Pulse steroids for cidp

The most common mononeuropathies are due to entrapment of nerves at anatomically vulnerable sites. These sites include places where nerves pass through tight canals in the tissues or where they are surrounded by hard tissues or subject to repeated pressure or motions that stress the nerve. The most common entrapment neuropathy is carpal tunnel syndrome (CTS), which is an entrapment neuropathy that produces chronic damage to the median nerve at the wrist. Anything that compromises the volume of the carpal tunnel (congenitally small carpal tunnel; thickening of the ligaments; disruption or swelling of the joint; inflammation of the synovium) can promote CTS. A controversial subject is how much occupational activities (such as typing) contribute to symptoms. The symptoms of CTS include decreased sensation in the radial digits (sparing the palm) along with potential dysesthesias provoked by wrist position (including at night). There may be weakness in thumb abduction and opposition (often with some clumsiness) and atrophy of the thenar muscles. Pain is common, but is less predictable and the distribution may be well beyond the distribution of the median nerve, especially in the wrist and up the forearm to the elbow or even the shoulder.

Background   Chronic inflammatory demyelinating polyneuropathy (CIDP) is an immune-mediated neuropathy that responds to various immunosuppressive treatments. Oral daily prednisone therapy is effective and inexpensive, but the long-term treatment that is usually necessary leads to serious adverse effects. Consequently, intravenous immunoglobulin and plasma exchange have been widely used to treat CIDP, making treatment expensive and inconvenient. A steroid regimen that reduces adverse effects but preserves efficacy would simplify treatment. Pulsed steroids have nongenomic actions not seen with low-dose steroids, including rapid inhibition of arachidonic acid release and of calcium and sodium cycling across plasma membranes of immune cells.

My neuro. has had me on pulse steroids since the beginning. When I was first dx’d. he tried IVIG but that didnt seem to work so he put me on a regimin of 500mg. solumedrol via iv twice a week, then after 2 months switched me over to 500 mg methylprednisilone twice a week and is now trying to ween me down slowly, am now doing 320mg twice a week with his goal being to ween me down to just under 200mg twice a week sometime in july, which is when I see him again. The side effects are starting to pile up, mainly weight gain, moon face and sometimes horrible insomnia but the trade off is that in 7 months time I am back to about 85 to 90% of my pre CIDP abilities, so I guess that the trade off is worth it…at least so far.

The link between the nervous and immune systems also is important. Cytokines, a group of proteins found in the nervous system, are also part of the immune system—the body's shield for fighting off disease and responding to tissue injury. Cytokines can trigger pain by promoting inflammation, even in the absence of injury or damage. After trauma, cytokine levels rise in the brain and spinal cord and at the site where the injury occurred. Improvements in our understanding of the precise role of cytokines in producing pain may lead to new classes of drugs that can block the action of these substances to produce analgesia.

Pulse steroids for cidp

pulse steroids for cidp

The link between the nervous and immune systems also is important. Cytokines, a group of proteins found in the nervous system, are also part of the immune system—the body's shield for fighting off disease and responding to tissue injury. Cytokines can trigger pain by promoting inflammation, even in the absence of injury or damage. After trauma, cytokine levels rise in the brain and spinal cord and at the site where the injury occurred. Improvements in our understanding of the precise role of cytokines in producing pain may lead to new classes of drugs that can block the action of these substances to produce analgesia.

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