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THE MYSTERIOUS WORLD OF NEUROPATHY

CIDP Neuropathy also known as Chronic Inflammatory Demyelinating polyneuropathy is a type of neuropathy with certain specific features, both clinically and on the diagnostic nerve testing  (NCV TEST).

Peripheral neuropathy, a result of damage to your peripheral nerves, often causes weakness, numbness, and pain, usually in your hands and feet. It can also affect other areas of your body. Your peripheral nervous system sends information from your brain and spinal cord (central nervous system) to the rest of your body.

Peripheral neuropathy facts.

There are many causes of peripheral neuropathy, including diabetes, infections, genetics, toxin exposure, vitamin deficiency, tumors, trauma and drugs. Neuropathy can also occur due to some other body ailments that trigger an inflammatory response in the body and this leads to damage to the nerves. Such type of neuropathies are known as inflammatory and autoimmune types of neuropathy (underlying cause inflammation).  Neuropathy can also be seen in a good majority of patients due to an unknown cause, known as Idiopathic neuropathies. Seniors are frequently suffering from neuropathy diagnosed as neuropathy but without a cause.

However, most frequently the cause of neuropathy remains unknown and undisclosed by physician experts of this condition. There are several reasons for this. An important reason is that the nomenclature of classifying Neuropathy is quite poorly formatted in the Neurology literature. Due to the overwhelming influence of academic institutions on medical literature, the approach is more academic rather than pragmatic.

There is a large percentage of neuropathy patients that are not referred to expert neurologists, and furthermore, a strong majority of neurologists in community practice are unable to classify the neuropathy of a patient based on its underlying cause. The most frequent diagnosis is Idiopathic neuropathy, meaning neuropathy of unknown cause. These patients are given medication like Lyrica or Neurontin for symptoms (nerve pain or neuralgia) relief.

Diabetes-induced neuropathy remains to be the most common neuropathy diagnosed with a cause. The treatment remains symptomatic only and an advice to better control diabetes.

In common practice, neuropathy is also classified as; neuropathy due to a disease of a single nerve (eg. Carpal Tunnel Syndrome), or collection of nerve (Mononeuritis Multiplex) and distal branches of several (all) the nerves in the feet and (OR) hands (Peripheral neuropathy).

The above neuropathy classification does not disclose the cause of neuropathy, though there are common patterns, for example, carpal tunnel is a single nerve neuropathy caused by compression of a nerve at the wrist.  Diabetes commonly causes neuropathy that is peripheral neuropathy.

Neuropathy is also understood by expert neurologists based on what type of nerve (functionality) is involved in the neuropathy. Since nerves are either Sensory (take information to the brain) or Motor (bring information from the brain to the boy-muscles). A neuropathy can be a Sensory neuropathy or Motor neuropathy. Frequently both motor and sensory components are involved, also known as sensory-motor neuropathy. This type of classification does not explain the cause of neuropathy. Diabetes usually causes a mixed type of sensory motor neuropathy; however, a pure motor type of neuropathy can be seen in ALS.

Last but not the least, there is another way of understanding neuropathy, depending on what part of the nerve is damaged. All nerves have an inner section called Axon and outer layers of covering known as Myelin. When the nerve axon is damaged, it’s called axonopathy and when the myelin is damaged, it’s known as Demyelinating neuropathy.

There are 100’s of ways the causes and combination of neuropathy can be classified, and they are a challenge to understand.

 

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CIDP is a type of neuropathy which is a chronic condition that occurs due to inflammation as an underlying cause that causes damage to the myelin affecting peripheral nerves.

This condition is commonly under-diagnosed in community neurologist because of the restrictive expertise of performing the nerve conduction testing. Not all who do the test can extract from the data a diagnosis of CIDP. These NCV tests are commonly concluded as peripheral neuropathy only.

Due to the complex nature of the world of neuropathy, its condition and its understanding are limited and CIDP patients are not diagnosed, and this causes delay and damage to the nerves.

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