Title : Cross sectional study on the correlation of clinical features with nerve conduction of peripheral nerves in leprosy
Abstract:
Leprosy, also known as Hansen’s disease, is a chronic granulomatous infection caused by the bacterium Mycobacterium leprae, a slow-growing obligate intracellular bacterial pathogen affecting skin and peripheral nerves. Leprosy is a major cause of peripheral neuropathy in low resource countries, that affects at least a third (1, of the individuals diagnosed with leprosy. affecting sensory, motor and autonomic nerve functions. We present a series of cases involving five leprosy patients who underwent NCS as part of their diagnostic workup. The patients exhibited different clinical presentations, including sensory loss, motor weakness, and nerve thickening. The NCS was performed using standard techniques, assessing sensory and motor nerve conduction velocities, distal latencies, amplitudes, and F-wave studies.
Case 1: A 45-year-old male presented with hypoesthesia and weakness in the left hand. NCS revealed significant slowing of sensory and motor conduction velocities across the affected median nerve, consistent with a demyelinating neuropathy.
Case 2: A 32-year-old female complained of numbness and tingling sensations in both feet. NCS demonstrated reduced sensory nerve action potentials and prolonged distal latencies in the sural nerves, indicative of an axonal neuropathy.
Case 3: A 55-year-old male presented with clawing of the right hand and difficulty in fine motor movements. NCS revealed reduced compound muscle action potentials and prolonged distal latencies in the ulnar nerve, suggesting mixed axonal and demyelinating neuropathy.
Case 4: A 28-year-old female exhibited muscle weakness and atrophy in the right foot. NCS findings showed significant reduction in motor conduction velocities and amplitudes in the peroneal nerve, consistent with an axonal neuropathy.
Case 5: A 60-year-old male had facial nerve palsy and loss of sensation on the right side of the face. NCS demonstrated absent sensory and motor responses in the affected facial nerve, indicative of a complete nerve lesion.
Conclusion: Nerve conduction study plays a crucial role in the evaluation of leprosy-related neuropathies, aiding in diagnosis, classification, and monitoring of nerve involvement. This case series highlights the diverse NCS findings observed in leprosy patients and emphasizes the importance of incorporating NCS into the comprehensive management of leprosy neuropathy. Although making a clinical diagnosis of leprosy is frequently straightforward, there is not a good point-of-care test to confirm the diagnosis. A delay in diagnosis may result in important negative outcomes, such as an increased risk of nerve damage . NCS (nerve conduction studies)is a study of conduction of nerve impulse along the peripheral nerves. It serves as a diagnostic as well as a monitoring tool for leprosy. NCS can detect subclinical neuropathy up to 12 weeks before the clinical neuropathy. So NCS can help in early diagnosis and treatment of leprosy and hence prevention of disability and deformity. Nerve conduction study is cost- effective ,at the same time it is a non-invasive modality that is useful for studying early changes in the nerves. NCS can become a tool that can be used in countries in which leprosy is endemic.
