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Leprous Neuropathy: Observational Study Highlighting the Role of Electrophysiology in Early Diagnosis
Background Worldwide leprosy is a common cause of peripheral neuropathy. Electrophysiology is underutilized in its diagnosis.
Objective This study aims to evaluate the usefulness of electrophysiological study in the diagnosis of leprous neuropathy.
Materials and Methods Clinical and electrophysiological abnormalities of 36 histopathology proven leprosy patients from January 2015 to January 2017 were studied.
Statistical Analysis Proportions were compared by Chi-square test.
Results Total patients were 36. Thirty-four patients had abnormal electrophysiology and 34 had neurological deficits like weakness, sensory changes, and thickening. By clinical examination, multiple nerve involvement (motor weakness, sensory changes, and nerve thickening) occurred in 29, single nerve in 5, and no nerve involvement in 2. With electrophysiology, multiple nerve involvement (mononeuritis multiplex) was present in 32, single nerve in 2, and normal conduction parameters in 2. From the 36 patients, a total of 1,008 nerves were subjected to clinical examination and 132 were picked up clinically as affected, (13.1%). Electrophysiological study was done in 504 nerves, and 215 were found to be involved, (43%). Nerve abnormality detected by electrophysiology is significantly higher than clinical detection. (Chi-square =164.4054; p = 0.0000). Clinically, the most commonly affected nerve was unar (27) and the least affected was median (2) nerve. Electrophysiology detected 69% of nerves with demyelination and 35% of nerves with axonal features (mosaic pattern).
Discussion There was subclinical neuropathy with electroclinical dissociation, as evidenced by more abnormality in electrophysiology than clinical examination. The nerve involvement was mononeuritis or mononeuritis multiplex pattern, both clinically and electrophysiologically. Electrophysiology showed both axonal and demyelinating nerve involvement (mosaic pattern). All the three features are present in leprous neuropathy. In corollary, if a patient has these electrophysiological features, he should be thoroughly investigated for leprosy.
Conclusion Triple findings, such as subclinical neuropathy with electroclinical dissociation, mononeuritis multiplex, and mosaic pattern of demyelination and axonopathy, suggest leprous neuropathy
Keywordsleprous neuropathy - electrophysiology - nerve conduction study - subclinical - electroclinical dissociation - mosaic pattern - mononeuritis multiplex
16 June 2021 (online)
© 2021. Association for Helping Neurosurgical Sick People. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)
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- 1 Hammi C, Yeung B. Neuropathy. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2020
- 2 Pannikar V. Enhanced global strategy for further reducing the disease burden due to leprosy: 2011-2015. Lepr Rev 2009; 80 (04) 353-354
- 3 Richardus JH, Habbema JD. The impact of leprosy control on the transmission of M. leprae: is elimination being attained?. Lepr Rev 2007; 78 (04) 330-337
- 4 Devi K, Renu V, Asokan N, Ambooken B. Childhood leprosy in the light of global leprosy strategy 2016-2020. Indian J Lepr 2019; 91 (01) 1-6
- 5 Babu A, Bhat MR, Jayaraman J. Childhood leprosy in the postelimination era: A vision achieved or a concern growing at large. Indian J Paediatr Dermatol 2018; 19: 26-30
- 6 World Health Organization. Leprosy: world focused on ending transmission among children. Accessed October 4, 2020 at at https://www.who.int/neglected_diseases/news/Leprosy_ending_transmission_among_children/en/.
- 7 Hackett ER, Shipley DE, Livengood R. Motor nerve conduction velocity studies of the ulnar nerve in patients with leprosy. Int J Lepr Other Mycobact Dis 1968; 36 (03) 282-287
- 8 Verghese M, Ittimani KV, Satyanarayan KR, Mathai R, Bhakthaviziam C. A study of the conduction velocity of the motor fibers of ulnar and median nerves in leprosy. Int J Lepr Other Mycobact Dis 1970; 38 (03) 271-277
- 9 Wagenaar I, Post E, Brandsma W. et al. Early detection of neuropathy in leprosy: a comparison of five tests for field settings. Infect Dis Poverty 2017; 6 (01) 115
- 10 Vasanthy B, Nair VCP, Haris AA, George J. Nerve conduction study for early detection of leprosy. Int J Med Health Res 2018; 4 (12) 4-8
- 11 Husain S, Malaviya GN. Early nerve damage in leprosy: an electrophysiological study of ulnar and median nerves in patients with and without clinical neural deficits. Neurol India 2007; 55 (01) 22-26
- 12 van Brakel WH, Nicholls PG, Wilder-Smith EP, Das L, Barkataki P, Lockwood DN. INFIR Study Group. Early diagnosis of neuropathy in leprosy–comparing diagnostic tests in a large prospective study (the INFIR cohort study). PLoS Negl Trop Dis 2008; 2 (04) e212
- 13 Siao P, Kaku M. A clinician’s approach to peripheral neuropathy. Semin Neurol 2019; 39 (05) 519-530
- 14 Hughes RA. Peripheral neuropathy. BMJ 2002; 324 (7335) 466-469
- 15 Vodusek DB, Amarenco G. S Podnar. Clinical neurophysiological tests. In: Abrams P, Cardozo L, Khoury S, Wein A, eds. Incontinence. 4th ed. Plymouth, United Kingdom: Health Publication Ltd 2009; 523-540
- 16 Van Brakel WH, Nicholls PG, Das L. et al. The INFIR Cohort Study: assessment of sensory and motor neuropathy in leprosy at baseline. Lepr Rev 2005; 76 (04) 277-295
- 17 Brown TR, Kovindha A, Wathanadilokkol U, Piefer A, Smith T, Kraft GH. Leprosy neuropathy: correlation of clinical and electrophysiological tests. Indian J Lepr 1996; 68 (01) 1-14
- 18 Ramakrishnan AG, Srinivasan TM. Electrophysiological correlates of hanseniasis. Int J Lepr Other Mycobact Dis 1995; 63 (03) 395-408
- 19 Kumar N, Malhotra HS, Garg RK. et al. Comprehensive electrophysiology in leprous neuropathy - Is there a clinico-electrophysiological dissociation?. Clin Neurophysiol 2016; 127 (08) 2747-2755
- 20 Samant G, Shetty VP, Uplekar MW, Antia NH. Clinical and electrophysiological evaluation of nerve function impairment following cessation of multidrug therapy in leprosy. Lepr Rev 1999; 70 (01) 10-20
- 21 Cabalar M, Yayla V, Ulutas S, Senadim S, Oktar AC. The clinical & neurophysiological study of leprosy. Pak J Med Sci 2014; 30 (03) 501-506
- 22 Jardim M, Vital R, Balassiano S, Hacker M, Illarramendi X, Sarno E. Pattern of nerve conduction study in leprosy neuropathy. Neurology 2014; 82 (10) 319-321
- 23 Sebille A. Respective importance of different nerve conduction velocities in leprosy. J Neurol Sci 1978; 38 (01) 89-95
- 24 Ramadan W, Mourad B, Fadel W, Ghoraba E. Clinical, electrophysiological, and immunopathological study of peripheral nerves in Hansen’s disease. Lepr Rev 2001; 72 (01) 35-49
- 25 Kar S, Krishnan A, Singh N, Singh R, Pawar S. Nerve damage in leprosy: An electrophysiological evaluation of ulnar and median nerves in patients with clinical neural deficits: a pilot study. Indian Dermatol Online J 2013; 4 (02) 97-101
- 26 Lastória JC, Abreu MA. Leprosy: a review of laboratory and therapeutic aspects–part 2. An Bras Dermatol 2014; 89 (03) 389-401
- 27 DeFaria CR, Silva IM. Electromyographic diagnosis of leprosy. Arq Neuropsiquiatr 1990; 48 (04) 403-413
- 28 Misra UK, Kalita J, Nair PP. Diagnostic approach to peripheral neuropathy. Ann Indian Acad Neurol 2008; 11 (02) 89-97
- 29 Donofrio P AAEM mlnlmonograph #34.polyneuropathy: classification by nerve conduction studies and electromyography. Muscle Nerve 1990; 13 (10) 889-903