Late follow-up of peripheral neural decompression in leprosy: functional and clinical outcomes

Abstract

Background: Peripheral neural surgical decompression (PNSD) is used as a complementary therapy to the clinical treatment of neuritis to preserve neural function. Objective: To evaluate the long-term (≥ 1 year) clinical and functional results for PNSD in leprosy neuritis. Methods: This cross-sectional study included leprosy patients who were in late postoperative period (LPO) of surgical decompression of ulnar, median, tibial, and fibular nerves. Socioeconomic, epidemiological, and clinical data were collected. The following instruments were used in this evaluation: visual analogue pain scale (VAS), Douleur Neuropathique en 4 Questions (DN4), SALSA scale, and simplified neurological assessment protocol. The preoperative (PrO) and 180-day postoperative (PO180) results were compared. Results: We evaluated 246 nerves from 90 patients: 56.6% were on multidrug therapy (MDT) and 43.3% discharged from MDT. Motor scores and pain intensity showed statistically significant improvement (p<0.01). There was an increase in sensory scores only for bilateral ulnar nerves (p<0.05). Of the operated cases, 26.0% of patients were referred for surgery of ulnar neuritis and 23.6% of tibial neuritis. Neuropathic pain was reported in 41% of cases. Daily dose of prednisone reduced from 39.6 mg (±3.0) in PrO, 16.3 mg (±5.2) in PO180, to 1.7 mg (±0.8) in LPO. The SALSA scale results showed mild activity limitation in 51% and moderate in 34% of patients. Eighty percent of individuals reported that the results reached their expectations. Conclusions: PNSD in leprosy was effective in the long term to decrease the prevalence and intensity of pain, improve motor function, and reduce the dose of corticosteroids, which is reflected in the patients’ satisfaction.

Assessment of neuropathic pain in leprosy patients with relapse or treatment failure by infrared thermography: A cross-sectional study

“…was shown between the groups, the prevalence of disability grade II was high (37.9%) in the PWP group. These findings confirm that NP is a late complication of leprosy [39].…”

Difficulties coping with leprosy during treatment and post-discharge

“…(2) Em casos de reacões hansenicas, quando reação do tipo 1, faz-se tratamento com antiinflamatórios não-hormonais (AINEs) e analgésicos, se as manifestações forem apenas cutâneas; se estas forem acompanhadas de neurites ou de reações mais graves (ulcerações ou edema), utiliza-se prednisona (1mg/kg/dia ou 40mg/dia), com redução gradual conforme a melhora clínica, até a retirada total em um período de cerca de 4 -6 meses; quando reação do tipo 2, utiliza-se talidomida (100 -400 mg/dia) em pacientes masculinos, crianças e idosos apenas com lesões cutâneas. (7,8) Em mulheres em idade fértil, tenta-se inicialmente o uso apenas de AINEs e analgésicos, se não houver resposta terapêutica, introduz-se prednisona (40 mg/dia), com redução gradual conforme a Portuguese | Rev. enferm.…”

“…Portanto, nota-se que o tratamento da hanseníase é longo e complexo. (7,8) A reação hansênica tipo 1 gera inflamacão (inflamacões oculares associadas podem levar à cegueira), dor em lesões pré-existentes (pode gerar úlceras) e, se chegar a lesar nervos faciais, causar paralisia facial; a reação hansênica tipo 2 resulta em inflamacão aguda da pele e dos nervos e pode formar nódulos subcutaneos dolorosos, sendo mais difícil de tratar que a tipo 1 devido à sua natureza sistemica e recorrente; assim, observa-se que o paciente com hanseníase apresenta um quadro extremamente debilitante. (9) É válido destacar que a prevalencia da hanseníase é associada também a um baixo nível educacional, baixo alcance e/ou qualidade do sistema de saúde, investimento insuficiente em prevencão e precárias condicões de moradia.…”

A review of nutrition in neuropathic pain of leprosy

“…Nerve stimulation techniques such as transcutaneous electrical or peripheral nerve stimulation, spinal cord, and deep brain stimulation, and direct current stimulation are being explored as potential therapeutic options, as well as surgical nerve decompression. 32 , 42 , 46 , 47 Likewise, nonpharmaceutical techniques that work to alleviate the psychological burden of PNP have been implicated as therapeutics. These include behavioural, cognitive and animal therapy; guided imagery; diaphragmatic breathing; mindfulness-based stress reduction; acupuncture; and exercise.…”