title: Comprehensive electrophysiology in leprous neuropathy - Is there a clinico-electrophysiological dissociation?
abstract: The diagnosis of leprous neuropathy is mostly empirical and electrophysiological studies may not truly represent the clinical findings. This study comprehensively evaluates the neuroelectrophysiology and looks at clinico-electrophysiological dissociation.
  
  
  
  Conventional electrophysiological recording included evaluation of median, ulnar, radial, tibial, and common peroneal nerve; an extended protocol included great auricular, phrenic, and facial nerves, along with sympathetic skin response and blink reflex. Nerve biopsy and slit skin smear were done to aid categorization.
  
  
  
  Forty-six patients of leprosy were enrolled. Mononeuritis multiplex was the commonest presentation. Sensory loss was commoner than motor deficits. Approximately 60% of all cases were nerve-biopsy proven. Nerve thickening was present in 38.7% (214/552) of nerves examined. Clinico-electrophysiological dissociation between nerve thickening and nerve conduction findings was present in median, ulnar, great auricular, and common peroneal nerves.
  
  
  
  Electrophysiological findings outnumber occurrence of nerve thickening and clinical deficits in leprous neuropathy. From a clinical perspective, enlargement of great auricular, ulnar, and common peroneal nerves may be more sensitive in predicting electrophysiological abnormalities.
  
  
  
  A comprehensive nerve conduction study including great auricular and phrenic nerves, coupled with a sympathetic skin response, may aid in detecting cases with paucity of findings since such a combination is seldom seen in other disorders.
authors.affiliation: Department of Neurology, King George's Medical University, U.P., Lucknow 226003, India. Electronic address: drneeraj2903@gmail.com.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Kumar
authors.affiliation: Department of Neurology, King George's Medical University, U.P., Lucknow 226003, India. Electronic address: drhsmalhotra@gmail.com.
authors.forename: Hardeep Singh
authors.initials: HS
authors.lastname: Malhotra
authors.affiliation: Department of Neurology, King George's Medical University, U.P., Lucknow 226003, India. Electronic address: garg50@yahoo.com.
authors.forename: Ravindra Kumar
authors.initials: RK
authors.lastname: Garg
authors.affiliation: Breach Candy Hospital, Mumbai, India. Electronic address: rakesh_lalla@yahoo.com.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Lalla
authors.affiliation: Department of Pathology, R.M.L. Institute of Medical Sciences, Lucknow 226010, India. Electronic address: drkiranpreetmalhotra@yahoo.co.in.
authors.forename: Kiran Preet
authors.initials: KP
authors.lastname: Malhotra
authors.affiliation: Department of Microbiology, King George's Medical University, U.P., Lucknow 226003, India. Electronic address: amita602002@yahoo.com.
authors.forename: Amita
authors.initials: A
authors.lastname: Jain
authors.affiliation: Department of Neurology, King George's Medical University, U.P., Lucknow 226003, India. Electronic address: imranrizvi09@gmail.com.
authors.forename: Imran
authors.initials: I
authors.lastname: Rizvi
mesh_terms: D000328:Adult; D001917:Brachial Plexus / Q000503:physiopathology*; D004568:Electrodiagnosis; D005260:Female; D006801:Humans; D007918:Leprosy / Q000150:complications* / Q000503:physiopathology; D008297:Male; D009431:Neural Conduction / Q000502:physiology*; D009460:Neurologic Examination; D010523:Peripheral Nervous System Diseases / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D010543:Peroneal Nerve / Q000503:physiopathology; D011446:Prospective Studies; D013979:Tibial Nerve / Q000503:physiopathology
keywords: Great auricular nerve; Leprosy; Mononeuritis multiplex; Neuropathy; Sympathetic skin response