Abstract

After completing my neurological training my main field of interest was in cerebrovascular disorders. However, my practice changed in several ways in 1982 after I gave intravenous immunoglobulin (IVIg) to a 16-year-old boy with chronic inflammatory demyelinating polyneuropathy (CIDP) and he improved. Similar patients started to be referred to me and I began to see many types of peripheral neuropathy and so learned a lot about diseases of the peripheral nervous system in general, and the diagnostic strategies required to sort them out. That first patient undoubtedly had an impact on my whole neurological practice.

He had been admitted with a 2-month history of progressive weakness in his arms and legs, which became paralysed. There were no tendon reflexes apart from one depressed ankle reflex. There were no sensory signs, although he had some tingling in the hands and feet. Nerve conduction velocities were somewhat slow: 40 m/s in the