Vol 13 (01) ◽  
pp. 18 ◽  
Author(s):  
Said R Beydoun ◽  
Thomas H Brannagan III ◽  
Peter Donofrio ◽  
Carol Lee Koski ◽  
Eric Lancaster ◽  
...  
Keyword(s):  
Peripheral Nerves ◽  
Ivig Therapy ◽  
Chronic Inflammatory Demyelinating Polyradiculoneuropathy ◽  
Sensory Function ◽  
Therapeutic Interventions ◽  
First Line ◽  
Chronic Disability ◽  
Treatable Condition ◽  
Progressive Weakness

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), which is caused by demyelination of the peripheral nerves, is characterized by progressive weakness and impaired sensory function in the arms and legs. CIDP is a treatable condition in which early diagnosis is crucial to limit chronic disability. CIDP can mimic other neuropathies and it is important to identify these in order to ensure prompt treatment. Patients with other causes of neuropathy should be suspected of having CIDP if there is rapid progress or proximal weakness. Intravenous immunoglobulin (IVIG), corticosteroids, and plasma exchange are first-line therapies. The IVIG CIDP Efficacy (ICE) trial, the largest trial reported of any CIDP treatment, demonstrated that IVIG therapy reduced disability and functional impairment, as well as improved quality of life. Autoantibodies against membrane proteins of the peripheral nerve axons or the myelin sheath have been reported recently, and an improved understanding of antibody responses in CIDP may enable the development of future targeted therapeutic interventions.

scholarly journals A Case of Idiopathic Chronic Inflammatory Demyelinating Polyradiculoneuropathy

2013 ◽  
Vol 28 (2) ◽  
pp. 132-140
Author(s):  
Moniruzzaman Bhuiyan ◽  
Mohammad Najim Uddin ◽  
Md Masud Rana ◽  
Anis Ahmed ◽  
Md Rafiqul Islam ◽  
...  
Keyword(s):  
Steroid Therapy ◽  
Marked Improvement ◽  
Chronic Inflammatory Demyelinating Polyradiculoneuropathy ◽  
Oral Steroid ◽  
Diagnostic Dilemma ◽  
Patient Reported ◽  
Oral Steroid Therapy ◽  
Treatable Condition ◽  
Progressive Weakness

A 40 years old man presented with progressive weakness and distal paraesthesia of limbs with difficulty in walking for last seven years. As the patient was not investigated thoroughly, a diagnostic dilemma was persisted. This patient went abroad & investigated thoroughly and yet not reached to a confirm diagnosis. Subsequently this patient reported to us and diagnosed it to be a case of Idiopathic Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP) responded to oral steroid therapy. After follow-up, this patient showed marked improvement. So diagnostic dilemma that persisted with such a patient that showed improvement with treatment and a challenge to a treatable condition had encouraged us to report the case. DOI: http://dx.doi.org/10.3329/bjn.v28i2.17185 Bangladesh Journal of Neuroscience 2012; Vol. 28 (2): 132-140

Chronic Inflammatory Demyelinating Polyradiculoneuropathy - An Overview of Intravenous Immunoglobulin Therapy

2009 ◽  
Vol 4 (1) ◽  
pp. 72
Author(s):  
Vera Bril ◽  
Keyword(s):  
Intravenous Immunoglobulin ◽  
Ivig Therapy ◽  
Immunoglobulin Therapy ◽  
Chronic Inflammatory Demyelinating Polyradiculoneuropathy ◽  
Intravenous Immunoglobulin Therapy ◽  
Short And Long Term ◽  
Term Data ◽  
Ivig Administration

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a significant source of disability, and early diagnosis and immunomodulatory therapy administration are critical to minimise disease progression and axonal degeneration. Intravenous immunoglobulin (IVIg) therapy is considered to be a first-line treatment for CIDP. Comparative short- and long-term data of IVIg versus corticosteroids in CIDP patients are limited. Of the five published placebo-controlled studies in CIDP, four reported only on short-term improvements in disability (≤6 weeks). However, the IGIV CIDP Efficacy (ICE) study, the largest randomised, placebo-controlled CIDP study published to date (n=117), reported significant improvements in disability, functional impairment and quality of life with IVIg (Gamunex®) 1g/kg maintenance therapy every three weeks for up to 48 weeks. Furthermore, long-term IVIg administration was safe and well tolerated, particularly given the short duration of the infusions. Data suggest that a long-term scheduled maintenance regimen of IVIg in appropriate patients may provide substantial benefit and reduce the risk of CIDP relapse.

Progressive Numbness and Tingling

2018 ◽  
pp. 209-214
Author(s):  
Aaron E. Miller ◽  
Tracy M. DeAngelis ◽  
Michelle Fabian ◽  
Ilana Katz Sand
Keyword(s):  
Conduction Velocity ◽  
Intravenous Immunoglobulins ◽  
Chronic Inflammatory Demyelinating Polyradiculoneuropathy ◽  
First Line ◽  
Long Duration ◽  
Chronic Therapy ◽  
Sensory Involvement ◽  
Electrodiagnostic Study ◽  
Progressive Weakness ◽  
Steroid Sparing

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a subacute progressive polyneuropathy thought to arise from an autoimmune origin. Patients most typically present with symmetrical, progressive weakness that often affects proximal and distal muscles equally. Sensory involvement is common. Confirmation of the likelihood of demyelinating polyneuropathy can be obtained by electrodiagnostic study, which should include all four limbs. Marked slowing of conduction velocity is found in the vast majority of cases. Electromyography will typically show signs of denervation and partial reinnervation, such as fibrillation potentials and giant, long-duration, polyphasic potentials. Corticosteroids, intravenous immunoglobulins, or plasmapheresis are the most typical first-line treatments for CIDP. Steroid-sparing immunosuppressants may be used if chronic therapy is necessary. Most patients will improve to some degree with treatment.

Malignant Gastrointestinal Obstruction: Options for Decompression and Nutrition

2020 ◽  
Vol 04 (03) ◽  
pp. 311-322
Author(s):  
Robert J. Litwin ◽  
Johanna L. Chan ◽  
Steven Y. Huang
Keyword(s):  
Clinical Presentation ◽  
Practice Patterns ◽  
Patient Care Team ◽  
Therapeutic Interventions ◽  
Collaborative Approach ◽  
Malignant Bowel Obstruction ◽  
Advanced Malignancy ◽  
Gastrointestinal Obstruction ◽  
Malignant Gastrointestinal Obstruction

AbstractMalignant bowel obstruction (MBO) is a relatively common condition affecting patients with advanced malignancy. Therapeutic interventions should be aimed at maintaining quality of life. Given the lack of prospective controlled studies in this patient population, patient management is often based on local practice patterns and anecdotal experience. To foster a collaborative approach among the members of the patient care team involving internal medicine, oncology, palliative care, clinical nutrition, surgery, gastroenterology, and interventional radiology physicians, it is important to improve our understanding of MBO. The purpose of this article is to describe the clinical presentation, pathophysiology, as well as medical, surgical, and nonsurgical palliative options available to patients with MBO for purposes of decompression and nutrition.

ДИАГНОСТИКА ХРОНИЧЕСКИХ ИНДУЦИРОВАННЫХ КРАПИВНИЦ

2019 ◽  
Author(s):  
E.Yu. Borzova
Keyword(s):  
Biological Therapy ◽  
Meta Analysis ◽  
Treatment Algorithm ◽  
The Novel ◽  
First Line ◽  
Systemic Reactions ◽  
Significant Impairment ◽  
Challenge Tests ◽  
First Line Treatment

Хронические индуцированные крапивницы имеют важное социально-экономическое значение вследствие риска развития системных реакций и значительного снижения качества жизни пациентов. Диагностика хронических индуцированных крапивниц основывается на анамнестических данных и проведении провокационных тестов. Современный протокол ведения больных хронической крапивницей включает применение неседативных антигистаминных препаратов. Международные согласительные документы по лечению крапивницы рекомендуют 4-кратное увеличение суточной дозы неседативных антигистаминных препаратов при их неэффективности в стандартных дозах. Данные мета-анализа указывают на эффективность омализумаба при хронических индуцированных крапивницах. В перспективе ожидается расширение арсенала генно-инженерной биологической терапии хронических индуцированных крапивниц.Chronic inducible urticarias are characterized by the risks of systemic reactions and a significant impairment of patients quality of life. The diagnosis of chronic inducible urticarias relies on the patients history and the challenge tests. A treatment algorithm for the management of chronic inducible urticarias includes nonsedating antihistamines as a first-line treatment. The international guidelines for the management of chronic inducible urticarias recommend updosing of nonsedating antihistamines up to four fold if standard doses are not effective. The meta-analysis suggests the efficacy of omalizumab in chronic inducible urticarias. In the prospect, the novel options of biological therapy for chronic inducible urticarias are expected.

The effectiveness of a digital pelvic floor training program in thetreatment of urinary incontinence – a real-world evaluation (Preprint)

2019 ◽  
Author(s):  
Sabine Keim ◽  
Alexandra von Au ◽  
Lina Maria Matthies ◽  
Stephanie Wallwiener ◽  
Sarah Brugger ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Pelvic Floor ◽  
University Hospital ◽  
First Line ◽  
First Line Therapy ◽  
A Value ◽  
Pelvic Floor Training ◽  
Significant Impairment ◽  
Pelvic Floor Weakness

BACKGROUND Background: Many women experience urinary incontinence (UI) during andafter pregnancy due to pelvic floor weakness. First-line therapy is conservative treatment, which nowadays can be facilitated by using digitalsolutions. OBJECTIVE The aim ofthe present study was to investigate the efficacy and effectiveness of pelvinain patients with existing UI. METHODS Methods: In the present observational study we analyzed the effectivenessof pelvina, a certified digital pelvic floor training course, in reducing UI symptoms by regularly applying “The Questionnaire for Urinary Incontinence Diagnosis” (QUID) and furthermore examining quality of life (QoL) by conducting the SF-6D. RESULTS Results: In this prospective study, 373 patients with a median age of 36 years (IQR 33 - 47 years) were included. At baseline the patients had a median QUID of 11 (IQR 11 - 15). During the course, incontinence improved significantly to a QUID of 5 (IQR 2 – 11; p<0.001). Additionally, the patients had also shown a significant impairment in their QoL at baseline with a value of 19 (IQR 16 - 22) in SF-6D. After completing the course, the QoL had risen to 24 (IQR 20 - 26). CONCLUSIONS Conclusion: Use of the certified digital pelvic floor course pelvinasignificantly reduces existing UI due to pelvic floor weakness over the timespan of the course. At the same time QoL is significantly improved. CLINICALTRIAL The present study was approved by the ethics committee of the Heidelberg University Hospital (S-392/2019)

scholarly journals P121 The efficacy of treatment interventions on fatigue in adolescents with juvenile idiopathic arthritis: a literature review

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Sebastian Moshtael ◽  
Sonia Khanom ◽  
Janet E McDonagh
Keyword(s):  
Quality Of Life ◽  
Juvenile Idiopathic Arthritis ◽  
Young People ◽  
Rating Scale ◽  
Outcome Measure ◽  
Therapeutic Interventions ◽  
Current Evidence ◽  
Original Research ◽  
Qualitative Synthesis

Abstract Background/Aims  Fatigue has been reported by young people and professionals alike as a major challenge for people living with juvenile idiopathic arthritis (JIA) . It remains unclear as to how therapeutic interventions impacts on this major symptom. The aim of this review was to determine the current evidence for the effectiveness of therapeutic interventions, non- pharmacological and pharmacological, on improving fatigue in adolescents with JIA. Methods  Three electronic databases (MEDLINE, EMBASE, PsycINFO) were searched from 2000 to Feb 2020; in addition to manual searches. Articles were eligible for inclusion if they (i) were original research papers, (ii) had fatigue as a primary outcome measure (iii) included adolescents (10-25 years) and (iv) were available in the English language. Results  Of the 3,142 records identified, 31 underwent full text assessment and 4 studies were included in the qualitative synthesis including 2 from the Netherlands, 1 Germany, and 1 from Canada. The total number of participants across the 4 studies was 824. Three were randomised controlled trials of nonpharmacological interventions and one was a cohort study from a national drug registry including older adolescents JIA (mean: 19-years). Measurement tools included the Paediatric Quality of life multidimensional fatigue scale, (2 studies), the Checklist for Individual Strength CIS-20 (1 study), a numeric rating scale (1 study). In one study a visual analogue scale for energy level was also utilised. In 2 studies baseline prevalence of fatigue was reported as 60% and 76% respectively. Significant reduction in fatigue was observed in all three nonpharmacological studies. In the registry study, fatigue was noted to be prevalent in spite of the disease being in inactive or minimally active on biologic therapy. In 3 studies the relationship between health-related quality of life and fatigue was highlighted and showed a decreased quality of life in fatigued young people. Conclusion  Fatigue is a significant problem in JIA during adolescence and influences quality of life. Improvements in fatigue with non-pharmacological interventions have been reported. However, at present, data is insufficient to conclusively decide which treatment intervention is most efficacious in treating fatigue in young people with JIA. Fatigue should be considered as an important outcome measure for the management of JIA in future evaluations of interventions. Disclosure  S. Moshtael: None. S. Khanom: None. J.E. McDonagh: None.

Practice Guidelines: How Good are Medicine's New Recipes?

1995 ◽  
Vol 23 (1) ◽  
pp. 47-48 ◽  
Author(s):  
Alexander Morgan Capron
Keyword(s):  
Health Care ◽  
Nonprofit Organizations ◽  
Medical Knowledge ◽  
Medical Specialty ◽  
Therapeutic Interventions ◽  
Medical Interventions ◽  
Practice Parameters ◽  
Wide Range ◽  
Standard Of Practice

Over the last decade, standards for when and how to undertake a wide range of medical interventions have poured forth from medical specialty groups, commercial and nonprofit organizations, and state and federal panels. Known by a variety of names—from practice parameters to clinical guidelines—and intended for a range of purposes—from diminishing the incidence of maloccurences in hospitals to cutting the costs of health care—these guidelines share one important feature: the intention of decreasing the range of variation in medical practice. Such standardization immediately appeals to anyone interested in improving the quality of health care and, in particular, reducing inappropriate medical interventions, in light of the difficulties for a conscientious physician today in adhering to the best standard of practice when faced with ever increasing medical knowledge and the growing number and complexity of diagnostic, preventive, and therapeutic interventions.

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