Abstract
Forty-two patients with leprosy (7 with tuberculoid type, 30 borderline, 5 lepromatous) were studied electrophysiologically during reactions. Thirty-three had type I reactions while 9 had type II reactions. Each patient received 60 mg/day prednisolone tapered over a 6-week period. Motor conduction studies were performed on one clinically affected and one unaffected nerve and were repeated 12 weeks after the beginning of steroid therapy. Significant motor conduction abnormalities were observed in 14 affected (33.3%) and 8 unaffected nerves (19.1%). The majority of these nerves were in patients with borderline leprosy having type I reactions. Following steroid therapy, nerve function improved in 14 affected (33.3%) and 20 unaffected nerves (47.66%). However, 5 affected (10.2%) and 12 unaffected nerves (28.5%) showed a worsening of nerve function following steroid therapy. The majority of the nerves that showed improvement with steroid therapy had type I reactions, while those that showed deterioration had type II reactions. Steroids improved nerve function mainly in patients with type I reactions. Their role in patients with type II reactions remains debatable.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Becx-Bleumink M, Berhe D (1992) Occurrence of reactions, their diagnosis and management in leprosy patients treated with multidrug therapy; experience in the leprosy control program of the All Africa Leprosy and Rehabilitation Training Centre (ALERT) in Ethiopia. Int J Lepr Other Mycobact Dis 60: 173–184
Dharmendra (1978) Leprosy. Kothari, Bombay
Garven HSD, Gairns FW, Smith G (1962) The nerve fibres populations of the leg in chronic occlusive arterial disease in man. Scott Med J 7: 250
Hackett ER, Shipley DE, Livengood R (1968) Motor nerve conduction velocity studies of the ulnar nerve in patients with leprosy. Int J Lep Other Mycobact Dis 36: 282–287
Imkamp FMJH (1985) Standardised schemes for steroid treatment in ENL and reversal reactions. Int J Lepr Other Mycobact Dis 53: 313–317
Indian Association of Leprologists (1982) The consensus classification of leprosy approved by the Indian Association of Leprologists. Lepr India 54: 17–25
Job CK (1989) Nerve damage in leprosy. XIII Leprosy Congress State-ofthe-art Lectures. Int J Lepr Other Mycobact Dis 57: 532–539
Jollife DS (1977) Leprosy reactional states and their treatment. Br J Dermatol 97: 345–353
Kirkwood BR (1988) Essentials of medical statistics. Blackwell, Oxford
Lockwood DNJ, Vinayakumar S, Stanley INA, McAdam KPWJ, Colston MJ (1993) Clinical features and outcome of reversal (Type I) reactions in Hyderabad, India. Int J Lepr Other Mycobact Dis 61: 8–15
Magora A, Sheskin J, Sagher F, Gonen B (1970) The condition of the peripheral nerve in leprosy under various forms of treatment-conduction velocity studies in long term follow-up. Int J Lepr Other Mycobact Dis 38: 149–163
Miglietta O (1987) Electrophysiologic studies in chronic occlusive peripheral vascular disease. Arch Phys Med 48: 89
Naafs B, Pearson JMH, Baar AJM (1976) A follow up study of nerve lesions in leprosy during and after reaction using motor nerve conduction velocity. Int J Lepr Other Mycobact Dis 44: 188–197
Naafs B, Pearson JMH, Wheate HW (1979) Reversal reaction: the prevention of permanent nerve damage; comparison of short- and long-term steroid treatment. Int J Lepr Other Mycobact Dis 47: 7–12
Pearson JMH (1981) The use of corticosteroids in leprosy (editorial). Lepr Rev 52: 293–298
Pearson JMH (1982) The evaluation of nerve damage in leprosy. Lepr Rev 53: 119–130
Pearson JMH, Ross WF (1975) Nerve involvement in leprosy-pathology, differential diagnosis and principles of management. Lepr Rev 46: 199–212
Pfaltzgraff RE (1989) The management of reaction in leprosy. Int J Lepr Other Mycobact Dis 57: 103–109
Rao SP, Taori GM, Desikan KV, Nayar S (1995) Clinical and electrophysiological assessment of leprosy patients on dapsone monotherapy. A two year follow up study. Int J Lepr Other Mycobact Dis 67(2): 167–176
Rose P, Waters MFR (1991) Reversal reactions in leprosy and their management. Lepr Rev 62: 113–121
Sheskin J, Magora A, Sagher F (1969) Motor conduction velocity studies in patients with leprosy reaction treated with thalidomide and other drugs. Int J Lepr Other Mycobact Dis 37: 359–364
Sirsat AM, Lalitha VS, Pandya SS (1987) Dapsone neuropathy — report of three cases and pathologic features of a motor nerve. Int J Lepr Other Mycobact Dis 55: 23–29
Sohi AS, Kandhari KC, Singh N (1971) Motor nerve conduction studies in leprosy. Int J Dermatol 10: 151–155
Srinavasan H, Rao KS, Shanmugam N (1982) Steroid therapy in recent ‘Quiet Nerve Paralysis’ in leprosy: report of a study of twenty five patients. Lepr India 54: 412–419
Swift TR, Hackett ER, Shipley DE, Miner KM (1973) The peroneal and tibial nerves in lepromatous leprosy clinical and electrophysiologic observations. Int J Lepr Other Mycobact Dis 41: 25–34
Touw-Langendijk EMJ, Brandsma JW, Andersen JG (1984) Treatment of ulnar and median nerve function loss in borderline leprosy. Lepr Rev 55: 41–46
World Health Organization (1982) Chemotherapy for leprosy control programmes. TRS No. 675
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Thacker, A.K., Chandra, S., Mukhija, R.D. et al. Electro-physiological evaluation of nerves during reactions in leprosy. J Neurol 243, 530–535 (1996). https://doi.org/10.1007/BF00886875
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00886875