Reply To: EMG Testing axonal vs peripheral & more

You may have already been to see your doctor before you sign in here again. A surprising percentage of CIDP patients do not respond to IVIG. For those who do not respond, there are other treatments available. Ask your doctor about them.

Textbook EMGs might only be a part of the ‘classic’ diagnosis. For example, according to Dr. Lewis, patients may also have:

“Pertinent physical findings are limited to the nervous system, except when the condition is associated with other diseases. Such findings may include the following.

Signs of cranial nerve (CN) involvement (eg, facial muscle paralysis or diplopia)
Gait abnormalities
Motor deficits (eg, symmetric weakness of both proximal and distal muscles in upper and lower extremities)
Diminished or absent deep tendon reflexes
Sensory deficits (typically in stocking-glove distribution)
Impaired coordination”

Your post mentions things you have read. There is a comprehensive and complicated article in Medscape by Dr. Lewis. The link is here:

http://emedicine.medscape.com/article/1172965-overview

There is another article in the Journal of Neurology…. “Clinical diagnosis

The diagnosis of CIDP relies on a combination of clinical and electrophysiological criteria. A number of criteria have been proposed. The European Federation of Neurological Societies (EFNS)/Peripheral Nerve Society (PNS) guidelines were developed for clinical and research use.7 The criteria combine clinical features and electrophysiological evidence to define CIDP, with supportive criteria including elevated cerebrospinal fluid (CSF) protein, gadolinium enhancement of nerve roots or plexus on MRI or nerve biopsy findings providing supplemental diagnostic evidence. Electrodiagnostic evidence of peripheral nerve demyelination in motor nerves is required for diagnosis, including distal latency prolongation, reduction of motor conduction velocity, prolongation of F-wave latency and partial motor conduction block and must be identified in at least two nerves for a diagnosis of ‘definite’ CIDP”

Here: http://jnnp.bmj.com/content/early/2015/02/12/jnnp-2014-309697.full

In other words, the clinical presentation combined with the appropriate lab work is an important part of the diagnosis.

From a different source: “The most important laboratory studies that support of the diagnosis of CIDP are the cerebrospinal fluid (CSF) examination, NCS, and nerve biopsy. Of these three, the CSF evaluation is the most sensitive as protein is elevated in up to 94 % of cases with normal white cells”

Nerve biopsy is not considered so important these days. As stated, elevated CSF and abnormal nerve conduction studies narrow down the diagnosis. However, not all patients initially have elevated CSF, some have reported their CSF elevated later on.

In my case, the CSF has never been elevated.

Continued, two way conversations with your doctor should lead you in the right direction.