Effectiveness of Repeat Inpatient Rehabilitation Admissions in Chronic Inflammatory Demyelinating Polyneuropathy: A Case Report

Case Diagnosis: A 69-year-old male with chronic inflammatory demyelinating polyneuropathy (CIDP).

Case Description or Program Description: The patient presented with progressive ascending quadriparesis and diffuse sensory loss of 2-days duration with no reported recent illness or vaccination. After presumed diagnosis of Guillain-Barre syndrome, intravenous immunoglobulin (IVIG), gabapentin, and a 5-day course of oral methylprednisolone was administered. One week later, the patient experienced worsening quadriparesis without respiratory failure and was subsequently transferred to the intensive care unit for close monitoring. Physical exam revealed 0/5 strength in the bilateral upper and lower extremities and impaired sensation to light touch inferior to the T3 dermatome. Lumbar puncture and sural nerve biopsy are performed and reveal albuminocytologic dissociation and demyelination with macrophage-mediated inflammation, consistent with diagnosis of CIDP. The patient underwent a total of seven rounds of IVIG and nine repeat admissions to inpatient rehabilitation over an 18-month period.

Setting: Inpatient rehabilitation hospital.

Assessment/Results: Frequent IVIG and physical and occupational therapy (PT/OT) resulted in strength improvement to ⅗ in proximal and ⅖ in distal bilateral upper and lower extremities without recovery in sensation. The patient progressed to moderate-minimal assistance in activities of daily living and was beginning to ambulate with knee-ankle-foot orthotics.

Discussion (relevance): First-line treatment for CIDP has been strongly established as plasmapheresis or IVIG, immunosuppressant therapy, and routine PT/OT. Though research has been conducted investigating therapeutic immunosuppressant dosing and plasmapheresis/IVIG regularity, the current literature fails to specify the frequency and setting of PT/OT. To the author’s knowledge, no studies have compared the effectiveness of repeat inpatient rehabilitation admissions to outpatient PT/OT in the recovery of CIDP.

Conclusions: CIDP is a debilitating neurologic condition requiring treatment from a multi-disciplinary team of physicians and therapists. Further research comparing the efficacy of PT/OT in inpatient rehabilitation, skilled nursing, and outpatient facilities are required to enhance therapy recommendations in CIDP patients.