Vol. 30-31/2021-2022 Nr 60
okładka czasopisma Child Neurology
powiększenie okładki
Journal Info

CHILD NEUROLOGY

Journal of the Polish Society of Child Neurologists

PL ISSN 1230-3690
e-ISSN 2451-1897
DOI 10.20966
Semiannual


Powrót

Przewlekła zapalna polineuropatia demielinizacyjna u dzieci


Childhood chronic inflammatory demyelinating polyneuropathy




Katedra i Klinika Neurologii, Warszawski Uniwersytet Medyczny, ul. Banacha 1a 02–097 Warszawa

https://doi.org/10.20966/chn.2017.53.409
Neurol Dziec 2017; 26, 53: 39-46
Full text PDF Przewlekła zapalna polineuropatia demielinizacyjna u dzieci



STRESZCZENIE
Przewlekła zapalna polineuropatia demielinizacyjna (Chronic inflammatory demyelinating polyneuropathy, CIDP) jest rzadką chorobą o podłożu autoimmunologicznym charakteryzującą się postępującym niedowładem i/lub zaburzeniami czucia oraz hipo- lub arefleksją. Dziecięca postać CIDP najczęściej rozwija się w ciągu 8 tygodni, ale u 20% choroba ma początek podostry (4–8 tygodni), a u pozostałych ostry (< 4 tygodni). Czasami pierwsze objawy poprzedzone są infekcją układu oddechowego bądź pokarmowego. Typowy obraz kliniczny to postępujący, symetryczny niedowład mięśni proksymalnych i dystalnych kończyn dolnych prowadzący do zaburzeń chodu i upadków. CIDP u dzieci przeważnie ma przebieg rzutowo-remisyjny. Kryteria rozpoznania obejmują również zmiany o charakterze demielinizacji stwierdzane w elektroneurografii (ENG) oraz badanie płynu mózgowo-rdzeniowego, które wykazuje rozszczepienie białkowo-komórkowe. Biopsja nerwu łydkowego nie jest już zalecana w rutynowej diagnostyce. CIDP należy różnicować przede wszystkim z zespołem Guillain’a-Barrego (Guillain-Barré syndrome, GBS), dziedzicznymi czuciowo-ruchowymi polineuropatiami, szczególnie chorobą Charcot-Marie-Tooth (CMT), oraz poliradikulopatią w przebiegu boreliozy. Leczeniem pierwszego rzutu są dożylne wlewy immunoglobulin (intravenous immunoglobulin, IVIg) oraz glikokortykosteroidy (GKS), po których u większości pacjentów występuje dość szybka poprawa stanu klinicznego. W drugim rzucie można zastosować leczenie skojarzone IVIg z GKS, plazmaferezę, a także dołączyć leki immunosupresyjne, przeważnie azatioprynę. CIDP u dzieci ma dobre rokowanie, najczęściej występuje remisja, całkowita bądź z minimalnymi objawami ubytkowymi.

Słowa kluczowe: przewlekła zapalna polineuropatia demielinizacyjna, zespół Guillain- Barré, choroba Charcot-Marie-Tooth, IVIg


ABSTRACT
Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare autoimmune disease characterised by progressive weakness and/or sensory symptoms and hipo- or areflexia. The disease develops insidiously (> 8 weeks) in most cases but 20% has a subacute onset (4–8 weeks) and 20% an acute onset (< 4 weeks). Sometimes first symptoms are preceded by a respiratory tract infection or gastroenteritis. The typical clinical presentation is a progressive symmetrical weakness of proximal and distal muscles of lower limbs leading to gait disturbance and falls. Childhood CIDP in most cases has a relapsing- remitting course. Diagnostic criteria include also demyelinating changes in nerves in the nerve conduction study (NCV) and elevated protein levels without pleocytosis in cerebrospinal fluid. The sural biopsy is no longer recommended in a routine diagnosis. Differential diagnosis includes Guillain-Barré syndrome (GBS), hereditary sensorimotor polyneuropathies, especially Charcot-Marie-Tooth disease (CMT), and polyradiculopathy as a presenting symptom of boreliosis. The first-line treatment is intravenous immunoglobulin (IVIg) and corticosteroids, both of which improve patients’ symptoms quite quickly. The second- line treatment includes IVIg together with corticosteroids, plasma exchange and an immunosuppressive drug, most commonly azathioprine. The childhood CIDP has a good prognosis with a remission or minimal deficits in most cases.

Key words: chronic inflammatory demyelinating polyneuropathy, Guillain- -Barré syndrome, Charcot-Marie-Tooth disease, intravenous immunoglobulin


PIŚMIENNICTWO
[1] 
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: 617–618.
[2] 
Lunn M.P., Manji H., Choudhary P.P., et al.: Chronic inflammatory demy- elinating polyneuropthy a prevalence study in south east England. J Neu- rol Neurosurg Psychiatry 1999; 66: 677–680.
[3] 
McLeod J.G., Pollard J.D., Macaskill P., et al.: Prevalence of chronic in- flammatory demyelinating polyneuropathy in New South Wales, Austra- lia. Ann Neurol 1999; 46: 910–913.
[4] 
Iijima M., Koike H., Hattori N., et al.: Prevalence and incidence rates of chronic inflammatory demyelinating polyneuropathy in the Japanese population. J Neurol Neurosurg Psychiatry 2008; 79: 1040–1043.
[5] 
European Federation of Neurological Societies/Peripheral Nerve Soci- ety Guideline on management of paraproteinemic demyelinating neu- ropathies. Report of a Joint Task Force of the European Federation of Neurological Societies and the Peripheral Nerve Society – first revision. J Peripher Nerv Syst 2010; 15: 185–195.
[6] 
Rajabally Y.A., Simpson B.S., Beri S., et al.: Epidemiologic variability of chronic inflammatory demyelinating polyneuropathy with different diagnostic criteria: study of a UK population. Muscle Nerve 2009; 39: 432–438.
[7] 
McMillan H.J., Kang P.B., Jones H.R., et al.: Childhood chronic inflam- matory demyelinating polyradiculoneuropathy: combined analysis of a large cohort and eleven published series. Neuromuscul Disord 2013; 23: 103–111.
[8] 
Desai J., Ramos-Platt L., Mitchell W.G.: Treatment of pediatric chronic inflammatory demyelinating polyneuropathy: Challenges, controversies and questions. Ann Indian Acad Neurol 2015; 18: 327–330.
[9] 
Ouvrier R.: Peripheral neuropathies in the young child. Rev Neurol (Paris) 2004; 160: 1216–1220.
[10] 
Nevo Y., Pestronk A., Kornberg A.J., et al.: Childhood chronic inflamma- tory demyelinating neuropathies: clinical course and long-term follow- up. Neurology 1996; 47: 98–102.
[11] 
Ubogu E.E.: Inflammatory neuropathies: pathology, molecular markers and targets for specific therapeutic intervention. Acta Neuropathol 2015; 130: 445–468.
[12] 
Rossignol E., D’Anjou G., Lapointe N., et al.: Evolution and treatment of childhood chronic inflammatory polyneuropathy. Pediatr Neurol 2007; 36: 88–94.
[13] 
Ryan M.M., Grattan-Smith P.J., Procopis P.G., et al.: Childhood chronic in- flammatory demyelinating polyneuropathy: clinical course and long-term outcome. Neuromuscul Disord 2000; 10: 398–406.
[14] 
Rodriguez-Casero M.V., Shield L.K., Kornberg A.J.: Subacute inflam- matory demyelinating polyneuropathy in children. Neurology 2005; 64: 1786–1788.
[15] 
Hsu C.Y., Chuang Y.C., Chiu N.C., et al.: Childhood subacute inflammatory demyelinating polyneuropathy. Kaohsiung J Med Sci 2011; 27: 520–523.
[16] 
Oh S.J., Kurokawa K., de Almeida D.F., et al.: Subacute inflammatory demyelinating polyneuropathy. Neurology 2003; 61: 1507–1512.
[17] 
Mathey E.K., Park S.B., Hughes R.A., et al.: Chronic inflammatory demy- elinating polyradiculoneuropathy: from pathology to phenotype. J Neurol Neurosurg Psychiatry 2015; 86: 973–985.
[18] 
Hattori N., Ichimura M., Aoki S., et al.: Clinicopathological features of chronic inflammatory demyelinating polyradiculoneuropathy in child- hood. J Neurol Sci 1998; 154: 66–71.
[19] 
Ware T.L., Kornberg A.J., Rodriguez-Casero M.V., et al.: Childhood chron- ic inflammatory demyelinating polyneuropathy: an overview of 10 cases in the modern era. J Child Neurol 2014; 29: 43–48.
[20] 
McDonald D.G., Farrell M.A., McMenamin J.B.: Focal upper limb neu- ropathy in a child. Eur J Paediatr Neurol 2000; 4: 283–287.
[21] 
Nevo Y.: Childhood chronic inflammatory demyelinating polyneuropathy. Eur J Paediatr Neurol 1998; 2: 169–177.
[22] 
Odaka M., Yuki N., Hirata K.: Patients with chronic inflammatory demy- elinating polyneuropathy initially diagnosed as Guillain-Barré syndrome. J Neurol 2003; 250: 913–916.
[23] 
Rodriguez-Casero M.V., Shield L.K., Coleman L.T., et al.: Childhood chron- ic inflammatory demyelinating polyneuropathy with central nervous sys - tem demyelination resembling multiple sclerosis. Neuromuscul Disord 2003; 13: 158–161.
[24] 
Nevo Y., Topaloglu H.: 88th ENMC international workshop: childhood chronic inflammatory demyelinating polyneuropathy (including revised diagnostic criteria), Naarden, The Netherlands, December 8–10, 2000. Neuromuscul Disord 2002; 12: 195–200.
[25] 
Thaisetthawatkul P., Logigian E.L., Herrmann D.N.: Dispersion of the distal compound muscle action potential as a diagnostic criterion for chronic inflammatory demyelinating polyneuropathy. Neurology 2002; 59: 1526–1532.
[26] 
Molenaar D.S., Vermeulen M., de Haan R.: Diagnostic value of sural nerve biopsy in chronic inflammatory demyelinating polyneuropathy. J Neurol Neurosurg Psychiatry 1998; 64: 84–89.
[27] 
Ryan M.M.: Guillain-Barré syndrome in childhood. J Paediatr Child Health 2005; 41: 237–241.
[28] 
Roodbol J., de Wit M.Y., van den Berg B., et al.: Diagnosis of Guillain- Barré syndrome in children and validation of the Brighton criteria. J Neu- rol 2017; 264: 856–861.
[29] 
Dionne A., Nicolle M.W., Hahn A.F.: Clinical and electrophysiological parameters distinguishing acute-onset chronic inflammatory demyelin- ating polyneuropathy from acute inflammatory demyelinating polyneu- ropathy. Muscle Nerve 2010; 41: 202–207.
[30] 
Ramchandren S., Lewis R.A.: Chronic neuropathies – chronic inflamma- tory demyelinating neuropathy and its variants. Front Neurol Neurosci 2009; 26: 12–25.
[31] 
Mladenovic J., Milic Rasic V., Keckarevic Markovic M., et al.: Epidemiol- ogy of Charcot-Marie-Tooth disease in the population of Belgrade, Ser - bia. Neuroepidemiology 2011; 36: 177–182.
[32] 
Berciano J., García A., Combarros O.: Initial semeiology in children with Charcot-Marie-Tooth disease 1A duplication. Muscle Nerve 2003; 27: 34–39.
[33] 
Baba M., Takada H., Tomiyama M., et al.: Chronic inflammatory demy- elinating polyneuropathy in childhood. No To Shinkei 1993; 45: 233–240.
[34] 
Takada H., Baba M., Nunomura J., et al.: Chronic inflammatory demyelin- ating polyneuropathy in childhood – a case with markedly hypertrophic nerves and pes cavus. Rinsho Shinkeigaku 1993; 33: 36–39.
[35] 
Marques W. Jr., Funayama C.A., Secchin J.B., et al.: Coexistence of two chronic neuropathies in a young child: Charcot-Marie-Tooth disease type 1A and chronic inflammatory demyelinating polyneuropathy. Muscle Nerve 2010; 42: 598–600.
[36] 
Potulska-Chromik A., Ryniewicz B., Aragon-Gawinska K., et al.: Are elec - trophysiological criteria useful in distinguishing childhood demyelinating neuropathies? J Peripher Nerv Syst 2016; 21: 22–26.
[37] 
Connolly A.M.: Chronic inflammatory demyelinating polyneuropathy in childhood. Pediatr Neurol 2001; 24: 177–182.
[38] 
O’Connell S.: Lyme borreliosis: current issues in diagnosis and manage - ment. Curr Opin Infect Dis 2010; 23: 231–235.
[39] 
Pachner A.R., Steiner I.: Lyme neuroborreliosis: infection, immunity, and inflammation. Lancet Neurol 2007; 6: 544–552.
[40] 
Christen H.J.: Lyme neuroborreliosis in children. Ann Med 1996; 28: 235–240.
[41] 
Dudzińska M., Stettner D.: Manifestacje kliniczne neuroboreliozy w ma- teriale Oddziału Neurologii Dziecięcej w Chorzowie. Neur Dziec 2011; 40: 27–33.
[42] 
Vânia Sousa M., Lopes de Carvalho I., Sofia Núncio M., et al.: Meningo - myeloradiculitis as an Unusual Presentation of Neuroborreliosis in Child- hood. Pediatr Infect Dis J 2015; 34: 1132–1133.
[43] 
Pachner A.R., Steere A.C.: Neurological findings of Lyme disease. Yale J Biol Med 1984; 57: 481–483.
[44] 
Moroni I., Bugiani M., Ciano C., et al.: Childhood-onset multifocal motor neuropathy with conduction blocks. Neurology 2006; 66: 922–924.
[45] 
Ramdas S., Prasad M., Spillane K., et al.: Acute motor neuropathy with pure distal involvement – a case report of multifocal motor neuropathy. Eur J Paediatr Neurol 2013; 17: 415–418.
[46] 
Van Asseldonk J.T., Franssen H., Van den Berg-Vos R.M., et al.: Multifo - cal motor neuropathy. Lancet Neurol 2005; 4: 309–319.
[47] 
Shih H., Gartner J.C. Jr.: Weight loss, hypertension, weakness, and limb pain in an 11-year-old boy. J Pediatr 2001; 138: 566–569.
[48] 
Riekhoff A.G., Jadoul C., Mercelis R., et al.: Childhood chronic inflamma- tory demyelinating polyneuroradiculopathy – three cases and a review of the literature. Eur J Paediatr Neurol 2012; 16: 315–331.
[49] 
Sladky J.T.: What is the best initial treatment for childhood chronic in- flammatory demyelinating polyneuropathy: corticosteroids or intrave - nous immunoglobulin? Muscle Nerve 2008; 38: 1638–1643.
[50] 
Obwieszczenie Ministra Zdrowia z dnia 28 sierpnia 2017 r. w sprawie wykazu refundowanych leków, środków spożywczych specjalnego prze - znaczenia żywieniowego oraz wyrobów medycznych: Załącznik B.67. Leczenie przetoczeniami immunoglobulin w chorobach neurologicznych.
[51] 
Eftimov F., Winer J.B., Vermeulen M., et al.: Intravenous immunoglobu- lin for chronic inflammatory demyelinating polyradiculoneuropathy. Co - chrane Database Syst Rev 2013;(12):CD001797.
[52] 
Teasley J.E.: Initial treatment of childhood chronic inflammatory demy- elinating polyradiculoneuropathy. Muscle Nerve 2008; 38: 1640–1643.
[53] 
Rabin M., Mutlu G., Stojkovic T., et al.: Chronic inflammatory demyelin- ating polyradiculoneuropathy: search for factors associated with treat- ment dependence or successful withdrawal. J Neurol Neurosurg Psy- chiatry 2014; 85: 901–906.
[54] 
Ripellino P., Fleetwood T., Cantello R., et al.: Treatment of chronic inflam- matory demyelinating polyneuropathy: from molecular bases to practical considerations. Autoimmune Dis 2014; 2014:201657.
Powrót
 

Most downloaded
Semiologiczna i psychiatryczna charakterystyka dzieci z psychogennymi napadami rzekomopadaczkowymi
Neurol Dziec 2018; 27, 55: 11-14
Autyzm dziecięcy – współczesne spojrzenie
Neurol Dziec 2010; 19, 38: 75-78
Obraz bólów głowy w literaturze pięknej i poezji na podstawie wybranych utworów
Neurol Dziec 2016; 25, 50: 9-17

Article tools
Export Citation
Format:

Scholar Google
Articles by:Łukawska M
Articles by:Potulska-Chromik A
Articles by:Kostera-Pruszczyk A

PubMed
Articles by:Łukawska M
Articles by:Potulska-Chromik A
Articles by:Kostera-Pruszczyk A


Copyright © 2017 by Polskie Towarzystwo Neurologów Dziecięcych