CIDP is both over- and underdiagnosed due to several factors, particularly in nonspecialist settings1,2
In a retrospective analysis of 112 adult patients,* nearly one-third of referred chronic inflammatory demyelinating polyneuropathy (CIDP) cases were misdiagnosed, while 20% (n=16) of confirmed cases were initially missed1
- The symptoms of CIDP are shared with other, more common diseases3
- Applying a broader category to specific symptoms (eg, classifying fatigue as weakness or pain as sensory loss) may lead to misdiagnosis3
- Numbness and/or weakness should be present for a diagnosis of CIDP to be correct3
- Diagnostic criteria, such as the guidelines developed by European Academy of Neurology/Peripheral Nerve Society (EAN/PNS), have not been widely adopted into clinical practice3
- CIDP includes several variants that may be confused with other disorders3
- There are no validated biomarkers to rule CIDP in or out. Instead, neurologists must analyze a large field of data, including the patient’s health history, physical assessments, and electrophysiologic studies3
The diagnostic journey for CIDP follows several key steps4:
- Mandatory electrodiagnostic testing, with nerve conduction studies providing the primary evidence of demyelination required to confirm the diagnosis and classify the presentation as typical CIDP or one of its recognized variants
- Supportive investigations where electrodiagnostic criteria are not met, including cerebrospinal fluid analysis, nerve ultrasound or magnetic resonance imaging, nerve biopsy, or a treatment trial with objective outcome assessment, may be used to reach a diagnosis
- Consideration of nodal and paranodal antibody testing where specific clinical features are present to identify autoimmune nodopathies, which are distinct from CIDP and respond differently to treatment
*A retrospective study conducted at a tertiary academic hospital in the Netherlands (2011 to 2017) evaluating CIDP over- and underdiagnosis in 112 adult patients using EFNS/PNS 2010 criteria. Limitations included retrospective design, potential referral-center bias, and limited reliability of classifications of objective improvement.1
References: 1. Broers MC, Bunschoten C, Drenthen J, et al. Eur J Neurol. 2021;28:2065-2073. doi:10.1111/ene.14796 2. Arvin-Berod C, Brackx F, Van de Veire L, et al. Front Neurol. 2026;16:1748903. doi:10.3389/fneur.2025.1748903 3. Allen JA. Neurol Ther. 2020;9(1):43-54. doi:10.1007/s40120-020-00184-6 4. Van den Bergh PYK, van Doorn PA, Hadden RDM, et al. Eur J Neurol. 2021;28:3556-3583. doi:10.1111/ene.14959