RESUMEN
OBJECTIVE: To analyze the role of high-resolution ultrasonography with color Doppler (HRUS with CD) to diagnose inflammatory activity (IA) in nerves of leprosy patients under type 1 (RT1) and 2 (RT2) reactions compared to Nerve Conduction Studies (NCS). METHODS: Leprosy patients with signs or symptoms suggestive of neuritis (RT1 and RT2) without corticosteroids use were selected. They were evaluated by NCS and subsequently by HRUS with CD. Subacute segmental demyelination and the presence of blood flow, respectively, were considered signs of IA. The two methods were compared for their ability to diagnose patients with leprosy reactions. RESULTS: A total of 257 nerves from 35 patients were evaluated. NCS and HRUS with CD diagnosed IA in 68% and 74% of patients, respectively. When both methods were used concomitantly, the diagnosis rate was 91.4%. HRUS with CD was particular helpful when there was minimal neurophysiological compromise in NCS or when motor potentials were not detected. CONCLUSION: HRUS with CD was able to detect leprosy reactions, especially when combined with NCS. It was especially useful in two opposite situations: nerves with only minor changes and those without motor response in NCS. SIGNIFICANCE: Our data shows the usefulness of HRUS and CD, similar to NCS, as a tool to diagnose leprosy reactions.
RESUMEN
BACKGROUND: Leprosy neuropathy, despite being primarily demyelinating, frequently leads to axonal loss. Neurophysiological examination of the nerves during Type 1 (T1R) and Type 2 reactions (T2R) may give some insight into the pathophysiological mechanisms. METHODS: Neurophysiological examinations were performed in 28 ulnar nerves during a clinical trial of steroid treatment effectiveness, 19 patients with T1R and nine with T2R. The nerves were monitored during a period of 6 months; there were eight assessments per nerve, for a total of 224 assessments. Nine neurophysiological parameters were assessed at three sites of the ulnar nerve. The compound motor action potential amplitudes elicited at wrist, elbow and above, as well as the conduction velocity and temporal dispersion across the elbow, were chosen to focus on the changes occurring in the parameters at the elbow tunnel. RESULTS AND CONCLUSION: Neurophysiological changes indicating axonal and demyelinating processes during both T1R and T2R were detected across the elbow. Changes in demyelination, i.e. a Conduction Block, as a primary event present during T2R, occurring as an acute phenomenon, were observed regularly; in T1R Temporal Dispersion, a subacute phenomenon, was seen. During treatment remyelination occurred after both types of reactions.
Asunto(s)
Antiinflamatorios/administración & dosificación , Lepra/complicaciones , Prednisona/administración & dosificación , Nervio Cubital/efectos de los fármacos , Neuropatías Cubitales/etiología , Adulto , Femenino , Humanos , Lepra/tratamiento farmacológico , Lepra/fisiopatología , Masculino , Persona de Mediana Edad , Conducción Nerviosa/fisiología , Dimensión del Dolor , Tiempo de Reacción , Resultado del Tratamiento , Neuropatías Cubitales/tratamiento farmacológico , Neuropatías Cubitales/fisiopatología , Adulto JovenRESUMEN
Os autores apresentam uma técnica para realizar estudo de conduçao nervosa em tatus (D. novemcinctus) e sugerem que 66.17 m/s poderia ser a média da velocidade de conduçao normal para o nervo ciático, um parâmetro que pode ser usado para a avaliaçao do sistema nervoso periférico nesse animal, considerando-se a sua escolha como modelo experimental na hanseníase, e mesmo em outras neuropatias periféricas.