Khadilkar Satish V, Patil Sarika B, Shetty Vanaja P
Bombay Hospital Institute of Medical Sciences, Mumbai, India.
Kokilaben Dhirubhai Ambani Hospital, Mumbai, India.
J Neurol Sci. 2021 Jan 15;420:117288. doi: 10.1016/j.jns.2020.117288. Epub 2020 Dec 25.
Neuropathies form an integral part of the symptomatology of leprosy. Neuropathies of leprosy take various forms and shapes. At one end is the cutaneous nerve involvement adjacent to the anaesthetic skin patch and the other is of symmetrical pansensory neuropathy and the devastating sensory ataxia of leprous ganglionits. Lepra reactions add to the spectrum. Hosts immunological status largely decides the clinical manifestations seen in nerves and skin. A wide array of diagnostic techniques like ultrasonography, magnetic resonance neurography, serological markers, molecular tests, skin biopsy and in selected cases, the nerve biopsy with special stains and electron microscopy are obtainable to help the clinical diagnosis. The unsuspecting clinician, lack of community awareness and limited availability of diagnostic tests are important adverse factors in the total outcome. Multi drug therapy is efficacious and corticosteroids reduce the impact of nerve damage in leprosy. The efficacy, dose and duration of corticosteroid therapy are presently inexact and other immune suppressants like azathioprine are being evaluated. Chronic disabilities and residual deficits require attention of multiple specialties. In the coming time, focus on prevention could lead to favourable results. This review will discuss the classification systems, common and uncommon clinical features, diagnostic armamentarium and therapeutic and preventive aspects of neuropathies of leprosy.
神经病变是麻风病症状学的一个组成部分。麻风病的神经病变有多种形式。一端是与麻醉性皮肤斑块相邻的皮神经受累，另一端是对称性全感觉神经病变以及麻风性神经炎严重的感觉性共济失调。麻风反应增加了其表现范围。宿主的免疫状态在很大程度上决定了在神经和皮肤中出现的临床表现。有多种诊断技术，如超声检查、磁共振神经成像、血清学标志物、分子检测、皮肤活检，在某些情况下，还有采用特殊染色和电子显微镜的神经活检，可用于协助临床诊断。毫无戒心的临床医生、社区意识的缺乏以及诊断检测的有限可得性是总体结果中的重要不利因素。多药联合疗法是有效的，皮质类固醇可减轻麻风病中神经损伤的影响。目前皮质类固醇疗法的疗效、剂量和疗程尚不准确，正在评估硫唑嘌呤等其他免疫抑制剂。慢性残疾和残留缺陷需要多个专科的关注。在未来，注重预防可能会带来良好的结果。本综述将讨论麻风病神经病变的分类系统、常见和不常见的临床特征、诊断方法以及治疗和预防方面。
