Confirm acquired demyelination before committing to long-term treatment
CIDP can be over- or under-diagnosed because weakness, numbness and abnormal nerve studies have many causes. Charité has a dedicated clinic for immune-mediated neuropathies including CIDP. Freiburg emphasizes the importance of early diagnostic confirmation, while Heidelberg's neurophysiology pathway uses sufficiently extensive electrophysiological testing to evaluate CIDP criteria.
- Pattern and duration of motor and sensory symptoms
- Neurological examination including strength and reflexes
- Motor and sensory nerve-conduction studies
- EMG when clinically relevant
- Review of previous studies to determine whether abnormalities are truly demyelinating
- Assessment for atypical or focal CIDP variants when the pattern is not classic
Supportive tests help exclude mimics and define the subtype
Electrophysiology is central, but supportive testing can strengthen or challenge the diagnosis. Freiburg lists CSF, selected antibody testing, nerve ultrasound or MRI and, in unusual cases, biopsy as possible supportive tools. Heidelberg's SOP includes CSF and paraprotein evaluation because monoclonal gammopathies and other disorders can resemble or modify the CIDP pathway.
- CSF protein and cell-count assessment when indicated
- Serum protein electrophoresis and immunofixation
- Selected testing for paraproteinemic or autoimmune neuropathies
- Nerve ultrasound or MR neurography in selected cases
- Diabetes, vitamin deficiency, toxic, hereditary and amyloid neuropathy review
- Nodal/paranodal antibody evaluation in selected atypical or treatment-refractory cases
IVIG or SCIG can be part of induction and maintenance therapy
Freiburg's current immunoneuropathy teaching material lists intravenous immunoglobulin and subcutaneous immunoglobulin among established CIDP treatment options. The exact regimen depends on disease severity, prior response, tolerability and whether the goal is induction or maintenance. Response should be assessed with objective strength and disability measures rather than symptoms alone.
Corticosteroids are another established treatment pathway
Corticosteroid strategies are also used for CIDP. The choice between immunoglobulin and steroid-based treatment depends on the phenotype, comorbidities, speed of response required, previous adverse effects and long-term management plan. A second opinion is especially useful when prolonged steroid exposure is causing complications or when the expected treatment response is unclear.
Plasma exchange and other escalation strategies are selected, not routine for everyone
For severe, refractory or diagnostically complex immune neuropathies, specialist centers may consider plasma exchange or immunoadsorption and, in selected subtypes, other immunotherapies. Freiburg's material separates these escalation approaches from standard maintenance treatment. The diagnosis should be revisited before labeling a patient 'refractory CIDP', particularly when repeated IVIG or steroids have produced no objective improvement.
Measure treatment response objectively
Heidelberg's CIDP SOP specifically emphasizes documenting muscle strength before and after treatment. Long-term management should track function using reproducible measures such as strength testing, walking ability, hand function and validated disability scores. This helps distinguish true treatment response from day-to-day symptom fluctuation and supports dose-spacing or treatment-change decisions.
CIDP and acute Guillain–Barré syndrome are not the same travel scenario
CIDP is usually chronic or relapsing and can often be reviewed electively when the patient is stable. Rapid progression over days, new inability to walk, facial or bulbar weakness, breathing difficulty or autonomic instability raises concern for an acute inflammatory neuropathy or another emergency. Those symptoms require immediate local assessment and should not wait for international travel arrangements.
What to send for a German CIDP second opinion
The most useful record package shows why CIDP was diagnosed and whether previous treatment produced objective benefit.
- Neurology and neuromuscular-clinic reports
- All nerve-conduction and EMG reports, preferably including the original measurements when available
- CSF results
- Serum electrophoresis, immunofixation and relevant antibody results
- MRI or nerve-ultrasound reports and images if performed
- Current and previous IVIG/SCIG schedules
- Corticosteroid and other immunotherapy history
- Objective strength, walking or disability scores before and after treatment
- A specific question: confirm CIDP, review a variant, assess treatment response or plan long-term therapy
Official sources
Sources last checked 2026-09-01. Clinical pathways, eligibility and hospital procedures can change; confirm current requirements directly with the treating center.
- Immune-mediated neuropathies / CIDP outpatient clinic — Charité – Universitätsmedizin Berlin ↗
- Inflammatory diseases of the peripheral nervous system — University Medical Center Freiburg ↗
- Immunoneuropathies – diagnosis and treatment options — University Medical Center Freiburg ↗
- Electrophysiology SOP – CIDP — Heidelberg University Hospital ↗