Leprous Neuropathy: Observational Study Highlighting the Role of Electrophysiology in Early Diagnosis

Vijayan, Beena Vasanthy; Dominic, Maria Rose; Nair, Vijayan Chandrathil Parameswaran

doi:10.1055/s-0041-1727575

Cited by 5 publications

(4 citation statements)

References 21 publications

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“…The number of nerve abnormalities detected by electrophysiological testing is significantly greater than that detected clinically 36 . In Hansen disease patients, motor weakness, sonographic thickening, and motor conduction abnormalities are positively correlated 37 .…”

Section: Discussionmentioning

confidence: 83%

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Neurological features of Hansen disease: a retrospective, multicenter cohort study

Chen,

Di,

Qian

et al. 2024

Sci Rep

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To elucidate the neurological features of Hansen disease. The medical records of patients with confirmed Hansen disease transferred from the neurology department were reviewed, and all medical and neurological manifestations of Hansen disease were assessed. Eleven patients with confirmed Hansen disease, 10 with newly detected Hansen disease and 1 with relapsed Hansen disease, who visited neurology departments were enrolled. The newly detected patients with Hansen disease were classified as having lepromatous leprosy (LL, n = 1), borderline lepromatous leprosy (BL, n = 2), borderline leprosy (BB, n = 2), borderline tuberculoid leprosy (BT, n = 1), tuberculoid leprosy (TT, n = 2), or pure neural leprosy (PNL, n = 2). All of the patients with confirmed Hansen were diagnosed with peripheral neuropathy (100.00%, 11/11). The symptoms and signs presented were mainly limb numbness (100.00%, 11/11), sensory and motor dysfunction (100.00%, 11/11), decreased muscle strength (90.90%, 10/11), and skin lesions (81.81%, 9/11). Nerve morphological features in nerve ultrasonography (US) included peripheral nerve asymmetry and segmental thickening (100.00%, 9/9). For neuro-electrophysiology feature, the frequency of no response of sensory nerves was significantly higher than those of motor nerves [(51.21% 42/82) vs (24.70%, 21/85)(P = 0.0183*)] by electrodiagnostic (EDX) studies. Nerve histological features in nerve biopsy analysis included demyelination (100.00%, 5/5) and axonal damage (60.00%, 3/5). In addition to confirmed diagnoses by acid-fast bacteria (AFB) staining (54.54%, 6/11) and skin pathology analysis (100.00%, 8/8), serology and molecular technology were positive in 36.36% (4/11) and 100.00% (11/11) of confirmed patients of Hansen disease, respectively. It is not uncommon for patients of Hansen disease to visit neurology departments due to peripheral neuropathy. The main pathological features of affected nerves are demyelination and axonal damage. The combination of nerve US, EDX studies, nerve biopsy, and serological and molecular tests can improve the diagnosis of Hansen disease.

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Section: Discussionmentioning

confidence: 83%

“…Patients with the TT type of Hansen disease were the most affected 33 , 34 . Electrophysiological testing showed both axonal and demyelinating nerve involvement 35 , 36 .…”

Section: Discussionmentioning

confidence: 99%

Neurological features of Hansen disease: a retrospective, multicenter cohort study

Chen,

Di,

Qian

et al. 2024

Sci Rep

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“…The ulnar and common fibular nerves are the most commonly affected nerves in leprosy, with 88% and 34% of involvement, respectively, 16 and it has been suggested that the cooler temperatures of these regions favor bacterial proliferation, 17 although this is not confirmed. The posterior tibial nerve is involved in 20% of the cases, 18 and the median nerve may be involved less often, with variables rates in the literature. Other nerves often involved are the superficial radial, dorsal ulnar cutaneous, great auricular, supraorbital branch of the trigeminal nerve, and sural nerve 19 .…”

Section: Resultsmentioning

confidence: 99%

Neuromuscular ultrasound in leprosy: A scanning protocol

Pirola,

Visser,

Nasr‐Eldin

et al. 2023

J of Clinical Ultrasound

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The diagnosis of leprosy neuropathies has been traditionally based on clinical findings and electrodiagnostic studies, but ultrasound has emerged as a new tool for use in clinical practice. We conducted a literature search on the subject and developed a pragmatic ultrasound scanning protocol for patients with confirmed or suspected leprosy neuropathy. We suggest scanning the ulnar, median, superficial radial, common fibular and sural nerves at specific sites and assessing cross‐sectional area, vascularity, and epineural thickness. Our protocol is potentially useful in differentiating leprosy neuropathies from other demyelinating neuropathies, but its applicability and accuracy must be evaluated in different centers.

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“…This can manifest clinically once the number of dysfunctional nerve fibres exceeds a limit. 13,17 In a study of 7 patients with abnormal electrophysiology of ulnar and median nerve trunks with no clinically apparent nerve dysfunction, it was seen that all subsequently went on to develop NFI. 13 Though studies have evaluated facial nerve branch dysfunction in leprosy based on clinical parameters like facial palsy and taste sensation, data on electrophysiological studies pertaining to facial nerve branch dysfunction namely temporal, zygomatic, and marginal mandibular nerve are limited, with studies confined to either the facial nerve trunk or zygomatic branch.…”

Section: Introductionmentioning

confidence: 99%

Facial nerve and branch dysfunction in leprosy - a study from India

Philip

George

Mathew

et al. 2022

LEPROSY

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Objective Involvement of the facial nerve in leprosy can result in debilitating features, including blindness. Electrophysiological studies addressing abnormalities in the facial nerve along with its branches are limited. This study was designed to assess the prevalence and pattern of clinical and subclinical involvement of the facial nerve and its branches in patients with active disease. Methods A hospital-based cross-sectional study was done in 75 patients who had leprosy. The facial nerve and branches were examined clinically and assessed electro-physiologically with nerve conduction studies (NCS), F wave, blink reflex and synkinesis. Results 64/75 (85%) patients had facial nerve involvement, of whom 58 had subclinical involvement. detected by electrophysiology and 6 had facial nerve palsy. 83% of patients had subclinical involvement and belonged to the borderline spectrum (27-BL, 21-BT), and 23 (48%) were in reactional states (T2R-12, T1R-11). Patients with facial lesions and reactional states showed significant association (p = 0.035) with clinical or subclinical facial nerve involvement. The marginal mandibular branch was the most commonly affected (50%) in those with subclinical involvement while in those with facial nerve palsy, the facial nerve trunk was most affected (50%). 12/58 (21%) with subclinical involvement and 5/6 patients with facial nerve palsy had an abnormal blink reflex. Abnormal F wave was observed in 7/42 (17%), (4 subclinical/3 facial nerve palsy). Conclusion Electrophysiological changes in the facial nerve, without clinical signs are common among patients in the borderline spectrum with about half being in reactional states. We know that many institutions may not have the equipment to conduct nerve

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Leprous Neuropathy: Observational Study Highlighting the Role of Electrophysiology in Early Diagnosis

Cited by 5 publications

References 21 publications

Neurological features of Hansen disease: a retrospective, multicenter cohort study

Neurological features of Hansen disease: a retrospective, multicenter cohort study

Neuromuscular ultrasound in leprosy: A scanning protocol

Facial nerve and branch dysfunction in leprosy - a study from India

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