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. 2022 Jan;43(1):573-582.
doi: 10.1007/s10072-021-05321-z. Epub 2021 May 21.

The neurophysiological lesson from the Italian CIDP database

Emanuele Spina  1 , Pietro Emiliano Doneddu  2 , Giuseppe Liberatore  2 , Dario Cocito  3 , Raffaella Fazio  4 , Chiara Briani  5 , Massimiliano Filosto  6 , Luana Benedetti  7   8 , Giovanni Antonini  9 , Giuseppe Cosentino  10   11 , Stefano Jann  12 , Anna Mazzeo  13 , Andrea Cortese  11   14 , Girolama Alessandra Marfia  15 , Angelo Maurizio Clerici  16 , Gabriele Siciliano  17 , Marinella Carpo  18 , Marco Luigetti  19 , Giuseppe Lauria  20   21 , Tiziana Rosso  22 , Guido Cavaletti  23 , Erdita Peci  3 , Stefano Tronci  4 , Marta Ruiz  5 , Stefano Cotti Piccinelli  6 , Angelo Schenone  7 , Luca Leonardi  9 , Luca Gentile  13 , Laura Piccolo  11 , Giorgia Mataluni  15 , Lucio Santoro  24 , Eduardo Nobile-Orazio  2   25 , Fiore Manganelli  26 ; on the behalf of the Italian CIDP Database Study Group
Affiliations

The neurophysiological lesson from the Italian CIDP database

Emanuele Spina et al. Neurol Sci. 2022 Jan.

Abstract

Introduction: Electrophysiological diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) may be challenging. Thus, with the aim ofproviding some practical advice in electrophysiological approach to a patient with suspected CIDP, we analyzed electrophysiological data from 499 patients enrolled inthe Italian CIDP Database.

Methods: We calculated the rate of each demyelinating feature, the rate of demyelinating features per nerve, the diagnostic rate for upper andlower limb nerves, and, using a ROC curve analysis, the diagnostic accuracy of each couple of nerves and each demyelinating feature, for every CIDP subtype.Moreover, we compared the electrophysiological data of definite and probable CIDP patients with those of possible and not-fulfilling CIDP patients, and by a logisticregression analysis, we estimated the odds ratio (OR) to make an electrophysiological diagnosis of definite or probable CIDP.

Results: The ulnar nerve had the highestrate of demyelinating features and, when tested bilaterally, had the highest diagnostic accuracy except for DADS in which peroneal nerves were the most informative.In possible and not-fulfilling CIDP patients, a lower number of nerves and proximal temporal dispersion (TD) measurements had been performed compared to definiteand probable CIDP patients. Importantly, OR for each tested motor nerve and each TD measurement was 1.59 and 1.33, respectively.

Conclusion: Our findingsdemonstrated that the diagnosis of CIDP may be missed due to inadequate or incomplete electrophysiological examination or interpretation. At the same time, thesedata taken together could be useful to draw a thoughtful electrophysiological approach to patients suspected of CIDP.

Keywords: CIDP; Diagnostic criteria; Nerve conduction; Neurophysiology.

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Conflict of interest statement

P.E.D. reported travel grants to attend scientific meetings from CSL Behring and Kedrion.

G.L. reported travel grants to attend scientific meetings from CSL Behring and Kedrion.

D.C. reported honoraria for lecturing from Shire, CSL Behring, and Kedrion and travel grants to attend scientific meeting from Shire, Kedrion, and CSL Behring.

R.F. has served on scientific advisory boards for CSL Behring and has received travel grants from Kedrion and CSL Behring to attend scientific meeting.

C.B. has served on scientific advisory boards for Pfizer and has received travel grants from Kedrion and CSL Behring to attend scientific meeting.

M.F. has served on scientific advisory boards for CSL Behring and Sarepta Therapeutics and has received travel grants from Sanofi Genzyme, Kedrion, Baxter and CSL Behring to attend scientific meeting.

G.A. reported honoraria for lecturing from Kedrion and Sanofi Genzyme, travel grants from Kedrion, Sanofi-Genzyme, and LJ Pharma.

G.C. reported travel grants to attend scientific meetings from CSL Behring and Kedrion.

S.J. reported research grants from Grifols, outside this work, and travel grants from Grifols and Kedrion.

A.M. reported travel grants from Kedrion and CSL Behring to attend scientific meeting.

A.C. reported travel grants to attend scientific meetings from Kedrion.

G.A.M. reported consulence fees and travel fundings from CSL Behring, Kedrion, Shire, and Grifols.

M.C. reported travel grants to attend scientific meetings from Kedrion.

M.L. reported honoraria for scientific board from Pfizer and Alnylam and travel grants from Pfizer, Grifols, and Kedrion to attend scientific meeting.

G.C. reported honoraria for lecturing and travel grants to attend scientific meetings from Kedrion.

E.P. reported travel grants to attend scientific meetings from CSL Behring.

L.G. reported travel grants from Kedrion and CSL Behring to attend scientific meeting.

G.M. reported consulence fees and travel fundings from CSL Behring, Kedrion, Shire, and Grifols.

L.S. reported personal fees for scientific events from CSL Behring and has received travel grants to attend scientific meetings from CSL Behring and Kedrion.

E.N.O. reported personal fees for Advisory or Scientific Board from Kedrion, Italy; Baxter, Italy; Novartis, Switzerland; CSL Behring, Italy; LFB, France; and Astellas, the Netherlands; outside the submitted work and travel grants to attend Scientific Meeting from Baxter, Grifols, Kedrion, and Novartis, Italy.

F.M. reported personal fees for scientific events from CSL Behring and has received travel grants to attend scientific meetings from CSL Behring and Kedrion.

The other authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
ROC curve analysis showing diagnostic accuracy for each nerve in the entire population
Fig. 2
Fig. 2
ROC curve analysis showing diagnostic accuracy for each demyelinating feature in the entire population
Fig. 3
Fig. 3
Diagnostic odds ratio for each tested nerve and proximal temporal dispersion measurement
See this image and copyright information in PMC

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