The effectiveness of early diagnostic tools for neural lesions in leprosy An observational cohort study

Abstract

IntroductionLeprosy can cause different lesions in peripheral nerves and inervatory structures.ObjectivesTo analyse the effectiveness of evaluation protocols used to identify neural lesions in leprosy such as Degree of Physical Disability (DPD), Simplified Neurological Assessment (SNA), and Neurodynamic Assessment (NDA).MethodDescriptive analytical study, associative, with 27 individuals treated in two outpatient leprosy clinics in São Paulo State, between 2017 and 2019, and 27 individuals from the paired control group. The Mann-Whitney, Multivariate Linear Regression and association between variables and P<0.05 values were used.ResultsThe test that most captured the neurological alterations was the SNA, with 22 (81.5%) in the upper limbs (ULs) and 25 (92.6%) in the lower limbs (LLs), followed by the NDA, with 20 (74.1%) in the ULs and 11 (40.7%) in the LLs. The DPD showed handicap in the hands of 16 (59.2%) individuals and in the feet of 17 (62.9%) individuals, and they have expressed sensitivity. DPD showed agreement with SNA in 21 (77.8%) of the cases in ULs (p=0.010) and 19 (70,4%) of the cases in LLs (p=0.060). DPD and NDA showed that in 19 (70.4%) of the patients evaluated there was concordance of results in ULs (p=0.143); 9 (33.3%) in LLs (p=0.125). SNA and the NDA in the ULs found agreement in 21 (77.8%); 11 (40.7%) (p=0.786) in the LLs.ConclusionThe three assessment instruments are specific and will hardly produce false positive tests. DPD can produce more false negatives than SNA. If there is an instrument to be chosen, it should be the SNA, since it is more sensitive, more accurate and has a less negative likelihood ratio. Neurodynamic tests were positive in 7.4% of individuals while there were still no changes in the SNA; afterwards, these changes appeared.