Atormac
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 3731  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  
 Resource Links
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (465 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this Article
   References

 Article Access Statistics
    Viewed154    
    Printed3    
    Emailed0    
    PDF Downloaded3    
    Comments [Add]    

Recommend this journal

 


 
Table of Contents    
LETTER TO EDITOR
Year : 2019  |  Volume : 67  |  Issue : 6  |  Page : 1565

A Relapsing Chronic Inflammatory Demyelinating Polyneuropathy Preceding Type I Diabetes in a Young Male


1 Department of Neurology, Military Hospital of Tunis, Tunisia
2 Department of Physiology, Faculty of Medicine of Tunis, Tunisia

Date of Web Publication20-Dec-2019

Correspondence Address:
Dr. Souissi Wala
Department of Neurology, Military Hospital of Tunis
Tunisia
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.273652

Rights and Permissions



How to cite this article:
Malek M, Wala S, Wafa K, Anis R, Ridha M. A Relapsing Chronic Inflammatory Demyelinating Polyneuropathy Preceding Type I Diabetes in a Young Male. Neurol India 2019;67:1565

How to cite this URL:
Malek M, Wala S, Wafa K, Anis R, Ridha M. A Relapsing Chronic Inflammatory Demyelinating Polyneuropathy Preceding Type I Diabetes in a Young Male. Neurol India [serial online] 2019 [cited 2020 Jan 21];67:1565. Available from: http://www.neurologyindia.com/text.asp?2019/67/6/1565/273652




Sir,

Chronic inflammatory demyelinating polyradiculopathy (CIDP) is considered as an autoimmune disorder of unknown etiology. However, some systemic disorders such as type 1 diabetes mellitus (T1DM) can be associated with its presentation.[1]

A 17-year-old male with no medical history was referred to our institution in November 2014 with complaints of progressive difficulty with gait that had been worsening gradually over five months. Neurological examination revealed areflexia, severe muscle weakness (modified Medical Research Council sum score 12 out of 45), and sensory impairment of the four limbs [Immune Neuropathies Cause and Treatment (INCAT) sensory sum score (ISS) 10 out of 20]. Electrophysiology study (EMG) findings were consistent with CIDP. His blood glucose level and hemoglobin A1c (HbA1c) were high (2g/dl and 12.9%, respectively). Auto antibody tests showed a positive range of anti- GAD, confirming a T1DM. A previous blood glucose level test done one month before his hospitalization was normal. The patient received steroids with a significant improvement. His diabetes was well-controlled on insulin. In April 2017, weakness of his left lower limb recurred. He received oral prednisolone. Within a month, he was able to walk without assistance.

This report shows a rare case of CIDP preceding few months of T1DM. CIDP is frequent in patients suffering from diabetes but affects them after severe years of diabetes.[2] As for this patient, he developed T1DM after CIDP because he was totally asymptomatic of T1DM with a normal blood glycemic level when he first had neurological symptoms. The mechanism underlying the association of type 1 diabetes and CIDP is still debated.[2] Some have hypothesized the existence of common autoantigen in peri-islet Schwann cells and peripheral nerve Schwann cells. In countries where IVIg has limited availability due to its high costs such as Tunisia or when plasmapheresis can be invasive, steroids can be the best therapeutic option.[3] The reason for this preference, apart from substantially lower costs, is the family's assistance that ensures a good diabetes control. The diagnosis of T1DM should be considered in each patient, especially among children and teenagers presenting CIDP even in the absence of general manifestation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Viala K, Maisonobe T, Stojkovic T, Koutlidis R, Ayrignac X, Musset L, et al. A current view of the diagnosis, clinical variants, response to treatment and prognosis of chronic inflammatory demyelinating polyradiculoneuropathy. J Peripher Nerv Syst 2010;15:50-6.  Back to cited text no. 1
    
2.
Dunnigan SK, Ebadi H, Breiner A, Katzberg HD, Barnett C, Perkins BA, et al. The characteristics of chronic inflammatory demyelinating polyneuropathy in patients with and without diabetes—an observational study, PLoS One 2014;9:e89344.  Back to cited text no. 2
    
3.
Malik RA. Wherefore art thou, o treatment for diabetic neuropathy? Int Rev Neurobiol 2016;127:287-317.  Back to cited text no. 3
    




 

Top
Print this article  Email this article
   
Online since 20th March '04
Published by Wolters Kluwer - Medknow