Neuropathy is an essential and almost always present manifestation of leprosy. Unfortunately,
this disease is still a public health problem in Brazil[1], and it still seems that we have a long way to succeed in its control. Leprosy neuropathy
has long been recognized as an important cause of peripheral nerve impairment, which
causes the most feared consequences of this disease.
The most effective measures to avoid nerve damage are i) avoid transmission, and ii)
early diagnosis and early treatment. Multi drug therapy is the standard treatment
protocol, and its adoption has proved very effective to treat this disease. Even though,
neuritis continues to be a frequent cause of nerve damage that can appear even in
treated patients.
There is no question that steroid therapy, and even the use of other immunosuppressors,
are effective in order to avoid the neuritis consequences (5), but the role of surgical
decompression is still a matter of discussion.
In this paper, Tiago et al.[2], evaluated the effects of peripheral neural surgical decompression (PNSD) in 90
leprosy patients using the following criteria: presence of nerve abscess, persistent
neuritis after 4 weeks of treatment, reentrant neuritis and tibial neuritis. Decompression
was performed on the most affected limb always in a combined manner: median and ulnar
nerves when operating on the upper limbs, and when operating on the lower limbs the
fibular and the tibial nerves. They have found significant differences when comparing
a patient's condition before and after surgery, including patient´s perception, pain
assessment, prednisone dosage and neurological assessment.
I think this study has definitely shown that surgery has an effective role in the
treatment of leprosy neuropathy. However, as stated in the paper by the authors, there
is still much work to be done in order to find a precise indication for this treatment
option. Is it really necessary to accomplish combined intervention? Is surgery better
than steroids or other imunossupressors? Is surgery better than pulsed intravenous
therapy with steroids? Are there other disease markers (electrophysiological or image
parameters) that could help choosing the best option?
Stimulated by this beautiful paper, leprosy researchers now have new challenges in
order to find the best options to better help leprosy patients.
