Root stimulation improves the detection of acquired demyelinating polyneuropathies

Thirty-one patients with a presentation compatible with an acquired demyelinating polyradiculoneuropathy were prospectively evaluated for proximal conduction block using root stimulation (RS) of cervical and/or lumbar roots. These same techniques were applied to 78 controls (40 pathological). Proximal conduction block was noted in 20/31 cases and none of the controls. Only 7 of 31 cases met published demyelinating criteria. Intravenous immune globulin therapy was completed by 21/31 patients and 20/21 responded. RS is superior to published electrophysiologic criteria for identifying demyelinating polyneuropathies and predicting who will respond to treatment. RS should be performed in all patients suspected of having an acquired demyelinating polyneuropathy when traditional nerve conduction studies criteria are nondiagnostic. RS reliably predicts those likely to respond to immunosuppressive therapy.