Chronic relapsing polyneuropathy is the older name for a disease that doctors now usually call chronic inflammatory demyelinating polyneuropathy (CIDP). It is a long-lasting nerve disease in which the body’s immune system attacks the “myelin” coat that covers peripheral nerves in the arms and legs. This damage slows or blocks nerve signals and causes slowly worsening weakness, numbness, and other nerve symptoms over at least eight weeks.
Chronic relapsing polyneuropathy is an older name often used for chronic inflammatory demyelinating polyneuropathy (CIDP). In this condition, the body’s own immune system attacks the myelin, the fatty coating around the peripheral nerves in the arms and legs. When myelin is damaged, nerve signals travel slowly or get blocked, which causes weakness, numbness, tingling, and trouble walking. The word “chronic” means symptoms last at least 8 weeks, and “relapsing” means symptoms improve, then come back again in flares. CIDP is rare but treatable, and early, continuous care can reduce disability and help protect nerves over time.
In simple words, chronic relapsing polyneuropathy is a chronic, often relapsing autoimmune nerve disease. “Chronic” means it lasts for a long time. “Relapsing” means symptoms can get worse, then partly improve, then get worse again. Many people need long-term follow-up and treatment to prevent permanent nerve damage.
Other names
Doctors and books use several other names for the same or very closely related condition:
Chronic inflammatory demyelinating polyneuropathy (CIDP)
Chronic inflammatory demyelinating polyradiculoneuropathy
Chronic relapsing (dysimmune) polyneuropathy
These names all describe an acquired autoimmune disease of the peripheral nerves with demyelination, high spinal-fluid protein, and very slow nerve conduction on tests.
How the disease happens
In a healthy person, myelin works like the plastic around an electric wire, helping nerve signals move quickly and smoothly to muscles and skin. In chronic relapsing polyneuropathy, immune cells that should protect the body instead attack this myelin on peripheral nerves. This is an autoimmune reaction.
When myelin is damaged, signals from the brain to the muscles and from the skin back to the brain become weak, slow, or blocked. Over time, this causes weakness, loss of feeling, loss of reflexes, poor balance, and tiredness. If inflammation lasts for a long time, the nerve fiber itself can also be injured, which makes recovery slower and sometimes incomplete.
Types
Doctors often talk about “typical” CIDP and several “atypical” or variant forms. All can have a chronic or relapsing course.
Typical (classical) CIDP – This is the most common type. It causes symmetrical weakness and sensory loss in both arms and both legs, affecting muscles near the trunk and far from the trunk.
Relapsing–remitting CIDP – In this type, symptoms get worse for weeks or months, then improve partly after treatment or on their own, and then flare again. Many people who say “chronic relapsing polyneuropathy” are describing this pattern.
Progressive CIDP – Here symptoms slowly get worse over months or years without clear relapses and remissions. It is still the same disease, but with a steady course instead of ups and downs.
Distal acquired demyelinating symmetric neuropathy (DADS) – This variant mainly affects the feet and hands first, with numbness and imbalance more than weakness. It is often linked to IgM monoclonal proteins and sometimes anti-MAG antibodies.
Lewis–Sumner syndrome / multifocal acquired demyelinating sensory and motor neuropathy (MADSAM) – This type affects nerves in a patchy, uneven way, often starting in one arm or hand. It can cause asymmetric weakness and sensory loss.
Pure motor CIDP – In this form, weakness is the main problem and there is little or no sensory loss. It mainly affects motor fibers of the nerves.
Pure sensory CIDP / chronic immune sensory polyradiculopathy – Here numbness, tingling, and balance problems are the main symptoms, with very little weakness. Nerve tests may show problems mostly in sensory nerves or roots.
Focal CIDP – This variant affects one limb or one nerve group, such as the brachial plexus, with imaging sometimes showing enlargement and inflammation in that area.
CIDP with diabetes or other systemic disease – Some patients have CIDP as well as diabetes, lupus, HIV, or other illnesses. In these people, doctors may call it “CIDP with diabetes” or “CIDP with lupus,” and they must separate it from neuropathy caused directly by those diseases.
CIDP with paraproteinemia / MGUS-associated CIDP – In some patients, CIDP appears together with monoclonal gammopathy of undetermined significance (MGUS) or other blood conditions. These patients often have DADS-like symptoms and special antibodies, and may respond differently to treatment.
All these patterns share the same core idea: an immune-mediated, often treatable demyelinating neuropathy, with a chronic or relapsing course.
Causes
For many people, the exact cause of chronic relapsing polyneuropathy is unknown, so doctors call it “idiopathic.” The main process is an autoimmune attack against myelin in peripheral nerves, but what starts that attack can differ from person to person.
Primary autoimmune reaction against myelin – In most cases, the immune system mistakenly sees myelin as foreign and attacks it, leading to demyelination and relapsing inflammation of peripheral nerves.
Preceding respiratory infection – Some people report a recent cough, cold, or other respiratory infection before symptoms start. These infections may “wake up” the immune system and trigger it to attack nerves by molecular mimicry.
Preceding gastrointestinal infection – Diarrhea or stomach infections have also been reported before the onset of CIDP in some patients, again suggesting immune stimulation by microbes that somewhat resemble nerve tissue.
Association with diabetes mellitus – Research shows that CIDP can appear more often in people with diabetes, and some groups describe “CIDP with diabetes” as a specific form. High blood sugar itself causes neuropathy, so doctors must carefully separate diabetic neuropathy from superimposed CIDP.
Systemic lupus erythematosus (SLE) – Lupus is a systemic autoimmune disease that can affect nerves. Reviews describe CIDP occurring in patients with lupus, probably because the immune system in these people is already misdirected and may also target peripheral nerves.
HIV infection – HIV can cause several neuropathies. CIDP-like demyelinating neuropathy has been reported across all stages of HIV infection, making HIV an important associated condition and possible trigger.
Hepatitis B infection – People with chronic hepatitis B can develop immune-mediated neuropathies, including CIDP, likely due to chronic immune activation and circulating immune complexes.
Hepatitis C infection – Hepatitis C is also linked with mixed cryoglobulinemia and autoimmune neuropathies. Case series show CIDP occurring in patients with hepatitis C and other immune-mediated complications.
Other autoimmune diseases (for example autoimmune thyroid disease) – People who already have one autoimmune disease are more likely to have another. Autoimmune thyroid problems and similar conditions are reported more often in patients with CIDP than in the general population.
Monoclonal gammopathy of undetermined significance (MGUS) – MGUS is a blood condition with a single abnormal antibody. It can be associated with CIDP and DADS-type neuropathy, especially when the abnormal protein is IgM.
Other paraproteinemias (including Waldenström macroglobulinemia and POEMS) – Some lymphoid cancers and plasma-cell disorders produce abnormal antibodies that can attack myelin or related proteins, leading to CIDP-like neuropathy.
Autoantibodies to nodal and paranodal proteins – In some patients, antibodies against proteins such as neurofascin-155 or contactin 1 have been found. These target the node of Ranvier and paranodal regions and can cause a form of autoimmune nodopathy with chronic demyelinating neuropathy.
Pregnancy-related immune changes – Pregnancy has been reported as a risk period for relapses in CIDP, probably because the immune system changes to support the fetus and can become unstable in people with existing autoimmune tendencies.
Chronic inflammatory or rheumatologic diseases – Conditions such as rheumatoid arthritis or mixed connective-tissue disease sometimes coexist with CIDP, again suggesting that long-standing systemic inflammation can help trigger or maintain autoimmune neuropathies.
Malignancies (for example non-Hodgkin lymphoma) – Some patients with lymphoma or other blood cancers develop chronic demyelinating neuropathy. In these cases, the cancer or its immune effects may act as a trigger.
Long-standing immune stimulation by chronic infection – Chronic infections (such as long-term viral infections) can keep the immune system activated. Reviews of associated diseases note that persistent immune activation is one of the suspected drivers of CIDP in some patients.
Genetic susceptibility (immune-system genes) – CIDP is not a simple inherited disease, but small studies suggest that some people may carry immune-system genes that make them more likely to develop autoimmune neuropathies when triggered by infections or other events.
Acute-onset CIDP after Guillain–Barré-like illness – A small group of patients first look like they have Guillain–Barré syndrome but later show a chronic or relapsing course and are reclassified as CIDP. The initial acute immune attack may “switch” into a chronic pattern.
Lifestyle and vascular risk factors (such as hypertension or unhealthy diet) – Some work from large databases suggests that vascular risk factors, obesity, and lifestyle habits might be more common in CIDP patients, but this link is still being studied and is not fully proven.
Unknown or idiopathic causes – In many people, no infection, disease, or special trigger can be found. For these cases, doctors simply say the cause is idiopathic, meaning unknown, and focus on treating the immune attack and protecting the nerves.
Symptoms
Gradual weakness in the legs – One of the most common early signs is slowly increasing weakness in the thighs and lower legs. People may find it harder to climb stairs, stand from a chair, or walk long distances.
Weakness in the arms and hands – Over time, weakness often spreads to the arms. Simple tasks such as lifting objects, turning keys, or buttoning clothes may become difficult.
Numbness in feet and hands – Many people feel “dead,” “wooden,” or numb areas in the toes and feet first, then in the fingers and hands, because sensory fibers are affected.
Tingling or “pins and needles” sensations – Tingling, buzzing, or electric feelings in the feet and hands are very common. These abnormal sensations are called paresthesias and come from faulty sensory signaling.
Loss of reflexes (areflexia or hyporeflexia) – When a doctor taps the knee or ankle tendon, the normal “kick” response may be weak or absent. This is a hallmark sign of demyelinating polyneuropathy.
Poor balance and unsteady walking – Because the brain receives poor information from feet and legs, people may feel wobbly, especially in the dark or when they close their eyes. They may sway or stumble and feel unsafe when walking.
Frequent falls or tripping – Weakness in ankle muscles and poor sensation in the feet can cause tripping over small obstacles and falls, which is a major concern, especially in older adults.
Foot drop – Some people develop weakness in the muscles that lift the front of the foot, so the toes drag when walking. This “foot drop” makes walking tiring and unsafe.
Hand clumsiness and poor fine motor skills – Writing, using cutlery, typing, or fastening small buttons may become slow and clumsy because of weakness and numbness in the hands.
Neuropathic pain or burning – Some people feel burning, stabbing, or aching pain in the feet, legs, or hands. This pain comes from irritated or damaged sensory fibers.
Muscle cramps and fatigue – Long-standing nerve damage can lead to muscle cramps, twitching, and strong tiredness, especially after activity, because muscles are not receiving clear nerve signals.
Difficulty rising from sitting or squatting – Weakness of thigh and hip muscles makes it hard to stand up without using the arms. People may notice this when getting off the toilet or out of a low chair.
Problems with coordination – When deep sensory fibers are affected, people may have difficulty placing their feet accurately, mis-step on stairs, or need to look at their feet to walk safely.
Autonomic symptoms (in some patients) – A few people may report dizziness when standing up, changes in sweating, or bowel and bladder changes. These are less common but can occur if autonomic fibers are involved.
Relapsing pattern of symptoms – In chronic relapsing forms, symptoms may worsen over weeks, then partly improve after treatment or spontaneously, and then return. Recognizing this pattern helps doctors suspect chronic relapsing polyneuropathy.
Diagnostic tests
Doctors diagnose chronic relapsing polyneuropathy by combining history, examination, nerve tests, fluid and blood tests, and sometimes imaging or biopsy. No single test is enough by itself, so guidelines recommend a step-by-step approach.
Physical examination
Full neurological examination – The neurologist looks at strength, sensation, reflexes, coordination, and gait. A pattern of symmetrical weakness and sensory loss in arms and legs, with reduced or absent reflexes, strongly suggests CIDP rather than many other neuropathies.
Reflex testing with a tendon hammer – The doctor taps the knees, ankles, and other tendons. In chronic relapsing polyneuropathy, these deep tendon reflexes are usually low or absent because the demyelinated nerves do not conduct the reflex signal properly.
Sensory examination for touch, pain, and temperature – Using cotton, a pin, or a cold object, the doctor tests whether the patient can feel light touch, pinprick, and temperature. Reduced sensation in a “stocking-glove” pattern fits with polyneuropathy.
Coordination and gait assessment – The patient is asked to walk, turn, stand on heels or toes, and sometimes walk heel-to-toe. The doctor looks for unsteady gait, wide stance, and difficulty with these tasks, which reflect sensory loss and weakness.
Manual (bedside) tests
Manual muscle testing (MRC grading) – The doctor pushes against the patient’s arms and legs to see how strong different muscle groups are. Strength is graded on a simple scale. In CIDP, many proximal and distal muscles can be weak, often on both sides.
Romberg test – The patient stands with feet together, first with eyes open and then closed. If balance worsens greatly when the eyes close, it suggests impaired position sense from large-fiber neuropathy, which is common in CIDP.
Gait and timed walking tests – Simple timed walking or “get up and go” tests help measure how much weakness and imbalance are affecting daily mobility, and they provide a baseline to follow response to treatment.
Vibration and joint-position testing with tuning fork – A tuning fork is placed on toes and ankles, and the doctor asks whether the patient feels vibration and joint movements. Loss of vibration is typical in demyelinating neuropathies and supports the diagnosis.
Laboratory and pathological tests
Cerebrospinal fluid (CSF) analysis via lumbar puncture – A spinal tap is done to measure protein and cell count in the fluid around the spinal cord. In about 85–90% of CIDP cases, protein is high but white blood cells are normal or low, called “albuminocytologic dissociation.”
Blood glucose and HbA1c testing – These tests look for diabetes or pre-diabetes, because diabetes is a common alternative cause of neuropathy and may coexist with CIDP. Knowing this helps doctors interpret symptoms and plan treatment.
Serum protein electrophoresis and immunofixation – These blood tests look for monoclonal proteins (paraproteins) such as IgM or IgG peaks. Finding a paraprotein may point toward MGUS-associated CIDP or other paraproteinemic neuropathies.
Autoimmune blood tests (ANA and related panels) – Tests like ANA and ENA panels help detect lupus and other autoimmune diseases that are sometimes associated with CIDP. This can change both diagnosis and treatment choices.
Sural nerve biopsy – A surgeon removes a tiny piece of a sensory nerve at the ankle. Under the microscope, CIDP often shows segmental demyelination, reduced myelinated fibers, inflammation, and sometimes “onion bulb” formations. Biopsy is mainly used when the diagnosis is uncertain.
Electrodiagnostic tests
Motor nerve conduction studies – Small electric shocks are applied to nerves and responses are recorded from muscles. In chronic relapsing polyneuropathy, motor nerve conduction is often slow, with prolonged distal latencies, reduced conduction velocity, and sometimes conduction block or temporal dispersion, all signs of demyelination.
Sensory nerve conduction studies – Similar tests record sensory nerve action potentials. Reduced amplitude and slowed conduction, especially in multiple nerves, support a diagnosis of CIDP and help separate it from purely axonal neuropathies.
Needle electromyography (EMG) – A fine needle electrode is inserted into muscles to look for signs of chronic denervation and reinnervation. In CIDP, EMG often shows a pattern consistent with demyelinating neuropathy and sometimes secondary axonal loss.
F-wave and late response studies – Special parts of nerve conduction testing, such as F-waves, help assess conduction along the whole length of motor nerves including roots. Prolonged or absent F-waves are common in demyelinating polyradiculoneuropathy.
Imaging tests
MRI of spinal nerve roots and cauda equina with contrast – MRI can show thickened, enhancing nerve roots in the lower spine or cauda equina, which supports an inflammatory demyelinating process and helps rule out tumors or other structural problems.
MRI of brachial or lumbosacral plexus – In focal or asymmetric cases, MRI of the nerve plexuses in the shoulder or pelvic region can show nerve enlargement and inflammation that match the symptoms.
Peripheral nerve ultrasound – High-resolution ultrasound can visualize large peripheral nerves. In some CIDP patients, ultrasound shows nerve swelling or changes in echotexture and is used as supportive evidence when other tests are unclear.
Non-pharmacological treatments (therapies and other approaches)
1. Supervised physical therapy
A physical therapist creates a safe exercise plan to keep muscles as strong and flexible as possible. The therapist works on walking, balance, standing up, and getting in and out of bed or chairs. The goal is “low, slow, and steady” exercise, not over-training. Gentle, regular movement can reduce fatigue, help circulation, and support nerve healing. It also lowers the risk of falls and joint stiffness, which are common in chronic relapsing polyneuropathy.
2. Occupational therapy (OT)
Occupational therapists help you manage daily activities like dressing, bathing, cooking, and work tasks. They suggest easier ways to do things, teach energy-saving strategies, and recommend tools like special grips or shower chairs. OT aims to keep you independent and safe, even when strength and feeling in your hands or legs are reduced. This support is especially helpful during relapses, when everyday tasks suddenly become harder and more tiring.
3. Aerobic exercise training
Gentle aerobic activities such as walking, cycling on a stationary bike, or swimming can improve heart and lung fitness, reduce fatigue, and support mental health. In CIDP, supervised multicomponent exercise programs (aerobic plus strength and balance work) have been shown to improve physical capacity and reduce tiredness when done regularly. Exercise must be tailored to your limits, with rest breaks, to avoid over-exertion that can worsen weakness.
4. Strength and resistance training
Light resistance training with bands or small weights focuses on weak muscle groups in the arms, hands, legs, and feet. The goal is not “bodybuilding” but maintaining function: standing, climbing stairs, lifting objects, and walking safely. Repeated, low-intensity sets help muscles work more efficiently without stressing inflamed nerves. Strength work also prevents muscle wasting that can appear after long relapses or periods of severe weakness.
5. Balance and gait training
CIDP often affects balance and coordination, making falls more likely. Therapists use specific balance exercises, such as standing on different surfaces, stepping patterns, and safe obstacle practice. They may also train you to walk with canes, walkers, or frames. These programs aim to reduce falls, boost confidence, and let you move more freely at home and outside, even when sensation in your feet is reduced.
6. Use of assistive devices
Canes, walkers, wheelchairs, ankle–foot orthoses (AFOs), and grab bars in the bathroom are not “signs of failure”; they are tools that keep you safe. These devices reduce the risk of falls, conserve energy, and allow longer walking distances. A therapist or rehabilitation doctor measures and adjusts devices so they fit correctly. Good equipment can make a big difference in quality of life for people with chronic relapsing polyneuropathy.
7. Orthotics and splints
Custom braces for ankles, knees, wrists, or fingers can support weak joints and help maintain a more normal posture and gait. For example, foot-drop braces hold the foot up during walking so it does not drag. Hand splints can keep fingers from curling and make it easier to grasp objects. These supports prevent long-term deformities and reduce pain caused by abnormal joint positions.
8. Pain-relief modalities (heat, cold, TENS, massage)
Non-drug pain strategies include warm packs to relax tight muscles, cold packs for inflamed areas, gentle massage to reduce muscle stiffness, and TENS (transcutaneous electrical nerve stimulation) units that send mild electrical signals through the skin. These methods do not cure nerve damage but can reduce discomfort and muscle spasm, especially when used alongside medications and exercise. A therapist can show how to use these safely at home.
9. Energy conservation and pacing
Chronic relapsing polyneuropathy often brings severe fatigue. Energy conservation means planning the day so that the most important tasks are done when you have the most strength, using rests between activities, and avoiding long, intense bursts. Sitting while doing chores, breaking tasks into small steps, and saying “no” to extra demands can protect against exhaustion and help maintain function over months and years.
10. Sleep hygiene strategies
Good sleep helps the immune system and nerve recovery. Simple rules include going to bed at a regular time, keeping the bedroom dark and quiet, limiting caffeine late in the day, and avoiding large meals before bedtime. Managing pain and nighttime leg cramps is also important so you can sleep longer without waking. Better sleep often results in less daytime fatigue and improved mood in people with CIDP.
11. Psychological support and cognitive-behavioural therapy (CBT)
Living with a long-term, relapsing nerve disease is stressful and can cause anxiety or depression. Talking therapies like CBT teach skills to cope with chronic pain, fear of relapse, and changes in work or social life. Learning relaxation, goal setting, and positive self-talk can reduce perceived pain and improve quality of life. Psychologists or counsellors with experience in chronic illness are especially helpful.
12. Mindfulness, relaxation, and breathing exercises
Mindfulness meditation, slow breathing, and guided imagery help calm the nervous system and lower stress hormones. These practices do not change the immune attack directly, but they can reduce muscle tension, improve sleep, and help people feel more in control of their condition. Short daily sessions are often easier to maintain than long ones, and many people use free phone apps or online videos as guides.
13. Education and patient support groups
Learning about CIDP from reliable sources and talking with others who have the same condition can lower fear and confusion. Patient organisations share practical tips about coping with flares, treatment side effects, travel, work, and disability benefits. Feeling understood and supported reduces loneliness and gives people confidence to ask questions and join decisions about their care.
14. Fall-prevention and home safety modifications
Simple changes at home can prevent serious injuries. These include removing loose rugs, adding railings on stairs, installing grab bars in the bathroom, and improving lighting, especially at night. Non-slip shoes and avoiding clutter in walking areas are also important. A therapist or nurse can review the home and suggest low-cost safety fixes tailored to your level of weakness and balance problems.
15. Vocational rehabilitation and workplace adjustment
Some people with chronic relapsing polyneuropathy can keep working if their job is adjusted. Vocational rehab specialists help discuss flexible hours, rest breaks, work-from-home days, and ergonomic chairs or keyboards. They may also guide retraining for lighter work if heavy physical roles become unsafe. Keeping some work participation can support mental health and financial stability.
16. Nutrition counselling and weight management
A dietitian can help design a balanced diet rich in whole grains, fruits, vegetables, lean proteins, and healthy fats. Proper nutrition supports muscle strength, immune function, and blood sugar control, which is especially important if diabetes is present. Keeping a healthy weight reduces stress on weak legs and joints, making walking easier and lowering the risk of other health problems.
17. Infection-prevention measures
Because immune therapies may weaken defence against infections, good hygiene is vital. Regular handwashing, avoiding close contact with sick people, staying up to date with recommended vaccines, and quickly treating chest or urinary infections can reduce complications. For some people, lung exercises and early use of antibiotics may be advised to prevent serious illness and hospital stays.
18. Smoking cessation and limiting alcohol
Smoking damages blood vessels and nerves, while heavy alcohol use can cause its own neuropathy and interfere with medications. Stopping smoking and keeping alcohol intake low or zero reduce extra nerve injury and improve general health. Doctors, nurses, or counsellors can offer programs, medications, or support services to help people quit and stay smoke-free.
19. Foot care and skin care
Numb feet are more likely to be injured without being noticed. Daily foot checks, comfortable shoes, and nail care help prevent ulcers and infections. Moisturising dry skin and protecting areas with reduced sensation reduces breakdown. Early treatment of cuts and blisters is important, especially if diabetes or circulation problems are also present, as these increase the risk of serious complications.
20. Regular structured follow-up visits
Scheduled follow-up with a neuromuscular specialist allows careful tracking of strength, walking, reflexes, and side effects of treatment. Small changes can be picked up early, and medication doses or therapy plans can be adjusted before a full relapse develops. Having a planned review schedule also reassures patients that their condition is being actively monitored over time.
Drug treatments
Important: The drugs below are examples only. Doses and schedules must always be decided by a neurologist based on your age, weight, other illnesses, and lab tests. Never start, stop, or change a medicine without your doctor’s advice.
1. Immune globulin IV (Gamunex-C)
Gamunex-C is an intravenous immune globulin (IVIG) approved by the FDA to treat CIDP in adults. It is made from pooled human antibodies and is given into a vein over several hours every few weeks. Typical doses are around 2 g/kg body weight per treatment cycle, divided over 2–5 days, then repeated at intervals to maintain strength. The drug calms the abnormal immune attack on myelin and improves or stabilises muscle power. Common side effects include headache, chills, nausea, and high blood pressure during infusion.
2. Immune globulin SC (Hizentra)
Hizentra is a subcutaneous immune globulin (SCIG) approved for maintenance therapy in adults with CIDP to prevent relapse of disability. Instead of infusing into a vein, Hizentra is slowly infused under the skin once weekly or every other week using a small pump. Doses usually range from 0.2–0.4 g/kg per week, adjusted by the doctor. This steady antibody supply helps keep the immune system calm between flares. Local site reactions, headache, and fatigue are common but often mild.
3. Immune globulin IV (Privigen)
Privigen is another IVIG product approved for treating CIDP in adults. It is given as periodic infusions, commonly every 3 weeks, with dosing based on body weight and clinical response. Like other IVIG products, it supplies normal antibodies that block harmful immune activity against nerve myelin. This can improve strength and sensation or slow worsening. Side effects may include headache, flu-like symptoms, and, rarely, blood clots or kidney problems, especially in high-risk patients.
4. Other IVIG brands (e.g., Gammaked and similar)
Several IVIG brands with similar immune-modulating effects are used for CIDP when available and appropriate. Their active ingredient is IgG, a type of antibody that interferes with autoimmune attacks on peripheral nerves. Dosing schedules are comparable to other IVIG products and are selected by the treating neurologist. Side effects and precautions are also similar, including infusion reactions, rare clotting risk, and kidney concerns in susceptible people.
5. Oral prednisone (corticosteroid)
Prednisone is a steroid that strongly reduces inflammation and auto-immune activity. In CIDP, it is often given as a daily oral dose (for example, 0.75–1 mg/kg/day) and then slowly tapering over months if improvement occurs. Prednisone can improve strength and walking but should not be stopped suddenly. Long-term use can cause weight gain, high blood sugar, high blood pressure, mood changes, bone thinning, and infection risk, so doctors monitor carefully.
6. Intravenous methylprednisolone
High-dose IV methylprednisolone pulses (given, for example, once weekly or monthly) can be used instead of daily oral steroids. This approach may give strong anti-inflammatory effects while reducing some side effects. Infusions are usually done in hospital or infusion centres and are combined with other treatments such as IVIG. Side effects include insomnia, mood changes, blood sugar spikes, and stomach upset, so monitoring is needed during and after infusions.
7. Azathioprine
Azathioprine is an immunosuppressant tablet sometimes used as a “steroid-sparing” drug to maintain control of CIDP while lowering steroid dose. It works by slowing down certain white blood cells that drive the autoimmune attack. It is usually taken once or twice daily, and its full effect may take several months. Regular blood tests check liver function and blood counts, because side effects can include low blood cells, liver irritation, nausea, and increased infection risk.
8. Mycophenolate mofetil
Mycophenolate also lowers immune cell activity and is used off-label in some patients who do not respond well to first-line therapies. It is usually given twice daily by mouth. It can help stabilise disease and allow steroid doses to be reduced. Possible side effects include stomach upset, diarrhoea, low white blood cells, and higher risk of infections. Women who are pregnant or planning pregnancy need special counselling, as the drug can harm a developing baby.
9. Cyclosporine
Cyclosporine is a strong immunosuppressant that blocks T-cell activation. In CIDP, it may be used in severe or treatment-resistant cases under specialist care. The dose is adjusted according to blood levels and kidney function tests. It can help reduce relapses but has important side effects, including high blood pressure, kidney damage, tremor, gum changes, and increased infection and cancer risk, so close monitoring is essential.
10. Cyclophosphamide
Cyclophosphamide is a powerful chemotherapy-type immunosuppressant used in very resistant CIDP cases. It is usually given as intermittent IV infusions. By strongly reducing immune cells, it may “reset” the abnormal immune response and improve severe disability. However, it carries serious risks such as low blood counts, infertility, infection, bladder irritation, and long-term cancer risk. For this reason, it is reserved for carefully selected patients and used for limited durations.
11. Rituximab
Rituximab is a monoclonal antibody that targets CD20-positive B cells, a type of immune cell. It is used off-label in some CIDP patients, especially those with associated conditions like certain antibodies or blood disorders. The drug is given as IV infusions spaced weeks apart. By depleting B cells, it can reduce auto-antibody production and help stabilize disease. Side effects include infusion reactions, low blood cells, and increased infection risk, including rare severe viral infections.
12. Tacrolimus
Tacrolimus is another strong immunosuppressant used occasionally in complex CIDP cases. It acts on T cells and is taken orally, with doses adjusted according to blood levels. Some reports suggest benefit in neuropathies that are hard to treat with standard options. Possible side effects include kidney damage, tremor, headaches, high blood pressure, and diabetes, so frequent lab tests are required.
13. Methotrexate
Methotrexate is a low-dose chemotherapy-type drug used in many autoimmune conditions. In CIDP, it may be tried as a maintenance or steroid-sparing drug. It is taken weekly by mouth or injection, with folic acid often given to reduce side effects. Doctors monitor liver function and blood counts to prevent toxicity. Side effects can include nausea, mouth sores, fatigue, liver irritation, and infection risk.
14. Gabapentin
Gabapentin is a nerve pain medicine often used for neuropathic pain. It does not treat the immune attack itself but can reduce burning, tingling, and shooting pains. It is started at a low dose (for example, at night) and increased slowly as needed and tolerated. Common side effects include sleepiness, dizziness, and weight gain. It is usually combined with disease-modifying treatments like IVIG or steroids.
15. Pregabalin
Pregabalin is similar to gabapentin but often works faster at stabilising nerve pain. It is taken one to three times daily, with doses adjusted for kidney function. Studies show it is effective in many types of neuropathic pain and may reduce the need for opioids. Side effects include dizziness, drowsiness, weight gain, and swelling of legs. As with gabapentin, it manages pain but does not cure CIDP.
16. Duloxetine
Duloxetine is an antidepressant that also treats nerve pain by affecting serotonin and noradrenaline in the brain. It is usually taken once daily at a fixed dose. Studies in peripheral neuropathy show duloxetine is as effective as pregabalin for pain in many patients. Side effects may include nausea, dry mouth, increased sweating, and, rarely, changes in mood. It is particularly useful when a person also has depression or anxiety with chronic pain.
17. Amitriptyline
Amitriptyline is an older antidepressant widely used in low doses at night for nerve pain and sleep problems. It helps modulate pain signals and can improve sleep depth. Side effects include dry mouth, constipation, blurred vision, and morning drowsiness, so doctors usually start at a very low dose and increase slowly. It is avoided or used cautiously in older adults or people with heart rhythm problems.
18. Topical lidocaine patches
Lidocaine patches can be placed on painful skin areas to numb the nerves locally. They are especially helpful when pain is more superficial or localised. The patch is usually worn for up to 12 hours, followed by a break. Side effects are mostly mild skin irritation or redness under the patch. This option limits whole-body side effects and can be combined with oral pain medicines.
19. Tramadol (short-term)
Tramadol is a weak opioid-like painkiller sometimes used when other medicines do not control pain. It acts on opioid receptors and also affects serotonin and noradrenaline. Because of risks like dependence, drowsiness, constipation, and falls, it is usually reserved for short periods and lower doses. Doctors carefully balance benefits and risks, especially in people already taking other sedating medications.
20. Simple analgesics (paracetamol, NSAIDs)
Paracetamol (acetaminophen) and non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can lessen muscle and joint pain caused by altered posture, overuse, or inflammation. They do not treat the nerve damage itself but may improve comfort during flares or after therapy sessions. NSAIDs can irritate the stomach or affect kidneys and heart in some people, so they should be used cautiously and at the lowest effective dose.
Dietary molecular supplements
Evidence for supplements in CIDP is limited. They must not replace standard medical treatment. Always discuss supplements with your doctor to avoid interactions.
1. Omega-3 fatty acids (fish oil)
Omega-3 fats from fish oil have anti-inflammatory effects and may support general cardiovascular and nerve health. Typical doses used for inflammation in other conditions are about 1–3 g of combined EPA/DHA per day, but the exact dose should be chosen by a doctor. Omega-3s may gently reduce inflammatory signals and improve blood flow to nerves. Side effects can include fishy after-taste and, at high doses, a slightly increased bleeding tendency.
2. Vitamin D
Vitamin D helps regulate the immune system and maintain strong bones, which is important when steroids are used. Many people with chronic illness have low vitamin D levels. Doctors often prescribe 800–2000 IU per day or follow a specific high-dose plan if levels are very low. Adequate vitamin D may support immune balance and muscle function, but very high doses can cause high calcium levels and kidney problems.
3. Vitamin B12
Vitamin B12 is essential for healthy myelin and nerve repair. Low B12 can worsen neuropathy. If blood levels are low, doctors may give tablets or injections (for example, 1000 mcg monthly) to correct deficiency. In those with normal levels, extra B12 has unclear benefit, but it is generally safe in usual doses. Too much is rarely harmful but should still be guided by lab tests and medical advice.
4. Folate (vitamin B9)
Folate works with B12 in building DNA and supporting red blood cells and nerve function. When folate is low, doctors might suggest 400–800 mcg daily or a prescription dose. Correcting deficiency can improve general wellbeing and may support nerve health indirectly. Very high doses without medical supervision are not advised, especially if vitamin B12 deficiency has not been ruled out.
5. Alpha-lipoic acid
Alpha-lipoic acid is an antioxidant used in some countries for diabetic neuropathy. Typical study doses range around 600 mg per day. It may help protect nerves from oxidative stress and modestly reduce pain or burning sensations. Side effects can include stomach upset and, rarely, low blood sugar, so people with diabetes must monitor glucose carefully. Its role in CIDP is still experimental.
6. Acetyl-L-carnitine
Acetyl-L-carnitine supports energy production in nerve cells and mitochondria. Some studies in other neuropathies suggest it may relieve pain and support nerve regeneration at doses around 500–1000 mg two or three times daily. Possible side effects include nausea and agitation in some people. Because evidence in CIDP is limited, use should be individualised and supervised by a clinician.
7. Coenzyme Q10 (CoQ10)
CoQ10 is another mitochondrial cofactor that may improve cellular energy and reduce oxidative stress. Common supplement doses range from 100–300 mg per day with food. Some people report better stamina and less fatigue, although strong evidence in CIDP is lacking. Side effects are rare but may include stomach upset or insomnia at higher doses.
8. Magnesium
Magnesium supports muscle relaxation and nerve signalling. It may help with muscle cramps and sleep quality in some people. Typical oral doses range from 200–400 mg per day of elemental magnesium, adjusted to avoid diarrhoea. People with kidney problems must be careful, as magnesium can build up. While it does not treat immune damage, it can make symptoms more manageable.
9. Curcumin (turmeric extract)
Curcumin has anti-inflammatory and antioxidant properties in laboratory studies. It is often taken in doses of 500–1000 mg of standardised extract daily, preferably with black pepper or fat to improve absorption. Some people report less general inflammation and joint pain, but its direct effect on CIDP is not proven. Possible side effects include stomach upset or gallbladder issues in high doses.
10. Probiotics
Probiotics are “good bacteria” that support gut health, which may interact with the immune system. Typical doses vary widely by product and strain. A balanced gut microbiome may help keep immune responses better regulated, although data in CIDP are indirect. Side effects are usually mild gas or bloating. People with severe immune suppression should discuss probiotics carefully with their doctors.
Immune-modulating and regenerative therapies
1. High-dose IVIG as immune “reset”
In some severe or relapsing cases, neurologists may use higher IVIG loading doses to quickly control immune activity, followed by maintenance infusions. The goal is to strongly block harmful antibodies and inflammatory factors damaging myelin. This approach can act like a “reset” for the immune system. Because IVIG is a blood product, doctors watch carefully for side effects such as headache, thrombosis, or kidney problems and adjust dosing over time.
2. Long-term SCIG maintenance (Hizentra)
Using SCIG for long-term maintenance lets patients self-administer therapy at home, giving more stable IgG levels and fewer hospital visits. This continuous “top-up” of antibodies provides ongoing immune modulation, which helps prevent relapses in chronic relapsing polyneuropathy. Doses are gradually adjusted between 0.2–0.4 g/kg per week based on symptoms and strength testing. This therapy is a key long-term strategy rather than a simple “painkiller.”
3. Autologous hematopoietic stem cell transplantation (HSCT)
In very severe, treatment-resistant CIDP, some centres have used HSCT. Doctors first mobilise and collect the patient’s own blood stem cells, then give strong chemotherapy to wipe out the over-active immune system. Afterwards, the stem cells are returned to “rebuild” immunity. This can lead to long remissions in selected patients but carries serious risks, including infection, infertility, and even death, so it remains experimental and is only done in specialised centres.
4. Experimental mesenchymal stem cell therapies
Mesenchymal stem cells, taken from bone marrow or fat tissue and expanded in labs, have been studied in some autoimmune diseases because they can release anti-inflammatory factors. Their use in CIDP is still mostly limited to research and early studies. Potential benefits include reduced inflammation and support for tissue repair, but long-term safety and true effectiveness are not yet clear. These treatments should only be considered within approved clinical trials.
5. Rituximab as immune-rebuilding therapy
Rituximab, described earlier, can also be viewed as a “partial immune reset” because it removes many B cells for months at a time. In patients with CIDP linked to certain antibodies or other autoimmune conditions, this may produce long remissions. However, it increases infection risk and can reactivate certain viruses, so vaccinations and monitoring are important. Decisions about rituximab are highly individual and made by neuromuscular specialists.
6. Future remyelinating and neuroprotective agents
Researchers are studying drugs that might directly promote remyelination or protect axons (the core of the nerve fibre). These include small molecules that influence myelin-producing cells and antibodies targeting specific immune pathways. For now, they are experimental and not part of routine care. However, they offer hope that future treatments may do more than control inflammation and could actually repair damaged nerves in chronic relapsing polyneuropathy.
Surgeries and procedures
1. Therapeutic plasma exchange (plasmapheresis)
Plasma exchange is a procedure where blood is removed, the liquid part (plasma) is separated and discarded, and the blood cells are returned with replacement fluid. This removes harmful antibodies from the circulation. It is usually done several times over 1–2 weeks in hospital. It can quickly improve strength in many CIDP patients, especially in severe relapses. Risks include low blood pressure, infection from catheters, and bleeding problems.
2. Central venous port placement
People who need frequent IVIG or plasma exchange may have a small port surgically placed under the skin and connected to a central vein. This makes repeated access easier and more comfortable than using arm veins each time. The procedure is done in an operating room or interventional suite. Ports can remain in place for months or years but must be flushed regularly and watched for infection or clot formation.
3. Orthopaedic tendon or joint surgery
In long-standing disease with severe weakness or contractures, orthopaedic surgeons may perform tendon lengthening or transfer procedures, or joint releases, to improve foot or hand position. The goal is to reduce deformity, improve shoe fitting, and make walking or grasping objects easier. Surgery is followed by rehabilitation and braces to maintain the corrected posture. It is considered only after the disease is stable and conservative measures have failed.
4. Spine or nerve decompression surgery (selected cases)
Sometimes, people with CIDP also have compressed nerves or spinal stenosis, which can worsen symptoms. In such cases, neurosurgeons may perform decompression surgery to relieve pressure on spinal nerves. This does not treat the autoimmune disease itself but can reduce additional nerve damage from mechanical compression. Decisions are based on imaging and careful neurological examination.
5. Nerve biopsy (diagnostic procedure)
A sural nerve biopsy is a surgical removal of a small nerve piece from the ankle area. It is done only when the diagnosis is unclear and other tests are not enough. Under a local anaesthetic, a small cut is made to remove a nerve sample, which is then examined under a microscope. This can show demyelination and inflammation. The main risk is permanent numbness in the small area supplied by that nerve.
Key prevention strategies
Keep all follow-up appointments with your neurologist so treatment can be adjusted early if strength or sensation changes.
Take medicines exactly as prescribed, including IVIG, steroids, and immunosuppressants; do not stop them suddenly without advice.
Avoid over-exertion and use pacing, because pushing too hard can increase fatigue and may worsen symptoms.
Prevent infections with good hygiene and recommended vaccines, as infections can trigger relapses or complications.
Protect your feet and skin to avoid ulcers, injuries, and infections that you may not feel due to numbness.
Maintain a healthy, balanced diet rich in whole foods, which supports energy, weight control, and general health.
Do regular, gentle exercise under medical guidance to preserve strength, balance, and heart health.
Stop smoking and limit alcohol, as both can worsen nerve damage and interact with medicines.
Manage other health conditions, such as diabetes, high blood pressure, or thyroid disease, since they can add to nerve problems and overall risk.
Learn about your condition and warning signs so you can call for help early if new symptoms appear.
When to see a doctor
You should see or contact a doctor urgently if you notice new or rapidly worsening weakness, especially in both legs or both arms, sudden trouble walking, climbing stairs, or lifting your arms. Sudden difficulty breathing, swallowing, or speaking clearly is an emergency and needs immediate hospital care. You should also seek medical help if you develop high fever, chest pain, shortness of breath, or signs of severe infection while on immune-modulating drugs. Regularly scheduled visits with a neurologist are also important even when you feel stable, so that small changes can be picked up early and your chronic relapsing polyneuropathy treatment plan can be updated.
What to eat and what to avoid
Eat plenty of colourful fruits and vegetables to provide vitamins, minerals, and antioxidants that support general immune and nerve health.
Choose whole grains like brown rice, oats, and whole-wheat bread to give steady energy and support healthy weight.
Include lean proteins such as fish, poultry, beans, and lentils to help maintain muscle mass during long-term illness.
Use healthy fats from olive oil, nuts, seeds, and oily fish to provide omega-3s and support heart and nerve health.
Stay well hydrated with water and low-sugar drinks, especially on days when you receive IV treatments or feel fatigued.
Avoid highly processed foods that are high in sugar, salt, and trans-fats, as they can worsen weight gain, diabetes, and heart disease.
Limit alcohol because it can cause or worsen neuropathy and can interact with many medications used in CIDP.
Be cautious with very high-dose supplements or “immune boosters” sold online, as they may not help and can be harmful or interact with drugs.
Avoid crash diets or fasting plans that cause rapid weight loss and muscle wasting, which can make weakness and fatigue worse.
Discuss any special diet (keto, vegan, etc.) with your doctor and dietitian to ensure you still get all essential nutrients for nerve and muscle health.
Frequently asked questions (FAQs)
1. Is chronic relapsing polyneuropathy the same as CIDP?
In many modern sources, chronic relapsing polyneuropathy is considered a form or older name of CIDP, a chronic inflammatory attack on the myelin of peripheral nerves. The key features are symptoms lasting at least 8 weeks and often showing relapsing–remitting patterns.
2. Can chronic relapsing polyneuropathy be cured?
At present, CIDP is usually controlled rather than cured. Treatments like IVIG, steroids, and immunosuppressants can reduce inflammation, improve strength, and prevent relapses. Many people live for years with good function, but ongoing maintenance therapy and follow-up are often needed.
3. What is the first-line treatment?
Most guidelines recommend IVIG, corticosteroids, or plasma exchange as first-line options. IVIG is often preferred because it combines good effectiveness with a relatively safer profile. The choice depends on each person’s age, other illnesses, and how quickly treatment is needed.
4. How long will I need treatment?
The duration is very individual. Some people can slowly reduce or stop therapy after months or years, while others need long-term maintenance to keep symptoms stable. Doctors regularly reassess weakness, sensation, and function to decide when to adjust doses or try tapering.
5. Are IVIG and SCIG equally effective?
Studies and regulatory approvals show that both IVIG and SCIG can maintain strength and prevent relapses in CIDP when dosed correctly. IVIG is usually used for induction or when rapid response is needed, while SCIG is popular for long-term home maintenance because it provides steady levels and more convenience.
6. Will exercise make my nerves worse?
Appropriate, supervised exercise is generally safe and beneficial. It can improve fitness, strength, and balance and may even support nerve health. The key is to avoid over-exertion; low-to-moderate intensity, with rest days, is best. A therapist familiar with CIDP should guide your plan.
7. Can diet alone treat chronic relapsing polyneuropathy?
No. A healthy diet supports overall wellbeing, weight control, and energy, but it cannot replace immune therapies like IVIG, steroids, or immunosuppressants. Diet is an important part of self-care, not the main disease treatment.
8. Are supplements like omega-3 or vitamin D required?
Supplements may be helpful if you have proven deficiencies or special needs, but they should always be discussed with your doctor. Over-supplementation can be harmful. Simple blood tests can guide whether vitamin D, B12, or other nutrients are needed.
9. Are there specific triggers for relapses?
Infections, major surgery, severe stress, and stopping treatment too quickly may contribute to relapses in some people. However, not every relapse has a clear trigger. Keeping good infection prevention habits and following the treatment plan lowers the risk.
10. Is chronic relapsing polyneuropathy hereditary?
Most cases of CIDP are not inherited. It is usually an acquired autoimmune disease. Some hereditary neuropathies can look similar, so neurologists may order genetic tests if the story suggests a genetic cause, especially in younger patients or those with family history.
11. Can children get chronic relapsing polyneuropathy?
CIDP mainly affects adults but can occur in children. Diagnosis is harder in young patients, and treatment is usually given in specialised paediatric centres using similar principles—IVIG, steroids, and rehabilitation therapies. Parents should seek care from paediatric neurologists with neuromuscular experience.
12. Can I work or study with this condition?
Many people continue working or studying with adjustments, such as flexible schedules, remote work, mobility aids, and extra rest breaks. Occupational and vocational therapists can help arrange these supports. Open communication with employers or schools often helps maintain participation and independence.
13. Are pregnancy and CIDP compatible?
Some people with CIDP have healthy pregnancies, but symptoms may improve or worsen during or after pregnancy. Treatment plans may need adjustment to protect both parent and baby. Pregnant patients with CIDP should be followed closely by neurologists and obstetricians familiar with high-risk pregnancies.
14. What is the long-term outlook (prognosis)?
With early diagnosis and appropriate treatment, many people with chronic relapsing polyneuropathy maintain or regain the ability to walk and perform daily tasks. Some may have mild lasting weakness or numbness; others may have more significant disability. Ongoing follow-up and timely treatment of relapses improve the long-term outlook.
15. Where can I find reliable information and support?
Trusted sources include patient organisations and specialist neuromuscular centres, which provide education materials, webinars, and support groups. These groups can help you understand treatment options, rehabilitation, and research updates, and connect you with others living with CIDP worldwide.
Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.
The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members
Last Updated: January 24, 2026.
