Nerve decompression for leprous neuropathy: A prospective study from Ecuador

Wan, Eric L.; Noboa, Jonathan; Baltodano, Pablo A.; Jousin, Renato Martinez; Ericson, William B.; Wilton, James; Rosson, Gedge D.; Dellon, A. Lee

doi:10.47276/lr.88.1.95

Cited by 6 publications

(12 citation statements)

References 26 publications

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“…The 11 studies included in the final sample were comprised of a single RCT 13 , classified as level II evidence, and 10 prospective cohort studies, classified as level IV evidence, published between 1976 and 2020, and written in English and French 7,[14][15][16][17][18][19][20][21][22] . Four studies were conducted in India 7,13,18,20 , one in Ecuador 14 , one in Nepal 16 , one in Madagascar (Africa) 17 , and one in France 19 , while three studies did not provide information regarding the study site 15,21,22 . The sample sizes ranged from 10-500 participants, and the follow-up time ranged from 15 months 7,13-22 to 20 years 15,18 , as shown in Table 1.…”

Section: Resultsmentioning

confidence: 99%

Effectiveness of neurolysis as a treatment for complications of leprosy neuritis: a systematic review

Gonçalves

Fuentealba-Torres

Silva

et al. 2023

Rev. Soc. Bras. Med. Trop.

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Background: Complications of leprosy neuritis are considered serious and apparent, with the potential to disable and/or limit individuals. These complications affect not only a patient's physical functioning, but also their family and social lives, while directly impacting the ability to work and/or maintain financial independence, subsequently interfering with their overall quality of life. The present review, therefore, aimed to analyze the effectiveness of neurolysis as an alternative treatment for the complications associated with leprosy neuritis. Methods:The present review was performed based on the Joanna Briggs Institute methodology, in an effort to answer the following research question: what is the effectiveness of neurolysis as a treatment for leprosy neuritis complications? This research question was defined using the patient-intervention-outcome (PIO) framework, where leprosy represents 'P', neurolysis for 'I', and neuropathic pain/ motor function/sensorial function/physical disability/quality of life for 'O'. Randomized and non-randomized clinical trials and prospective observational cohort studies were included in the present review, with no time or date restrictions. Results:The present review included 1 randomized clinical trial and 10 prospective studies, published between 1976 and 2020. All of the outcomes showed improvement, with relief from neuropathic pain being the primary finding. Conclusions:The evidence obtained in the present review suggested that neurolysis is an effective alternative for the treatment of physical disabilities, the recovery of sensory and motor function, the restoration of quality of life, and neuropathic pain relief.

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Section: Resultsmentioning

confidence: 99%

Effectiveness of neurolysis as a treatment for complications of leprosy neuritis: a systematic review

Gonçalves

Fuentealba-Torres

Silva

et al. 2023

Rev. Soc. Bras. Med. Trop.

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“…Regarding the results of the studies selected, the grouping of coincident themes allowed the construction of four categories that summarize the main findings and are In category 1, only seven of the reviewed studies used the assessment of QoL as an outcome investigated following interventions. These studies included surgical (84) interventions, as well as those of self-care oriented health education (58) , therapeutic workshops (43) , stretching-specific physical therapy (56) , medication with emphasis on the treatment of type 1 leprosy reaction (60) , and neuropathic pain (51) .…”

Section: Resultsmentioning

confidence: 99%

“…The performance of surgical intervention for nerve decompression in patients with leprosy-related neuropathy resulted in a significant improvement in QoL (84) .…”

Section: Main Findingsmentioning

confidence: 99%

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Leprosy patients quality of life: a scoping review

Barcelos

Sousa

Almeida

et al. 2021

Rev. esc. enferm. USP

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Objective: To explore the scientific evidence regarding the leprosy patients quality of life. Method: Scoping review according to the Joanna Briggs Institute methodology, with articles indexed in PubMed, Cochrane, LILACS, Embase, CINAHL, Scopus, Web of Science, PsyINFO, INFOLEP, and Google Scholar databases, published in full in Portuguese, English, or Spanish. Results: Seventy-four studies were identified, with 71 of quantitative approach and 3 with a mixed method. There was a predominance of studies published in Brazil (58.1%), with an adult population, (97.3%) and recruited in reference centers for the treatment of leprosy (52.7%). There was greater use of the WHOQOL-bref (50%) and SF-36 (18.9%) instruments to assess quality of life. The study showed that the greatest impairment in quality of life was related to the delay in the diagnosis of the disease, to leprosy reactions, physical disabilities, neuropathic pain, and stigma. Conclusion: Most studies were developed in endemic countries, with adults, and based on observational studies, and the worst scores obtained were associated with physical domain impairment.

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“…In addition, the reduction in the values of these averages after the end of multidrug therapy demonstrates to what extent the treatment was able to modify the sensation profile, especially of the feet of these patients, and the most marked improvement being was evident among patients with fewer affected limbs, reaffirming the proposition that early diagnosis and treatment are essential in preventing deformities and disability. It is worth emphasizing that those patients who, even after multidrug therapy, still have residual disability detected by the SWM test, may benefit from appropriate peripheral nerve decompression surgery, preventing definitive neural damage from leprosy, as described by Wan et al [ 34 , 35 ]. Furthermore, considering the binomial logistic regression analysis, we emphasize that regardless of the initial severity weight based on the number of altered SWM-test points, the treatment was undoubtedly able to recover the sensation of hands and feet.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of altered patterns of tactile sensation in the diagnosis and monitoring of leprosy using the Semmes-Weinstein monofilaments

et al. 2022

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Background Leprosy neuropathy is the most common peripheral neuropathy of infectious etiology worldwide; it is characterized as asymmetric and focal multiple mononeuropathy. Semmes-Weinstein monofilament (SWM) test is a simple method to assess sensory nerve function. Methods and findings In this prospective cohort study, a dermatologist carried out hands and feet tactile sensation test with SWM in 107 multibacillary leprosy patients at diagnosis and in 76 patients at the end of treatment from 2016 to 2019. At diagnosis, 81/107 (75.7%) patients had some degree of functional disability, and 46 (43%) of them had altered SWM-test in the hands and 94 (87.9%) of them in the feet. After one year of multibacillary multidrug therapy, the disability decreasing to 44/76 patients (57.9%) and decreasing of the percentual of patients with altered SWM-test to 18% for the hands, and to 28.7% for the feet. At the end of treatment, the number of SMW-test points presented improvement in the hands of 22 (28.9%) patients, and in the feet of 47 (61.8%). In the hands, by SWM-test, only the radial nerve point demonstrated a significant asymmetry, while in the feet, the difference between the sum of altered SWM-test points showed significant asymmetry between both sides, highlighting the tibial nerve for the establishment of asymmetric leprosy neuropathy. In Spearman’s correlation analysis, a positive correlation with statistical significance was observed between the number of hands and feet SWM altered points at diagnosis and the degree of disability at diagnosis (0.69) and at the end of the treatment (0.80). Conclusion The patterns of hands and feet tactile sensation at diagnosis and their consequent modifications with the anti-leprosy drugs define the bacterial etiology of neuropathy, an important tool for the clinical diagnosis and follow up of the disease, highlighting the tibial nerve findings, the most affected nerve among leprosy patients by SWM-test, with significant asymmetry and focality impairments.

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Nerve decompression for leprous neuropathy: A prospective study from Ecuador

Cited by 6 publications

References 26 publications

Effectiveness of neurolysis as a treatment for complications of leprosy neuritis: a systematic review

Effectiveness of neurolysis as a treatment for complications of leprosy neuritis: a systematic review

Leprosy patients quality of life: a scoping review

Evaluation of altered patterns of tactile sensation in the diagnosis and monitoring of leprosy using the Semmes-Weinstein monofilaments

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