Kronik İnflamatuvar Demiyelinizan Polinöropati Tedavisi
Özet
Kronik İnflamatuvar Demiyelinizan Polinöropati (Chronic Inflammatory Demyelinating Polyneuropathy-CIDP), edinilmiş polinöropatiler içinde sınıflandırılan, 40-60 yaş arası ve erkeklerde daha sık izlenen bir periferik nöropati türüdür. Klinik olarak en az iki aydır progresif şekilde var olan, distal ve proksimal kasları eşit şekilde etkileyen, simetrik motor güçsüzlük ile karakterizedir. Duyusal olarak ise vibrasyon ve eklem pozisyon duyusu gibi derin duyularda, yüzeyel duyulara nazaran daha baskın tutulum görülür. Vakaların %60’ı tipik CIDP ile gelirken geri kalan formlarda atipik özellikler izlenebilir. Teşhisinde anamnez, klinik muayene ve elektrofizyolojik çalışmalar çok önemlidir. Klinik ve elektrofizyolojik tanı kriterleri belirlenmiştir. Tedavisi ile ilgili bugün için sınırlar büyük oranda belirlenmiştir. Tedavi indüksiyon ve idame tedavisi olarak ikiye ayrılır. Her ikisi için de birinci basamak tedavide intravenöz immunoglobülin (IVIG) ve kortikosteroidler kullanılır. Bu tedaviye yanıt vermeyen vakalarda, kontrendikasyon ve/veya yan etki gelişen hastalarda plazma değişim tedavisi kullanılır. Bu üç tedaviye yanıt vermeyen hastalarda etkinlikleri belirsiz olsa da diğer immünsüpresifler kullanılabilir. Tüm tedavilere yanıtsız vakalarda tanı mutlaka gözden geçirilmelidir.
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