Autonomic Dysfunction in Iraqi Patients with Chronic Inflammatory Demyelinating Polyneuropathy
American Journal of Internal Medicine
Volume 6, Issue 1, January 2018, Pages: 10-19
Received: Dec. 6, 2017; Accepted: Dec. 18, 2017; Published: Jan. 29, 2018
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Mohammed Majeed Kamil, Neurology Department, Baquba Teaching Hospital, Dyiala, Iraq
HaiderAli Mohammed, Neurology Department, Neurosurgery Teaching Hospital, Baghdad, Iraq
Bahaa Hassan, Neurology Department, Neurosciences Teaching Hospital, Baghdad, Iraq
Basim Hanoon, Neurology Department, Neurosciences Teaching Hospital, Baghdad, Iraq
Hassan Naji, Neurology Department, Neurosurgery Teaching Hospital, Baghdad, Iraq
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Objective:The purpose of this study is to evaluate the autonomic disturbance in patients with chronic inflammatory demyelinating polyneuropathy.Methods:Thirty-eight patients who fit into the AAN criteria of diagnosis of CIDP were studied. Five standard cardiovascular autonomic Ewing tests were performed for every patient in addition to the assessment of autonomic symptoms.Results: The study includes 32 males and 6 females their age ranged from 10 to 69 years. In this study we have seen one child with CIDP whose age was ten years and he had PST impairment. Sexual disturbance was the majorautonomic symptom seen in the males [40.6%], while urinary disturbance 2was the major autonomic disturbance encountered in females [66.6%]. Autonomic function tests [AFT] showed that one quarter of males and half of the females had abnormal AFT. In patients aged between 50-59 years, [40%] having normal autonomic function test, [40%] had PST impairment, while the others have mixed impairment [20%]. None of the patients had pure sympathetic impairment. Regarding the types of CIDP the largest percent [84.2%] of patients have classic type of CIDP while 7.8%, 5.2% and 2.6% had DADS, MADSAM and MMN respectively.Conclusions: Autonomic dysfunction was common in Iraqi CIDP patients. PST impairment is a major pattern of dysautonomia in CIDP. Sexual disturbance in males while urinary disturbance in females were the most common autonomic symptoms encountered. VM, HR response to standing allow an early detection of autonomic dysfunction even in asymptomatic individuals.
Autonomic Dysfunction, CIDP, Iraqi Patients
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Mohammed Majeed Kamil, HaiderAli Mohammed, Bahaa Hassan, Basim Hanoon, Hassan Naji, Autonomic Dysfunction in Iraqi Patients with Chronic Inflammatory Demyelinating Polyneuropathy, American Journal of Internal Medicine. Vol. 6, No. 1, 2018, pp. 10-19. doi: 10.11648/j.ajim.20180601.12
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Barohn RJ, Saperstein DS: Guillain-Barre syndrome and chronic inflammatory demyelinating polyneuropathy. SeminNeurol 1998; 18(1):49-61.
Dalakas MC, Engel WK. Chronic relapsing (dysimmune) polyneuropathy: pathogenesis and treatment. Ann Neurol 1981;9:Suppl: 134-45.
Barohn RJ, Kissel JT, Warmolts JR, MendellJR. Chronic inflammatory demyelinating polyradiculoneuropathy: clinical characteristics, course, and recommendations for diagnostic criteria. Arch Neurol 1989; 46: 878-84.
Research criteria for diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP): report from an ad hoc subcommittee of the American Academy of Neurology AIDS Task Force. Neurology 1991; 41:617-8.
Katz JS, Saperstein DS, Gronseth G, Amato AA, Barohn RJ. Distal acquired demyelinating symmetric neuropathy. Neurology 2000; 54:615-20.
Mygland A, Monstad P. Chronic acquired demyelinating symmetric polyneuropathy classified by pattern of weakness. Arch Neurol 2003; 60:260-4.
Federico P, Zochodne DW, Hahn AF, Brown WF, Feasby TE. Multifocal motor neuropathy improved by IVIg: randomized, double- blind, placebo-controlled study. Neurology 2000; 55:1256-62.
Pestronk A. Multifocal motor neuropathy: diagnosis and treatment. Neurology 1998; 51: Suppl 5:S22-S24.
Oh SJ, Claussen GC, Kim DS. Motor and sensory demyelinating mononeuropathy multiplex (multifocal motor and sensory demyelinating neuropathy): a separate entity or a variant of chronic inflammatory demyelinating polyneuropathy? J PeripherNervSyst 1997; 2:362-9.
Lewis RA, Sumner AJ, Brown AJ, Asbury AK. Multifocal demyelinating neuropathy with persistent conduction block. Neurology 1982; 32:958-64.
Viala K, Renie L, Maisonobe T, et al. Follow- up study and response to treatment in 23 patients with Lewis-Sumner syndrome. Brain 2004; 127:2010-7.
Alaedini A, Sander HW, Hays AP, Latov N. Antiganglioside antibodies in multifocal acquired sensory and motor neuropathy. Arch Neurol 2003; 60:42-6.
Thomas HM. Recurrent polyneuritis: a clinical lecture. Phil Med J. 1898; 1:885-889.
Harris W, Newcomb WD. A case of relapsing interstitial hypertrophic polyneuritis. Brain. 1929; 52:108-116.
Denny-Brown D, Brenner C. Paralysis of nerve induced by direct pressure and by tourniquet. Arch Neurol Psychiatry. 1944;51:1-26.
Dyck PJ, Gutrecht JA, Baston JA, Karnes WE, Dale AJ. Histologic and teased-fiber measurements of sural nerve in disorders of lower motor and primary sensory neurons. Mayo Clin Proc. 1968; 43: 81-123.
Dyck PJ, Lais AC, Ohta M, Bastron JA, Okazaki H, Groover RV. Chronic inflammatory polyradiculoneuropathy. Mayo Clin Proc.1975; 50:621- 637
Austin JH. Recurrent polyneuropathiesand their corticosteroid treatment; with five year observations of a placebo-controlled case treated with corticotrophin, cortisone, and prednisone. Brain 1958; 81:157-92.
Connolly AM. Chronic inflammatory demyelinating polyneuropathy in childhood. PediatrNeurol 2001; 24:177-82.
McLeod JG, Pollard JD, Macaskill P, Mohamed A, Spring P, Khurana V. Prevalence of chronic inflammatory demyelinating polyneuropathy in New South Wales, Australia. Ann Neurol 1999; 46:910-3.
Lunn MP, Manji H, Choudhary PP, Hughes RA, Thomas PK. Chronic inflammatory demyelinating polyradiculoneuropathy: a prevalence study in south east England. J NeurolNeurosurg Psychiatry 1999;66:677-80.
Mygland A, Monstadt P. Chronic polyneuropathies in Vest-Agder, Norway. Eur J Neurol. 2001; 8: 157–165.
Mohamed A, Pollard J, Walsh JC, et al. Prevalence of CIDP in NSW. J ClinNeurosci 1997; 4:403.
Korinthenberg R: Chronic inflammatory demyelinating polyradiculoneuropathy in children and their response to treatment. Neuropediatrics 1999 Aug; 30(4): 190-6.
Bouchard C, Lacroix C, Plante V, et al: Clinicopathologic findings and prognosis of chronic inflammatory demyelinating polyneuropathy. Neurology 1999 Feb; 52(3): 498-503.
Sander HW, Latov N. Research criteria for defining patients with CIDP. Neurology 2003; 60: Suppl 3:S8-S15.
Gorson KC, Allam G, Ropper AH. Chronic inflammatory demyelinating polyneuropathy: clinical features and response to treatment in 67 consecutive patients with and without a monoclonal gammopathy. Neurology 1997;48:321-8.
Gorson KC, Ropper AH, Adelman LS, Weinberg DH. Influence of diabetes mellitus on chronic inflammatory demyelinating polyneuropathy. Muscle Nerve 2000; 23:37-43.
Haq RU, Pendlebury WW, Fries TJ, Tandan R. Chronic inflammatory demyelinating polyradiculoneuropathy in diabetic patients. Muscle Nerve 2003; 27:465-70.
Ginsberg L, Malik O, Kenton AR, et al. Coexistent hereditary and inflammatory neuropathy. Brain 2004; 127:193-202.
Saperstein DS, Katz JS, Amato AA, Barohn RJ. Clinical spectrum of chronic acquired demyelinating polyneuropathies. Muscle Nerve 2001; 24:311-24.
Hughes R, Bensa S, Willison H, et al. Randomized controlled trial of intravenous immunoglobulin versus oral prednisolone in chronic inflammatory demyelinating polyradiculoneuropathy. Ann Neurol 2001; 50: 195-201.
Mathias CJ.Autonomic disorders and their recognition. The N Engl J Med 1997; 336:721-4.
Rogelio MG. Central autonomic regulation; Primer on ANS. In: David R, Low PAL, Polinsky RJ eds. California, Academic Press, 1996; 1: 3-12.
Engstrom J, Martin JR. Disorders of ANS. In : Isselbacher KJ, Brawn WE, Wilson ID, Martine JB, Fauci AS, Kasper DI eds. Harrison s Principles of Internal Medicine, 14th ed. New York, Mc-Graw-Hill 1998; 371:2372-8.
Drovy V E , Nisipeanu P F, Kroczyn A D. Tests of autonomic dysfunction in patients with multiple sclerosis. Acta Neurol Scand 1995; 92(5):356-60.
Bebarroch E E. CNS Disorders. In: Robertson D, Low Ph A, Polinsky R J eds. Primer on ANS. California, Academic Press, 1996; 9: 226-30.
Landsbery L, Young JR. Physiology and pharmacology ANS. In:Isselbacher KJ, Brawn WE, Wilson ID, Martine JB, Fauci AS, Kasper DI eds. Harrison s Principles of Internal Medicine, 14th ed. New York, Mc-Graw-Hill 1998; 70: 430-1.
Macleod JG, Tuck RR. Disorders of ANS: Part 1; Patho-physiology and clinical features. Ann Neurol 1987; 21:114-30.
Macleod JG, Tuck RR. Disorders of ANS: Part 2; Investigation and Treatment. Ann Neurol 1987; 21:114-30.
Ewing DJ, Clarke BF. Diagnosis and management of diabetic autonomic neuropathy. Brit Med J 1982; 285: 915-8.
]Pfeifer M. Cardiovascular assessment. In: Dyck PJ, Thomas PK eds. Diabetic neuropathy, 2nd ed., 1999; 11: 171-83.
Low PA, Fealey RD. Sudomotor neuropathy. In: Dyck PJ, Thomas PK eds. Diabetic neuropathy, 2nd ed., 1999; 13:191-9.
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