Sharma Khema R, Saadia Daniela, Facca Alicia G, Bhatia Rita, Ayyar D Ram, Sheremata William
Department of Neurology, University of Miami School of Medicine, Miami, FL 33136, USA.
J Clin Neuromuscul Dis. 2008 Jun;9(4):385-96. doi: 10.1097/CND.0b013e31816f18e3.
To describe temporal profile of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) in patients with definite, relapsing multiple sclerosis (MS).
Peripheral demyelinating neuropathy has been rarely reported in association with central nervous system demyelinating disorder indistinguishable from MS.
In addition to usual diagnostic studies for CIDP and MS in all 5 patients, we studied proximal segments of nerves using deep tendon reflex latency measurements of biceps reflex, patellar reflex, and ankle reflex.
All patients with MS subsequently (4-22 years) developed definite CIDP. Two of these patients developed multiple cranial nerve and spinal root enhancement on subsequent imaging without new intraparenchymal enhancement after a diagnosis of CIDP. The deep tendon reflex latencies were prolonged at more than 2 sites in all patients. Cerebral spinal fluid protein increased (70 +/- 19 to 144.8 +/- 17.4 mg/dL, P = 0.0001) at time of diagnosis of CIDP. Clinical improvement was observed in all patients after intravenous immunoglobulin therapy.
When patients with MS develop CIDP, manifestations of central and peripheral disease involvement seem to respond to intravenous immunoglobulin. These cases suggest that there may be common antigenic targets in central and peripheral nervous system in this subset of patients.
描述确诊为复发型多发性硬化症（MS）患者的慢性炎性脱髓鞘性多发性神经根神经病（CIDP）的时间特征。
与无法与MS区分的中枢神经系统脱髓鞘疾病相关的周围性脱髓鞘性神经病鲜有报道。
除了对所有5例患者进行CIDP和MS的常规诊断研究外，我们还通过测量肱二头肌反射、髌反射和踝反射的深腱反射潜伏期来研究神经近端节段。
所有MS患者随后（4 - 22年）均发展为确诊的CIDP。其中2例患者在CIDP诊断后，后续影像学检查显示多组颅神经和脊神经根强化，而脑实质内无新的强化。所有患者深腱反射潜伏期在2个以上部位延长。在CIDP诊断时，脑脊液蛋白升高（从70±19至144.8±17.4mg/dL，P = 0.0001）。所有患者在静脉注射免疫球蛋白治疗后临床症状改善。
MS患者发生CIDP时，中枢和周围疾病累及的表现似乎对静脉注射免疫球蛋白有反应。这些病例提示，在这部分患者的中枢和周围神经系统中可能存在共同的抗原靶点。
