Effect of steroid therapy on parameters of peripheral autonomic dysfunction in leprosy patients with acute neuritis.

Recent electrophysiological studies on peripheral autonomic dysfunction in leprosy patients show a high prevalence of autonomic dysfunction as measured by abnormal vasomotor reflexes (VMR) and absent sympathetic skin response (SSR). Nothing is known about the reversibility of these autonomic parameters with treatment. Since there is evidence that small fiber function may be the most reversible component in neuropathies, we measured the effect of steroid treatment on autonomic parameters together with motor and sensory functions in leprosy patients with acute neuritis. Control subjects were investigated for repeatability testing of autonomic function. Due to a relatively high variability on repeat VMR testing in the controls, we defined a change in VMR testing as a change of > 30%. With this definition, the VMR of 14.8% of the patients improved, 75% remained unchanged, and 10.2% worsened. Absent SSR became positive in 16.6% and remained unchanged in 83.4%. Improvement in sensory motor functions was seen in 21.2% and 1.3% of the patients, respectively.

Denatured muscle grafts for nerve repair. An experimental model of nerve damage in leprosy.

About 20% of patients with leprosy develop localised granulomatous lesions in peripheral nerves. We report experiments in guinea-pigs in which freeze-thawed autogenous muscle grafts were used for the treatment of such mycobacterial granulomas. Granulomas were induced in guinea-pig tibial nerves and the animals were left for 7 to 100 days in order to assess maximal damage. The local area of nerve damage was then excised and the gap filled with denatured muscle grafts. Clinical assessment after periods up to 150 days showed good sensory and motor recovery which correlated well with the histological findings. The muscle graft technique may be of value for the treatment of chronic nerve lesions in selected cases of leprosy.

Clinical profile and electrodiagnostic study of peripheral neuropathy.

A clinical analysis and electrophysiological study was performed in 40 cases of peripheral neuropathy. Motor nerve conduction velocity (MNCV) and electromyography (EMG) were also recorded in 20 healthy volunteers. Twelve cases were of diabetic neuropathy (DN), nine of Guillain-Barre syndrome (GBS), eight of idiopathic, six of leprous, three of toxic neuropathy and one each of acute intermittent porphyria (AIP) and carcinomatous neuropathy. The onset was insidious in a majority of the cases (70%), the presenting symptom being paraesthesia (27.5%). A variable sensory loss was the commonest finding (77.5%). Two patients each had evidence of cranial nerve involvement and affection of urinary bladder and bowel. In both DN and GBS there was a significant reduction in the MNCV especially in the peroneal nerves. In DN 41.6% had evidence of decreased motor unit potentials and 16.6% showed spontaneous fibrillatory activity. For GBS these figures were 77.7% and 8.3% respectively. The peripheral nerve involvement was variable in leprosy and the EMG was normal in all, but one case.

[The value of electromyographic studies in leprosy]. / Intérêt de l'examen électromyographique dans la lèpre.

In Dakar, during a definite period of time, all the new leprosy cases have been subjected to an electromyographic examination before treatment: a total of 37 patients and 518 examined nerves including all clinical forms: NCV: 33% of the examined nerves are found to be affected. The sensory nerves are frequently and early involved. In frequency order: sural (54%), posterior tibial (50%), sensory ulnar (35%), sensory median (29%), motor ulnar (28%), lateral popliteal (17%) and motor median (12%). The study of the SCV seems relatively more reliable than the sensory testing in the case of the ulnar and the median (75 comparisons): concordance in 69% of the cases; SCV only abnormal in 19%; sensory testing only abnormal in 12%. The EMG detection is superior to the motor testing and to the motor nerve conduction for the lateral popliteal (32 comparisons): 41% of concordant examination; 59% of differences among which 44% of anomalies revealed only by detection.

[Frequency of the association of perforating plantar leprotic lesions and truncal involvement of the posterior tibial nerve]. / Fréquence de l'association entre les maux perforants plantaires lépreux et l'atteinte tronculaire du nerf tibial postérieur.

This study was performed to determine the electrophysiological status of the posterior tibial nerve and its muscular innervation in patients both with and without plantar ulcers without osteitis. In both cases, motor distal latencies remained normal, but the denervation of the plantar muscles was significantly more important in patients with ulcers. These results show that axonal degeneration is predominant in leprous neuritis affecting the tibial nerves. Neurolysis was performed in twelve patients in the retromalleolar part of the tibial nerve. All patients have recover from their ulcers, but no improvement of their electrophysiological parameters was observed.

Sensory testing: a sensitive method in the follow-up of nerve involvement.

Sensory testing (ST) as a parameter in assessing nerve damage and as a guide in anti-reaction treatment is discussed in comparison with established methods like voluntary muscle testing (VMT) and motor nerve conduction velocity (MCV). Sensory testing is shown to be a valuable addition to the existing tests and may even be used as a single parameter.

The place of electrical stimulation in the physiotherapy of leprosy.

The production of nerve and muscle impulses by faradic and interrupted direct current, and the "Strength-duration curves" plotted for normal, denervated, and partially denervated muscles, are described. The advantages and disadvantages of such electrical stimulation in the testing of recent paralysis, the treatment of recent paralysis, and following tendon transfer surgery, in leprosy patients, are discussed. In the light of these, electrical stimulation is concluded to have only a minor role in the Physiotherapy of leprosy.

Innervation of muscle in leprosy with special reference to the muscle spindle.

The pattern of extrafusal and intrafusal innervation was studied in muscle biopsies from the flexor carpi ulnaris and biceps brachii muscles, which were clinically unimpaired. Smudginess and enlargement of the motor end plates were the most definitely abnormal feature of the extrafusal innervation pattern; the intrafusal fibers, on the other hand, were either unremarkable or showed increased tortuosity, beading and in more extreme cases of grossly complicated intertwining pattern. Bacilli were frequently found in the spindles, no component being spared. The study emphasizes the significant involvement of striated muscle in leprosy, a fact not revealed by clinical examination alone.

Nerve conduction studies in leprosy.

Motor and sensory nerve conduction studies have been performed on the peripheral nerves in the upper and lower limbs of 30 control subjects, and 36 subjects with leprosy from the Aboriginal population of the Northern Territory of Australia. Impairment of conduction was demonstrated in the vast majority of clinically abnormal nerves, and a large proportion of nerves which appeared clinically to be uninvolved. In a third group of subjects, abnormal conduction was demonstrated in a significant number of nerves which were considered to be clinically enlarged but in whom the diagnosis was initially in doubt. The majority of these patients were subsequently proven to have leprosy. It is concluded that nerve conduction studies are of considerable value in the diagnosis and management of leprosy.