Peripheral Neuropathies: Experience with Large Multicentre Trials

Abstract

Peripheral neuropathies pose a peculiar challenge in assessing response to therapeutic interventions. Superficially, one would expect it to be a simple matter to assess the presence or lack of response to any intervention in peripheral neuropathies. After all, the peripheral nervous system is readily available to examination by both non-invasive and invasive tests. Experience has proved this to be a false expectation when dealing with chronic axonal neuropathies. For the most part, no therapy is available for these neuropathies. Generally, the elimination of cause (e.g. toxic drug) or minimisation of metabolic derangement (e.g. impaired glycaemic control) are the only therapies available for chronic neuropathies. As more therapeutic interventions are proposed (e.g. aldose reductase inhibitors in diabetic polyneuropathy, nerve growth factor for small-fibre neuropathies), accurate methods of assessing response are essential. In the case of autoimmune neuropathies — e.g. acute inflammatory demyelinating polyneuropathy (AIDP), chronic inflammatory demyelinating polyneuropathy (CIDP) — positive clinical and electrophysiological therapeutic responses are shown more readily, and successful therapies are available.