Progression of leprosy neuropathy: a case series study

Abstract

A need still exists to determine the clinical and neurophysiological characteristics of leprosy neuropathy at distinct times of the disease by different methods that measure the various nerve fiber functions. A prospective clinical study was performed with 10 paucibacillary (PB) and 12 multibacillary (MB) patients evaluated at diagnosis and one year after cessation of multidrug therapy (MDT). Peripheral nerve function was assessed clinically and by means of the sympathetic skin response, skin vasomotor reflex, and nerve conduction study (NCS). At diagnosis, 73% of the total 22 patients had nerve function impairment (NFI). Autonomic function (χ2= 5.5, P= 0.019) and NCS (χ2= 7.765, P= 0.01) were significantly more altered in MB than PB patients. At final evaluation, NFI of the MB patients had worsened, especially among the six who had leprosy reaction. As the NFI of PB patients showed improvement, a significant difference between the two groups (χ2= 12.320, P= 0.001) was observed. A high prevalence of neuropathy was observed in newly diagnosed patients. Associating different tests with a thorough clinical neurological evaluation increases detection rates.

Leprosy neuropathy evaluated by NCS is independent of the patient's infectious state

“…Disability was recorded in accordance with the standard WHO grading criteria [46]. NFI was defined as clinically detectable impairment of the motor, sensory, and/or autonomic functions [41]. Table 1 Upper/lower limits values for the sensory and motor nerves evaluated [14,17,24,32].…”

Isolated median neuropathy as the first symptom of leprosy

“…In 396 new cases that included all forms of leprosy, van Brakel and Khawas observed that, in the upper extremities, the ulnar nerve was the most frequently affected, both in its motor (20%) and sensory components (17%), whereas the median sensory nerve was only affected in 8.8% of the cases. Other investigators have also observed the median nerve to be the least compromised in the upper extremities, but it was always associated with impairment of other nerves. We have reported here a rare presentation of leprosy in which median neuropathy was the first symptom of the disease.…”

“…A detailed neurological examination was performed to record the number and distribution of affected nerves. To define nerve function impairment (NFI) the following components were analyzed according to Vital et al …”

Neurological Complications of Leprosy

“…57 It may also worsen in the presence of reactions. 58 Small fiber neuropathy (SFN) is also reported in patients with leprosy, with a pattern of distal loss of sensitivity to temperature and pain. Thickening of nerves can be seen; one small study found this in about half of patients with SFN attributed to leprosy.…”