Submitted by: Niranjan Singh, MD
Edited by: Vishwajit Hegde, MD
Ingwersen J, Graf J, Kluge J, et al. CNS involvement in chronic inflammatory demyelinating polyneuropathy: Subtle retinal changes in optical coherence tomography. Neurol Neuroimmunol Neuroinflamm.
Chronic inflammatory demyelinating polyneuropathy (CIDP) is an autoimmune disease of the peripheral nervous system characterized by primary myelin destruction and secondary axonal damage leading to sensory, motor, and autonomic deficit. The disease may follow a relapsing remitting course, like multiple sclerosis.
Several studies have documented central nervous system (CNS) involvement, though this is a disease primarily involving peripheral nervous system (PNS). The authors in this article investigated structural retinal change as a marker of CNS involvement in CIDP compared with healthy individual using a spectral domain optical coherence tomography. Patients with CIDP and healthy controls were recruited at the Department of Neurology, Heinrich-Heine-University in Düsseldorf, Germany.
Of the 66 total individuals, 44 were patients with CIDP and 22 were healthy control subjects. Of the 44 patients with CIDP who were screened, 22 individuals were excluded because of concomitant diabetes mellitus and ophthalmic pathologies. An additional 7 single eyes were excluded because of drusen and macular edema. Of the remaining individuals, 22 were patients with CIDP and 22 age- and sex-matched controls.
This study found slight but significant volume reductions of the ganglion cell/inner plexiform layer complex (CIDP 1.86 vs HC 1.95 mm3
), the retinal pigment epithelium (CIDP 0.38 vs HC 0.40 mm3
), and the TMV (CIDP 8.48 vs HC 8.75 mm3
). The P value was less than 0.05. Overall the data suggest there is a subtle retinal neuro degeneration in patient with CIDP.
This small case control study presents data demonstrating subtle retinal degeneration in patients with CIDP detected by optical coherence tomography. This provides further evidence that there is CNS involvement in patients with CIDP. A number of case reports and case studies have shown similar finding of CNS involvement. There is evidence of prolonged latencies in VEP, brain stem acoustic potentials and somatosensory evoked potentials in patient with CIDP. This study did not reveal any alteration in peripheral retinal nerve fiber layer which is affected in patient with multiple sclerosis. At this point it can be only speculated that retinal degeneration is seen in the patient with immune mediated peripheral nerve damage and can be linked biologically. The pathogenesis remains to be established. The study is a small, size of 22.
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Thomas PK, Walker RW, Rudge P, et al. Chronic demyelinating peripheral neuropathy associated with multifocal central nervous system demyelination. Brain
. 1987;110(pt 1):53-76.
Mendell JR, Kolkin S, Kissel JT, Weiss KL, Chakeres DW, Rammohan KW. Evidence for central nervous system demyelination in chronic inflammatory demyelinating polyradiculoneuropathy. Neurology