Neurol. praxi. 2019;20(1):43-48 | DOI: 10.36290/neu.2019.090

Corticosteroids – therapy of the first choice?

doc. MUDr. Edvard Ehler, CSc.

Neurologická klinika FZS Univerzity Pardubice a Pardubické krajské nemocnice

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is the most frequent autoimmune neuropathy. The processes participating in pathogenesis of CIDP are primarily of humoral and also cellular immunity. In CIDP, the most frequent is classical form, which is characterized by clinically nearly symmetric and electrophysiologically multifocal impairment of motor and sensory fibers. Therapy of CIDP is initiated by „induction therapy“, consisting of corticosteroids, intravenous administration of high doses of immunoglobulins (IVIG) or therapeutic plasma exchange (TPE). In view of the high demands on the equipment and of more frequent adverse reactions in TPE, the use of corticosteroids or IVIG is the therapy of the first choice. In comparison with steroids the administration of IVIG displays quicker and stronger therapeutic effects, but with shorter duration. Administration of IVIG is also noticeably more expensive. The disadvantage of long lasting steroid therapy is the occurrence of adverse effects. Administration of IVIG is indicated as a first treatment in pure motor forms or in forms with prevailing motor impairment, in patients with contraindication of steroids and in children. Intravenous administration of steroids or repeated oral bolus therapy is associated with a lower occurrence of adverse events in comparison with daily oral corticosteroid therapy.

Keywords: chronic inflammatory demyelinating polyradiculoneuropathy, immunoglobulins, therapeutic plasma exchange,corticosteroid therapy

Published: March 1, 2019  Show citation