Treatment of chronic dysimmune polyneuropathies

Chronic dysimmune neuropathies are less common than Guillain-Barré syndrome (GBS). They mainly comprise chronic idiopathic demyelinating polyneuropathy (CIDP), multifocal motor neuropathy with persistent conduction blocks (MMNCB) and polyneuropathy associated with monoclonal gammopathy. However, as GBS, they are considered to be immune-mediated disorders and they may respond to various immunosuppressive treatments, such as corticosteroids, plasma exchanges (PE) or intravenous immunoglobulins (IVIg). The first step is to characterize these neuropathies on clinical, electrophysiological and sometimes immunochemical criteria, because the response to treatment may be different according to the type of neuropathy. For example, polyneuropathy associated with IgM monoclonal gammopathy does not respond to steroids and MMNCB may worsen under PE, while CIDP may respond either to steroids, PE or IVIg. The second step is to choose the type and the regimen of the treatment. Some neurological conditions may require only short-term therapy, for example in relapsing CIDP, whereas other conditions may require long-term therapy.