This site: http://jnnp.bmj.com/cgi/content/full/64/1/84

I would be paying special attention to:

THE CONCLUSION IN THE ABSTRACT and, under METHODS the 'clinical features of patients w/CIDP. [IVIG IS used 'off-label for CIDP, but it is accepted practice]. Look at the #'s and percentages[confirming diagnosis in 40-60% patients]. This is an older article [10years] but an important article in that it states that other clinical features, such as response to IVIG are as effective as a seural biopsy.

Most insurance companies today do not require biopsies for IVIG 'off-label' use in treating CIDP. Criteria rely more on chomprehensive blood and spinal fluid analysis and nerve conduction tests. I believe I'd PM'ed you some info on your insurances plan and it's standards for IVIG...re-read it. Very carefully. I believe, I recall that they don't recommend seural biopsies as a rule, providing other diagnostic conditions were indicative of CIDP/autoimmune.

Further, how the sample is treated, prepared and assessed is a key to accurate diagnosis and the need for a biopsy!

There are two sides to biopsies, seural [I've read mostly negative comments on the procedure - ask kmeb] and punch biopsies [positive re s/e's but only confirms SMALL FIBER PNs - ask Bob B]. Biopsies do NOTHING regarding treatments, or treatment options, they only reinforce diagnosis. From my viewpoint, a seural biopsy was 'presented' to me as a diagnostic necessity, I DECLINED, but I'd met, essentially 9 of the 10 requirements for positive CIDP/acute progressive PN diagnosis.

ALAN will need to be VERY CLEAR reading on his own what the pros and cons are regarding such a REALLY INVASIVE procedure, should the biopsy be a seural one. Especially if other test results indicate actual or borderline CIDP.

Think long and hard about this, please! - j