title: Prevalence of leprous neuropathy determined by neurosensory testing in an endemic zone in Ecuador: Development of an algorithm to identify patients benefiting from early neurolysis.
abstract: The success of a microneurosurgical intervention in leprous neuropathy (LN) depends on the diagnosis of chronic compression before irreversible paralysis and digital loss occurs. In order to determine the effectiveness of a different approach for early identification of LN, neurosensory testing with the Pressure-Specified Sensory Device™ (PSSD), a validated and sensitive test, was performed in an endemic zone for leprosy. A cross-sectional study was conducted to analyze a patient sample meeting the World Health Organization (WHO) criteria for Hansen's disease. The prevalence of LN was based on the presence of ≥1 abnormal PSSD pressure threshold for a two-point static touch. A total of 312 upper and lower extremity nerves were evaluated in 39 patients. The PSSD found a 97.4% prevalence of LN. Tinel's sign was identified in 60% of these patients. An algorithm for early identification of patients with LN was proposed using PSSD testing based on the unilateral screening of the ulnar and deep peroneal nerves.
authors.affiliation: The Dellon Institutes for Peripheral Nerve Surgery, Towson, MD, USA.
authors.forename: Pablo A
authors.initials: PA
authors.lastname: Baltodano
authors.affiliation: The Dellon Institutes for Peripheral Nerve Surgery, Towson, MD, USA.
authors.forename: Danielle H
authors.initials: DH
authors.lastname: Rochlin
authors.affiliation: Damien House Organization, Guayaquil, Ecuador.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Noboa
authors.affiliation: The Dellon Institutes for Peripheral Nerve Surgery, Towson, MD, USA.
authors.forename: Karim A
authors.initials: KA
authors.lastname: Sarhane
authors.affiliation: The Dellon Institutes for Peripheral Nerve Surgery, Towson, MD, USA.
authors.forename: Gedge D
authors.initials: GD
authors.lastname: Rosson
authors.affiliation: The Dellon Institutes for Peripheral Nerve Surgery, Towson, MD, USA. Electronic address: ALDellon@Dellon.com.
authors.forename: A Lee
authors.initials: AL
authors.lastname: Dellon
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D000465:Algorithms; D002648:Child; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D004484:Ecuador / Q000453:epidemiology; D005121:Extremities / Q000294:innervation*; D005260:Female; D006801:Humans; D007918:Leprosy / Q000150:complications / Q000453:epidemiology; D008297:Male; D009408:Nerve Compression Syndromes / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D009460:Neurologic Examination / Q000295:instrumentation / Q000379:methods; D019635:Neurosurgical Procedures / Q000379:methods*; D018579:Patient Selection; D012684:Sensory Thresholds; D014110:Touch
keywords: Leprosy; Nerve compression; Neurolysis; Neurosensory testing