CIDP Vaccine Injuries 

What is Chronic inflammatory demyelinating polyneuropathy (CIDP)?

The influenza vaccine has been strongly linked as a cause of GBS and since GBS and CIDP are part of the same family of disease, many cases of CIDP have been compensated in the United States Court of Federal Claims.

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a neurological disorder characterized by progressive weakness and impaired sensory function in the legs and arms. The disorder, which is sometimes called chronic relapsing polyneuropathy, is caused by damage to the myelin sheath (the fatty covering that wraps around and protects nerve fibers) of the peripheral nerves.

Although it can occur at any age and in both genders, CIDP is more common in young adults, and in men more so than women. It often presents with symptoms that include tingling or numbness (beginning in the toes and fingers), weakness of the arms and legs, loss of deep tendon reflexes (areflexia), fatigue, and abnormal sensations.  CIDP is closely related to Guillain-Barre syndrome and it is considered the chronic counterpart of that acute disease.  

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a slowly developing autoimmune disorder in which the body's immune system attacks the myelin that insulates and protects your body’s nerves. The exact cause is not known.  Common symptoms are gradual weakness or sensation changes in the arms or legs, all of which may get worse over time, or may be intermittent. Early treatment with immunosuppressive medications is important to limit disease progression.

What is the prognosis?

The course of CIDP varies widely among individuals. Some may have a bout of CIDP followed by spontaneous recovery, while others may have many bouts with partial recovery in between relapses. The disease is a treatable cause of acquired neuropathy and initiation of early treatment to prevent loss of nerve axons is recommended. However, some individuals are left with some residual numbness or weakness.

How is CIDP diagnosed?

Because CIDP is rare, it’s often hard to correctly diagnose the disease, at least at first. Healthcare providers can confuse its symptoms with those of GBS, because of the similarity between the diseases. If symptoms last longer than 8 weeks, your healthcare provider may suspect CIDP.  After taking your medical history and doing a physical exam, your healthcare provider may do other tests to confirm a diagnosis including: 

  • blood and urine tests

  • a Nerve Conduction Study to look for myelin damage in peripheral nerves. This test is sometimes called an electromyogram (EMG). It involves using low electrical currents to test nerve function and response.

  • a lumbar puncture where a small needle is inserted into your back and a sample of your cerebrospinal fluid (CSF) is withdrawn. CSF is the fluid that surrounds your spinal cord. The procedure helps healthcare providers detect elevated levels of certain proteins related to the disease.

What treatment is available?

Treatment for CIDP includes corticosteroids such as prednisone, which may be prescribed alone or in combination with immunosuppressant drugs. Plasmapheresis (plasma exchange) and intravenous immunoglobulin (IVIg) therapy are effective. IVIg may be used even as a first-line therapy. Physiotherapy may improve muscle strength, function and mobility, and minimize the shrinkage of muscles and tendons and distortions of the joints.

How does Guillain-Barré Syndrome (GBS) differ from CIDP?

CIDP is distinguished from Guillain-Barré Syndrome (GBS) by time course and steroid responsiveness. Unlike GBS, CIDP typically has a slower course and can often times take up to 8 weeks to achieve peak weakness.  GBS, on the other hands, has a rapid onset of ascending paralysis, which can occur in a matter of days and has a peak weakness in less than four weeks after onset. Some CIDP patients may have a more acute onset and may present as multiple occurrences of GBS with ventilator failure. Typically, most patients present with weakness, both proximal and distal, paresthesias, and sensory loss that may be slowly progressive or have a more relapsing/remitting course.

Can CIDP be caused by vaccines?

CIDP is often considered the “chronic” version of GBS and is part of the same family of autoimmune diseases.  The influenza vaccine has been strongly linked as a cause of GBS and since GBS and CIDP are part of the same family of disease, many cases of CIDP have been compensated in the United States Court of Federal Claims.  Other vaccines associated with CIDP include the Hepatitis A, Hepatitis B, tetanus, TDaP, and MMR vaccines.


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Sources:

  1. https://www.ninds.nih.gov/Disorders/All-Disorders/Chronic-Inflammatory-Demyelinating-Polyneuropathy-CIDP-Information-Page

  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4845954/