Clinical, electrophysiological, and immunopathological study of peripheral nerves in Hansen's disease

Abstract

Ransen' s disease is a disease of peripheral nerves. Some patients deve10p peripheral neuropathy before the diagnosis of the disease, and others develop these complications after starting therapy. Electrophysiological (EP) studies were carried out in Ransen's disease patients. This work studied the neural deficits, electromyo graphy (EMG) and motor nerve conduction (MNC) variables in different types of leprosy and the immunopathology of sural nerve tissue in patients with severe neural deficits. Forty leprosy patients had neurological exarninations and EP study. Histo pathological and immunopathological study of sural nerve biopsy specimens was performed for 10 patients with severe neural deficits. The results of the neurological study showed that there was involvement of cranial nerves, muscular system, motor reflexes and sensory system and trophic and vasomotor changes. EP study showed significant changes in EMG of abductor digiti minimi in patients as compared to controls. MNC variables of common peroneal nerve were abnormal in 80% of alI patients, MNC of median nerve was abnormal in 72.5%, while MNC of ulnar nerve was abnormal in 70% and SNC of ulnar nerve was abnormal in 77.5% of the total. ln conclusion, electrophysiological investigations have an important role in the detec tion of muscle denervation and neuropathic changes in leprosy patients. These investigations are safe, rapid and non-invasive techniques. On the other hand immunopathological study revealed that the degree of immune positivity correlated with the degree of nerve fibrosis.

Primary neural leprosy: systematic review

“…Van Brakel and Khawas Ramadan et al 25 (C) assessed 40 patients, being the ulnar nerve the most frequent damaged and the claw hand the most common disability. All the sensory modalities were affected: superficial and deep sensitivities.…”

Early Diagnosis of Neuropathy in Leprosy—Comparing Diagnostic Tests in a Large Prospective Study (the INFIR Cohort Study)

“…They did not find advantage in motor nerve conduction (MNC) over VMT or sensory testing with monofilaments or a combination of the latter with nerve palpation. Investigators in cross-sectional studies have concluded that NC studies were very useful and would potentially detect pre-clinical neuropathy [19],[21],[24],[26].…”

Incomplete peripheral facial nerve palsy and ulnar neuropathy due to leprosy mistaken as faciobrachial stroke

“…Nerve disease in leprosy is more common in unstable subtypes of leprosy such as borderline tuberculoid (BT) or borderline lepromatous (BL) leprosy, with higher tendency for lepra reactions, thus there is also cranial nerve involvement in these subtypes (BT, BL) 3. Cranial nerve involvement has been seen more often during lepra reaction 1 and is more common in BT leprosy 4 5. Wani et al 5 showed that lepra reaction was a significant risk factor for new onset facial nerve palsy.…”