Background:Peripheral nerve involvement results in deformities in leprosy. High doses (40-60 mg) of steroids along with anti-leprosy drugs is the preferred treatment, even though 70-75% cases still develop deformity. Early surgical decompression of nerves gives better chances of preventing deformity. We have analyzed the role of early surgical decompression in such cases.Materials and Methods:Five hundred nerves (386 ulnar, 60 median and 54 posterior tibial) not responding to the medical treatment in 12 weeks, were undertaken for external and internal nerve trunk decompression. These cases were followed up for five to 20 years at various intervals.Results:The pain in nerve (neuralgia) recovered in all cases of ulnar, median and posterior tibial nerves. Full sensory recovery to pinprick and feather or cotton wool touch was seen in 50% cases of all the three nerves. Twenty percent cases maintained the preoperative levels of sensory status. Plantar ulcers healed within six months after decompression of posterior tibial nerve but six cases showed recurrence. Overall motor recovery in ulnar nerve was 89% and 70% in median nerve.Conclusions:The sensory recovery restores protective sensation which prevents secondary injuries. The improvement of motor power gives better function and improves the appearance, which in the absence of surgical intervention was not possible.
BackgroundWhile prednisolone is commonly used to treat recent nerve function impairment (NFI) in leprosy patients, the optimal treatment duration has not yet been established. In this “Treatment of Early Neuropathy in Leprosy” (TENLEP) trial, we evaluated whether a 32-week prednisolone course is more effective than a 20-week course in restoring and improving nerve function.MethodsIn this multi-centre, triple-blind, randomized controlled trial, leprosy patients who had recently developed clinical NFI (<6 months) were allocated to a prednisolone treatment regimen of either 20 weeks or 32 weeks. Prednisolone was started at either 45 or 60 mg/day, depending on the patient’s body weight, and was then tapered. Throughout follow up, NFI was assessed by voluntary muscle testing and monofilament testing. The primary outcome was the proportion of patients with improved or restored nerve function at week 78. As secondary outcomes, we analysed improvements between baseline and week 78 on the Reaction Severity Scale, the SALSA Scale and the Participation Scale. Serious Adverse Events and the need for additional prednisolone treatment were monitored and reported.ResultsWe included 868 patients in the study, 429 in the 20-week arm and 439 in the 32-week arm. At 78 weeks, the proportion of patients with improved or restored nerve function did not differ significantly between the groups: 78.1% in the 20-week arm and 77.5% in the 32-week arm (p = 0.821). Nor were there any differences in secondary outcomes, except for a significant higher proportion of Serious Adverse Events in the longer treatment arm.ConclusionIn our study, a 20-week course of prednisolone was as effective as a 32-week course in improving and restoring recent clinical NFI in leprosy patients. Twenty weeks is therefore the preferred initial treatment duration for leprosy neuropathy, after which likely only a minority of patients require further individualized treatment.
Siunmary 102 children with dermatitis predominantly affecting the weight-bearing areas of the feet, are described. Despite a clinical appearance suggestive of an allergic contact dermatitis, only thirteen children had positive patch tests to any substance in the European battery, or to constituents of their own footwear. The relationship of this condition to two similar dermatoses in the literature is discussed,
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