Dear Editor,
We thank Dr. Noor un nisa Irshad et al. for their interest in our study “Signs of Intracranial Hypertension in Chronic Inflammatory Polyradiculoneuropathies—A Cross‐Sectional Cohort Study” [1]. In response, we wish to convey some key considerations:
1. Long‐Term Outcome Data
Our study aimed to identify the prevalence and potential associations of intracranial hypertension (IH) signs in patients with inflammatory polyradiculoneuropathy (IPN), which previously was reported only anecdotally. With the benefit of hindsight, a longitudinal follow‐up would naturally increase the ability to gauge the clinical relevance of subclinical IH in IPN, particularly regarding visual outcomes, CIDP course, headache, and potentially also cognition. Now, we agree that a prospective longitudinal study over a longer term is needed to determine whether the frequent finding of subclinical IH is relevant in this population.
2. Potential Role of Immunotherapy
We recognize the importance of exploring how immunomodulatory and immunosuppressive therapies might influence IH risk. While most patients in our cohort were receiving treatment at the time of assessment, the heterogeneity in treatment regimens precluded reliable analysis of treatment‐IH interactions. Future prospective studies in larger cohorts might enable us to explore this further, especially in light of case‐based evidence suggesting therapeutic modulation of ICP [2, 3, 4].
3. Biomarker or Genetic Subgroup Analyses
Subtyping CIDP based on antibody‐positivity (e.g., anti‐NF155, CNTN1) or other biomarker profiles, while completely hypothetically, could be relevant for stratifying IH risk. Naturally, such subtyping requires much larger sample sizes than available in our study, creating an important avenue for future research to identify mechanistically distinct subgroups potentially more vulnerable to IH.
4. Comorbidities Beyond BMI
Indeed, our analysis did not systematically account for metabolic or vascular comorbidities (e.g., diabetes, dyslipidemia, or steroid‐induced changes), although patients with known secondary causes of IH (e.g., sinus vein thrombosis, etc.) were excluded. While higher BMI is likely the most relevant cofactor for IH, we concur that metabolic comorbidities may modulate IH risk, and that their inclusion in future analyses would enhance our ability to construct individualized risk profiles.
In conclusion, we appreciate the authors' insights, which underscore key next steps for research in this emerging area. Our study represents an initial effort to identify and characterize IH in IPN, suggesting a non‐negligible prevalence and a possible association with elevated CSF protein. However, as rightly noted, the clinical significance, pathophysiological underpinnings, and therapeutic implications remain to be clarified through prospective, multimodal, and biomarker‐integrated studies.
Conflicts of Interest
Stefan Macher: has participated in meetings sponsored by, received speaker honoraria or travel funding from Novartis, AbbVie, and Merz. Berthold Pemp: has received honoraria for consultancy/speaking from Chiesi, GenSight, Novartis, and Santen. Gabriel Bsteh: has participated in meetings sponsored by, received speaker honoraria or travel funding from Biogen, Celgene/Bristol Meyers Squibb, Janssen, Lilly, Medwhizz, Merck, Novartis, Roche, Sanofi‐Genzyme and Teva, and received honoraria for consulting Biogen, Celgene/Bristol Meyers Squibb, Janssen, Merck, Novartis, Roche, Sanofi‐Genzyme and Teva. He has received unrestricted research grants from Celgene/Bristol Meyers Squibb and Novartis. He serves as an Executive Committee member of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS).
Macher S., Pemp B., and Bsteh G., “Signs of Intracranial Hypertension in Chronic Inflammatory Polyradiculoneuropathies—A Cross Sectional Cohort Study,” European Journal of Neurology 33, no. 1 (2026): e70491, 10.1111/ene.70491.
Response to Dr. Noor un nisa Irshad et al.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
References
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.