Doctor's Notes

Impression: I agree with Dr. Glenn that the patient’s 4-5 month course of slow progression of primarily demyelinating sensory motor neuropathy, confirmed by EMG/NCS, is most consistent with CIDP. Lumbar puncture with CSF analysis is needed for the diagnosis. She has minimal motor involvement but is very uncomfortable from sensory involvement. As she has diabetes mellitus, obesity and hypertension, high dose steroids are probably a second line choice, although overall a little more effective than other immunotherapy. I recommend IV ig, should CSF prove consistent with the diagnosis (very high CSF protein with minimal WBC increase). I would give 2gm/kg in 3-4 days, then 0.5 gm/kg IV q.2 weeks x 3 months, then taper if possible. Discontinue Neurontin due to weight gain, although it probably has helped (she can now wiggle her toes comfortably), consider Trileptal.

Plan: The patient is interested in proceeding with LP. This is scheduled under fluoroscopy at Rex next week. She will taper Neurontin and start Trileptal, gradually increase up to 450 mg b.i.d. if needed, then check a level and sodium. Follow-up 2 weeks, she will probably have had her initial Iv ig.