The treatment of acute nerve function impairment in leprosy: results from a prospective cohort study in Bangladesh.
In this paper, the outcome of 132 patients having acute nerve function impairment (NFI) is reported at 4 and 12 months after the start of prednisolone treatment. In all, 68% of sensory nerves and 67% of motor nerves showed improvement at 12 months, with no statistical difference in responsiveness of various nerves to prednisolone. Duration and severity of impairment were not found significant predictors of treatment outcome. A core of 32% of impaired nerves did not respond to prednisolone, and 12% of impaired nerves had functional deterioration despite treatment. The mean eye-hand-foot (EHF) score improved from 2.02 to 1.33 in the treatment group (median score improved from 2 to 1). Approximately one-third of all patients requiring prednisolone treatment did not receive it, an important reason being that some patients developed new NFI against a background of chronic impairment, and were thus overlooked. The 'unjustly untreated' group of patients had a spontaneous sensory nerve function improvement rate of 62% and a motor nerve function improvement rate of 33% at 12 months from onset of NFI. The EHF score showed no statistically significant improvement.
Croft
R P
RP
Danish-Bangladesh Leprosy Mission (DBLM), Nilphamari. richard@crofts32.freeserve.co.uk
Nicholls
P G
PG
Richardus
J H
JH
Smith
W C
WC
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001459:Bangladesh; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007918:Leprosy / Q000150:complications*; D008297:Male; D010523:Peripheral Nervous System Diseases / Q000150:complications / Q000188:drug therapy*; D011239:Prednisolone / Q000627:therapeutic use*; D011446:Prospective Studies; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D011239:Prednisolone