scholarly journals Persistent Neuropathy in Lepromatous Leprosy Patients

2021 ◽  
Author(s):  
Patricia Penna ◽  
Robson Vital ◽  
IZABELA PITTA ◽  
Mariana Hacker ◽  
Ana Salles ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Peripheral Nerve ◽  
Nerve Biopsy ◽  
Lepromatous Leprosy ◽  
Nerve Damage ◽  
Sensory Nerves ◽  
High Dose ◽  
Peripheral Nerve Damage ◽  
End Of Treatment ◽  
Leprosy Patients

Abstract Lepromatous leprosy (LL) patients have evidence of extensive peripheral nerve damage as soon as a diagnosis is made, but most of them have few or no symptoms related to peripheral neuropathy. Usually, they do not have the cardinal signal of leprosy neuritis. However, disability caused by peripheral nerve injuries has consequences throughout the entire life of these patients and the pathophysiological mechanisms of nerve damage are still poorly understood. The objective of this study was to evaluate the outcome of peripheral neuropathy in a group of LL patients in an attempt to understand the mechanisms of nerve damage. We evaluated medical records of 14 LL patients that had undergone a neurological evaluation at the beginning of Leprosy treatment then worsened at least 4 years after the end of treatment and underwent nerve biopsy. The symptoms at the beginning of treatment were compared with those at the time of the biopsy. Pain was a symptom in only one patient at the beginning and was a complaint in 9 patients by the time of biopsy. Neurological examination showed that the majority of patients already had alterations in medium and large caliber fibers at the beginning of the treatment, and pain increased by the time of biopsy, while neurological symptoms and signs deteriorated independently of the use of prednisone or thalidomide. Nerve Conduction Studies demonstrated that sensory nerves were the most affected. LL patients can develop a silent progressive degenerative peripheral neuropathy, which continues to develop despite high dose long term corticoid therapy.

Focal peripheral neuropathy

2011 ◽  
Author(s):  
Michael Donaghy
Keyword(s):  
Peripheral Nerve ◽  
Immunosuppressive Treatment ◽  
Conduction Block ◽  
Multifocal Motor Neuropathy ◽  
Nerve Damage ◽  
High Dose ◽  
Motor Neuropathy ◽  
Peripheral Nerve Damage ◽  
Entrapment Neuropathies ◽  
Focal Neuropathy

Some causes of focal peripheral nerve damage are self-evident, such as involvement at sites of trauma, tissue necrosis, infiltration by tumour, or damage by radiotherapy. Focal compressive and entrapment neuropathies are particularly valuable to identify in civilian practice, since recovery may follow relief of the compression. Leprosy is a common global cause of focal neuropathy, which involves prominent loss of pain sensation with secondary acromutilation, and requires early antibiotic treatment. Mononeuritis multiplex due to vasculitis requires prompt diagnosis and immunosuppressive treatment to limit the severity and extent of peripheral nerve damage. Various other medical conditions, both inherited and acquired, can present with focal neuropathy rather than polyneuropathy, the most common of which are diabetes mellitus and hereditary liability to pressure palsies. A purely motor focal presentation should raise the question of multifocal motor neuropathy with conduction block, which usually responds well to high-dose intravenous immunoglobulin infusions.

scholarly journals Role of Inflammation in the Pathogenesis of Diabetic Peripheral Neuropathy

2019 ◽  
Vol 7 (14) ◽  
pp. 2267-2270 ◽  
Author(s):  
Daniela Ristikj-Stomnaroska ◽  
Valentina Risteska-Nejashmikj ◽  
Marija Papazova
Keyword(s):  
Peripheral Neuropathy ◽  
Peripheral Nerve ◽  
Diabetic Peripheral Neuropathy ◽  
Test Group ◽  
Nerve Damage ◽  
Control Group ◽  
Average Value ◽  
Peripheral Nerve Damage ◽  
Tnf Α

BACKGROUND: Diabetic peripheral neuropathy (DPN) means the presence of symptoms and/or signs of peripheral nerve damage that occur to people with diabetes, excluding all other causes of neuropathy. Chronic hyperglycaemia leads to increased secretion of tumour necrotic factor-alpha (TNF-α), with the development of micro and macroangiopathy, damage to nerve fibres and local demyelination. AIM: To determine the role of inflammation in the peripheral nerve damage process concerning people suffering from type II diabetes mellitus. MATERIAL AND METHODS: The study included a total of 80 subjects, men and women, divided into two groups: an examined group (n = 50) consisting of subjects with DPN at the age from 30 to 80 years and a control group (n = 30) of healthy subjects aged from 18 to 45. In the investigated group, a neurological examination was performed using the Diabetic Neuropathy Symptoms (DNS) Score and Electroneurography. All the subjects had the blood plasma concentration of TNF-α by ELISA technique. RESULTS: The average value of TNF-α in the test group was 8.24 ± 2.899 pg/ml, while the control group was 4.36 ± 2.622 pg/ml (p < 0.0001). The average value of TNF-α was correlated with the achieved DNS score in the investigated group (p = 0.005). Concerning the linear association of the concentration of TNF-α with the peripheral nerve velocity in the investigated group, no statistical significance was detected. CONCLUSION: Inflammation can play a role in the pathogenesis of diabetic autonomic neuropathy and cranial neuritis.

Chronic aspects of leprosy—neglected but important

2019 ◽  
Vol 113 (12) ◽  
pp. 813-817
Author(s):  
Diana N J Lockwood
Keyword(s):  
At Risk ◽  
Peripheral Nerve ◽  
Patient Empowerment ◽  
Nerve Damage ◽  
World Health ◽  
Peripheral Nerve Damage ◽  
Number Of Patients ◽  
Leprosy Patients ◽  
Pain Symptoms ◽  
Hands And Feet

AbstractThe chronic aspects of leprosy are discussed here. They are a consequence of the peripheral nerve damage that affects many patients during their lifetime with leprosy. The peripheral nerve damage leaves people unable to feel and with weakness in their hands and feet. They are at risk of damaging their hands and feet, causing the disabilities and deformities that characterise late leprosy.More than 200 000 new leprosy patients are diagnosed globally each year. Better data are needed from cohort studies to estimate the number of patients developing nerve damage and modelling studies are needed to estimate the number of patients who develop disabilities. For some of them, this will be a lifelong disability.Nerve damage is caused by inflammation in leprosy-affected nerves. Patients with nerve damage of &lt;6-mo duration need treatment with steroids. About 66% of multibacillary patients will develop nerve damage. Plastic graded monofilaments can be used to detect nerve damage in leprosy and diabetic clinics. Assessing nerve damage and treating patients with steroids in leprosy programmes needs to be strengthened. The World Health Organization has a successful programme for supplying antibiotics for treating leprosy infection to national leprosy programmes. They should take responsibility for providing steroids to national programmes since this is a core part of the treatment for &gt;66% of multibacillary patients. Patients need to be asked about neuropathic pain symptoms and treated if necessary.Treated leprosy patients are at risk of developing ulcers in their feet. Treatment and prevention needs to be improved through health education, providing protective footwear and patient empowerment.

scholarly journals Peripheral nerve biopsy: Is it still important for the early diagnosis of neural leprosy?

2021 ◽  
Author(s):  
Isabella Sabião Borges ◽  
João Victor Aguiar Moreira ◽  
Thales Junqueira Oliveira ◽  
Maria Fernanda Prado Rosa ◽  
Gabriel Nunes Melo Assunção ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Early Diagnosis ◽  
Peripheral Nerve ◽  
Clinical Evidence ◽  
Early Recognition ◽  
Diagnostic Errors ◽  
Nerve Biopsy ◽  
Skin Lesions ◽  
National Reference Center ◽  
Neural Impairment

Background: The early recognition of neural impairment in leprosy represents a challenge in clinical practice and peripheral nerve biopsy may be required for diagnostic. Objective: Characterize the epidemiological, clinical, electroneuromyographic, laboratory and histopathological aspects of patients undergoing peripheral nerve biopsy during investigation of primary neural leprosy. Methods: 104 patients with peripheral neuropathy, referred to a national reference center leprosy, were biopsied. All patients had clinical evidence of peripheral neuropathy associated with the absence of skin lesions and were being investigated. Results: Of 104 biopsied, leprosy was confirmed in 89.4%. 66 were classified as primary neural leprosy and 27 as neural relapse or reinfection. All cases confirmed presented asymmetric neural impairment with predominance of sensory symptoms (88.2%), followed by muscular weakness and/or amyotrophy in 44.1% and pain in 34.4%. Neural thickening of one or more nerves was observed in 78.5% of the patients. The biopsied nerves were: ulnar (67.8%), superficial fibular (21.5%), sural (8.6%), radial (1.1%) and deep fibular (1.1%). 29% presented histopathological abnormalities and 4.4% acid fast bacilli. Nerve and superjacent skin qPCR were positive in 49.5% and 24.8% of cases, respectively. The patients with multiple mononeuropathy presented higher frequency of neural thickening (p<0.0001) and histopathological abnormalities (p=0.0077), but lower rates of positivity of ELISA anti-PGL-I (p=0.0100), qPCR in the peripheral blood (p=0.0157), and in the slit skin smear (p=0.0032). Conclusions: Peripheral nerve biopsy is an important tool in the investigation of primary neural cases, contributing to the early diagnosis and reducing diagnostic errors and the need for empirical treatment.

A Case of Fever and a Wrist Drop

2018 ◽  
pp. 69-74
Author(s):  
Aaron E. Miller ◽  
Tracy M. DeAngelis ◽  
Michelle Fabian ◽  
Ilana Katz Sand
Keyword(s):  
Nervous System ◽  
Gastrointestinal Tract ◽  
Peripheral Neuropathy ◽  
Peripheral Nerve ◽  
Polyarteritis Nodosa ◽  
Joint Pain ◽  
Immunosuppressive Agents ◽  
Nerve Biopsy ◽  
Definitive Diagnosis ◽  
Wrist Drop

Polyarteritis nodosa (PAN) is a systemic illness that most often involves the skin, kidneys, and gastrointestinal tract, in addition to the peripheral nervous system. It most often affects middle-aged individuals, men more than women. The particular type of peripheral neuropathy is often mononeuropathy or mononeuritis multiplex—a condition in which there is discrete involvement of multiple individual nerves. Definitive diagnosis of the vascular nature of the neuropathy requires peripheral nerve biopsy, which will demonstrate inflammation throughout the walls of small and medium-sized arteries. The CNS is also frequently involved in PAN. Constitutional symptoms, including fever, fatigue, and diffuse muscle and joint pain, are common and raise the suspicion of a systemic illness. Treatment generally involves the use of corticosteroids and immunosuppressive agents such as cyclophosphamide or azathioprine.

scholarly journals Association of Serum Cholesterol Levels With Peripheral Nerve Damage in Patients With Type 2 Diabetes

2019 ◽  
Vol 2 (5) ◽  
pp. e194798 ◽  
Author(s):  
Johann M. E. Jende ◽  
Jan B. Groener ◽  
Christian Rother ◽  
Zoltan Kender ◽  
Artur Hahn ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Peripheral Nerve ◽  
Serum Cholesterol ◽  
Nerve Damage ◽  
Peripheral Nerve Damage ◽  
Cholesterol Levels
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