[Dysimmune peripheral neuropathies: evaluation of treatment]

Despite a supposed common mechanism with demyelination, dysimmune peripheral neuropathies compose a heterogeneous group in term of symptoms (sensory, motor, autonomic), localization of lesions (focal, multifocal or widely spreaded) as well as evolutions (acute, relapsing or chronic). The lacks of reliable biological or electrophysiological markers of evolution in dysimmune neuropathies require development of clinical scales for therapeutic trials and therapeutic decisions in daily practice. As elaboration of a universal scale is not a realistic goal, several specific measurement tools have been proposed for dysimmune neuropathies this past ten years. Highlighting the interest of functional scales as the ONLS, the European INCAT group made a remarkable effort to validate these scales in dysimmune neuropathies. However, there is a controversy concerning the relative interest of deficit scales versus functional scales. The deficit scales may be more sensitive to progression of the disease whereas the functional scales reflect the impact of neuropathy. The use of composite scales, mixing the evaluation of deficits, electrophysiological data and functional issues, is a promising solution, but the relative value of these parameters still remains to be defined.