title: Sensory testing in leprosy: comparison of ballpoint pen and monofilaments.
abstract: The 10 g monofilament has been replaced by the ballpoint pen in routine sensory testing of nerves in leprosy control in Ethiopia. Results of sensory testing between the ballpoint pen and different monofilaments on hands and feet were compared. Ballpoint pen underdiagnosis of loss of sensation was defined to occur when the pen was felt and the monofilament was not. Differences were evaluated both for individual test points (test point level) and for the test points of extremities collectively (extremity level). An extremity (either a hand or a foot) was defined as having sensory nerve function impairment (SNFI) if a supplying nerve had SNFI, which was the case when sensation was absent in two or more test points in the area supplied by that nerve. At test point level, the percentages with ballpoint pen underdiagnosis relative to the 2, 10, 20 and 50 g monofilaments were 40, 21, 9 and 7%, respectively, in the hands, and 47, 30, 15 and 7% in the feet. Ballpoint pen underdiagnosis percentages of SNFI at extremity level were 32, 18, 8 and 9% in the hands, and 37, 26, 14 and 6% in the feet. The risk of ballpoint pen underdiagnosis appears to be higher in extremities without visible damage. In conclusion, substantial levels of underdiagnosis of sensory loss with the ballpoint pen were observed. However, the consequences for the prognosis of treatment with corticosteroids in patients with the more subtle sensation loss noted here need to be established. Development and testing of guidelines is a prerequisite for the use of the ballpoint pen.
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
authors.forename: L F
authors.initials: LF
authors.lastname: Koelewijn
authors.forename: A
authors.initials: A
authors.lastname: Meima
authors.forename: S M
authors.initials: SM
authors.lastname: Broekhuis
authors.forename: J H
authors.initials: JH
authors.lastname: Richardus
authors.forename: P D
authors.initials: PD
authors.lastname: Mitchell
authors.forename: C
authors.initials: C
authors.lastname: Benbow
authors.forename: P R
authors.initials: PR
authors.lastname: Saunderson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007918:Leprosy / Q000150:complications* / Q000175:diagnosis; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000295:instrumentation* / Q000379:methods; D016017:Odds Ratio; D010523:Peripheral Nervous System Diseases / Q000175:diagnosis / Q000209:etiology; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012684:Sensory Thresholds; D012720:Severity of Illness Index; D020886:Somatosensory Disorders / Q000175:diagnosis* / Q000209:etiology; D014110:Touch