<unk>  <unk>  is an acquired immune-mediated<unk>  disorder of the peripheral nervous system but often can have central nervous system involvement. The disorder is sometimes called<unk>  relapsing<unk> .<unk>  is closely related to Guillain-Barre syndrome and it is considered the<unk>  counterpart of that acute disease.
The pathologic hallmark of the disease is loss of the myelin sheath (the fatty covering that wraps around and protects nerve fibers) of the peripheral nerves.<unk>  is disease believed to be due to immune cells, cells which normally protect the body, but are now attacking the nerves in the body. As a result, the affected nerves fail to respond, or respond only weakly, to stimuli causing numbing, tingling, pain, progressive muscle weakness, loss of deep tendon reflexes (areflexia), fatigue, and abnormal sensations.. The likelihood of progression of the disease is high.<unk>  is under-recognized and under-treated due to its heterogeneous presentation (both clinical and electrophysiological) and the limitations of clinical, serologic, and electrophysiologic diagnostic criteria. Despite these limitations, early diagnosis and treatment is important in preventing irreversible axonal loss and improving functional recovery.
Under-recognized and under-treated<unk>  is also due to limitations of clinical trials.  Although there are stringent research criteria for selecting patients to clinical trials, there are no generally agreed-on clinical diagnostic criteria for<unk>  due to its different presentations in symptoms and objective data. Application of the present research criteria to routine clinical practice often miss the diagnosis in a majority of patients and patients are often left untreated despite progression of their disease.
In some cases electrophysiological studies fail to show any evidence of demyelination, though conventional electrophysiological diagnostic criteria are not filled the patient may respond to immunomodulatory treatments. In such cases, presence of clinical characteristics suggestive of<unk>  are critical justifying fully investigations including sural nerve biopsy.
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