Abstract
Introduction
Leprosy is nowaday increasingly encountered in non-endemic countries. Nerve involvement is common. Swelling of the nerves may lead to entrapment neuropathy causing pain and neurological deficits. Delay in diagnosis and treatment may lead to loss of chance of improvement. Surgical decompression in conjunction with medical therapy allows relief of symptoms.
Methods
We present a retrospective series of 21 patients surgically treated in our center for leprosy entrapment neuropathy. We report presentation, treatment, and outcome at follow-up including a brief literature review.
Results
Twenty-one patients were treated for nerve entrapments in four different anatomical districts. We reported good clinical outcomes mainly in motor deficits but also in improvement of sensitive deficits and pain symptoms. We did not experience surgical complications.
Discussion
Although there is a lack of high-quality prospective studies comparing medical and surgical treatment of leprosy neuropathy, benefits of surgery are widely reported in series and case reports from endemic countries. There is scant literature from low-incidence countries even if leprosy incidence is nowaday increasing in these countries and will likelihood further increase in the future. Our results are in line with the literature presenting good outcomes after surgery.
Conclusion
We believe that a precise knowledge of the pathology and its management is crucial also for physicians who work in low-incidence countries to maximize healing chances with timely diagnosis and treatment.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Sasaki S, Takeshita F, Okuda K, Ishii N (2001) Mycobacterium lepraeand leprosy: a compendium. Microbiol Immunol 45(11):729–736
Ooi W, Srinivasan J (2004) Leprosy and the peripheral nervous system: basic and clinical aspects. Muscle Nerve 30(4):393–409
Rai D, Malhotra HS, Garg RK, Goel MM, Malhotra KP, Kumar V, Singh AK, Jain A, Kohli N, Singh SK (2013) Nerve abscess in primary neuritic leprosy. Lepr Rev 84(2):136–140
Bernardin R, Thomas B (1997) Surgery for neuritis in leprosy: indications for and results of different types of procedures. Lepr Rev 68(2):147–154
Van Veen NHJ, Schreuders TAR, Theuvenet WJ, Agrawal A, Richardus JH (2012) Decompressive surgery for treating nerve damage in leprosy. Cochrane Database of Syst Rev 12:1465–1858
Rodrigues L, Lockwood D (2011) Leprosy now: epidemiology, progress, challenges, and research gaps. Lancet Infect Dis 11(6):464–470
World Health Organization (2015) Global leprosy update: time for action, accountability and inclusion. Wkly Epidemiol Rec 91(35):405–420
Husain S (2013) Decompression of peripheral nerve trunks in leprosy prevents the development and progression of deformities? Indian J Lepr 85(4):163–169
Kumar P, Saxena R, Mohan L, Thacker AK, Mukhija RD (1997) Peripheral nerve abscess in leprosy: report of twenty cases. Indian J Lepr 69(2):143–147
Salafia A, Chauhan G (1996) Nerve abscess in children and adults leprosy patients: analysis of 145 cases and review of the literature. Acta Leprol 10(1):45–50
Turner D, McGuinness SL, Leder K (2015) Leprosy: diagnosis and management in a developed setting. Intern Med J 45(1):109–112
Simeoni S, Puccetti A, Tinazzi E, Codella OM, Sorleto M, Patuzzo G, Colato C, Tessari G, Lunardi C (2011) Leprosy initially misdiagnosed as sarcoidosis, adult-onset still disease, or autoinflammatory disease. J Clin Heumatol 17(8):432–435
Barkla S, Modi S (2013) Lepromatous leprosy: a rare presentation in Australia. Australas Med J 6(4):175–177
Wan EL, Rivadeneira AF, Jouvin RM, Dellon AL (2016) Treatment of peripheral neuropathy in leprosy: the case for nerve decompression. Plast Reconstr Surg Glob Open 4(3):e637
Gennaro S, Secci F, Fiaschi P, Merciadri P (2013) Supraorbital nerve entrapment neuropathy in Hansen’s disease. Neurol Sci 34(12):2243–2244
Pandya SS (1983) Surgery on the peripheral nerves in leprosy. Neurosurg Rev 6(3):153–154
Kazen R (1996) Role of surgery of nerves in leprosy in the restoration of sensibility in hands and feet of leprosy patients. Indian J Lepr 68(1):55–65
Nickerson DS, Nickerson DE (2010) A review of therapeutic nerve decompression for neuropathy in Hansen’s disease with research suggestions. J Reconstr Microsurg 26(4):277–284
Payne R, Baccon J, Dossett J, Scollard D, Byler D, Patel A, Harbaugh K (2015) Pure neuritic leprosy presenting as ulnar nerve neuropathy: a case report of electrodiagnostic, radiographic, and histopathological findings. J Neurosurg 123(5):1238–43.15
Ridley DS, Jopling WH (1966) Classification of leprosy according to immunity: a five group system. Int J Lepr 34:255–273
Gennaro S (2012) Neurolysis. In: Nunzi E, Massone C (eds) Leprosy: a Practigal Guide. Springer, pp. 303–308
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
All procedures were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments.
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Balestrino, A., Fiaschi, P., Riccardi, N. et al. Neurosurgical treatment of leprosy neuropathy in a low-incidence, European country. Neurol Sci 40, 1371–1375 (2019). https://doi.org/10.1007/s10072-019-03835-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10072-019-03835-1