Dermatology Division, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
National Reference Center in Sanitary Dermatology, Focusing on Leprosy, of Ribeirão Preto Clinical Hospital, Ribeirão Preto, Brazil.
PLoS One. 2022 Aug 10;17(8):e0272151. doi: 10.1371/journal.pone.0272151. eCollection 2022.
Leprosy neuropathy is the most common peripheral neuropathy of infectious etiology worldwide; it is characterized as asymmetric and focal multiple mononeuropathy. Semmes-Weinstein monofilament (SWM) test is a simple method to assess sensory nerve function.
In this prospective cohort study, a dermatologist carried out hands and feet tactile sensation test with SWM in 107 multibacillary leprosy patients at diagnosis and in 76 patients at the end of treatment from 2016 to 2019. At diagnosis, 81/107 (75.7%) patients had some degree of functional disability, and 46 (43%) of them had altered SWM-test in the hands and 94 (87.9%) of them in the feet. After one year of multibacillary multidrug therapy, the disability decreasing to 44/76 patients (57.9%) and decreasing of the percentual of patients with altered SWM-test to 18% for the hands, and to 28.7% for the feet. At the end of treatment, the number of SMW-test points presented improvement in the hands of 22 (28.9%) patients, and in the feet of 47 (61.8%). In the hands, by SWM-test, only the radial nerve point demonstrated a significant asymmetry, while in the feet, the difference between the sum of altered SWM-test points showed significant asymmetry between both sides, highlighting the tibial nerve for the establishment of asymmetric leprosy neuropathy. In Spearman's correlation analysis, a positive correlation with statistical significance was observed between the number of hands and feet SWM altered points at diagnosis and the degree of disability at diagnosis (0.69) and at the end of the treatment (0.80).
The patterns of hands and feet tactile sensation at diagnosis and their consequent modifications with the anti-leprosy drugs define the bacterial etiology of neuropathy, an important tool for the clinical diagnosis and follow up of the disease, highlighting the tibial nerve findings, the most affected nerve among leprosy patients by SWM-test, with significant asymmetry and focality impairments.
麻风神经病是全世界最常见的感染性病因所致周围神经病；其特征为非对称和局灶性多发性单神经病。Semmes-Weinstein 单丝（SWM）测试是一种评估感觉神经功能的简单方法。
在这项前瞻性队列研究中，一位皮肤科医生在 2016 年至 2019 年间，对 107 例多菌型麻风患者在诊断时和 76 例治疗结束时进行了手部和足部触觉 SWM 测试。在诊断时，81/107（75.7%）例患者存在一定程度的功能障碍，46（43%）例手部和 94（87.9%）例足部 SWM 测试异常。经过一年的多菌型多药治疗，残疾患者减少到 44/76 例（57.9%），手部 SWM 测试异常的患者比例降低到 18%，足部降低到 28.7%。在治疗结束时，手部的 22（28.9%）例和足部的 47（61.8%）例 SWM 测试点有改善。在手部，仅桡神经点表现出明显的不对称性，而在足部，双侧改变的 SWM 测试点之和的差异显示出明显的不对称性，突出了胫神经在不对称性麻风神经病中的作用。在 Spearman 相关性分析中，在诊断时和治疗结束时，手部和足部 SWM 异常点数与残疾程度之间存在显著的正相关（诊断时为 0.69，治疗结束时为 0.80）。
诊断时的手部和足部触觉感知模式及其随后的抗麻风药物改变，确定了神经病的细菌病因，这是临床诊断和疾病随访的重要工具，突出了胫神经的发现，这是 SWM 测试中受麻风病影响最严重的神经，具有显著的不对称性和局灶性损害。
