The blood donor plasma carries a small risk of hepatitis and other viruses despite the careful screening process at the Red Cross. Because of this a protein extract of plasma called albumen is usually used as it can be treated to kill viruses. This should be discussed with your doctor. Clinical trials have demonstrated the benefit of plasma exchange for CIDP. For some patients it allows control of the disease to be maintained when immunosuppressive drugs are insufficiently effective. Some patients however do not appear to respond to plasma exchange. For patients who do respond, regular plasma exchange (ie monthly) can help to maintain good function.
Intravenous Immunoglobulin (IVIG)
There is increasing evidence of the effectiveness against CIDP of intravenous (IV) infusions of immunoglobulin (IG) (- also called gammaglobulin or antibodies). Antibodies usually react with and neutralise germs that get into the body. These are 'good' antibodies. Sometimes antibodies attack the body itself and these 'bad' antibodies, or autoantibodies, may cause CIDP. However there are also anti-autoantibodies, which block these bad antibodies. It may be these anti-autoantibodies in immunoglobulin which help.
Whatever the explanation, some people with CIDP do seem to get better after having immunoglobulin. Research is going on to find out which patients. Unfortunately IVIG is often in short supply. IVIG is given by infusion into a vein, usually every day for 5 days. Each infusion takes about 2 hours. The immunoglobulin used in Australia is very safe, but abroad there have been very rare problems with transmission of hepatitis. There is a rare (about 1 in 40,000) risk of serious allergic reaction at the start of each infusion, so careful monitoring is essential. Some patients only need one course. Others need repeated courses. As with plasma exchange, regular (ie monthly) IVIG helps maintain function in some patients.
Physiotherapy has an important role to play in the assessment and management of CIDP. It helps to maximise a patient's physical potential, particularly where weakness is the predominant problem. The aims of physiotherapy are to: maximise muscle strength and minimise muscle wastage by exercise using strengthening techniques; minimise the development of contractures (or stiffness) around joints; a physiotherapist can advise on passive stretching techniques to help maintain full range movement at joints; facilitate mobility and function; sometimes, if muscles are very weak, function can be improved by the use of splints and provide a physical assessment which may help in planning future management.
Living with CIDP, Coping with Uncertainty
CIDP may follow a pattern of relapses and remissions or a more gradual increase in symptoms. During a relapse new symptoms may occur or old symptoms that had previously subsided may reoccur. Relapses can last for several months and may be relatively slight or quite severe. A remission occurs when the symptoms experienced during the relapse disappear either partially or completely for a period of time that may last weeks, months or even years.