Spitz Clarissa Neves, Pitta Izabela Jardim Rodrigues, Andrade Ligia Rocha, Sales Anna Maria, Sarno Euzenir Nunes, Villela Nivaldo Ribeiro, Pinheiro Roberta Olmo, Jardim Marcia Rodrigues
Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
Post-Graduate Program in Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil.
Front Med (Lausanne). 2023 Jun 15;10:1202108. doi: 10.3389/fmed.2023.1202108. eCollection 2023.
One of the main manifestations of leprosy is peripheral nerve impairment. Early diagnosis and treatment are important to reduce the impact of neurological impairment, which can cause deformities and physical disabilities. Leprosy neuropathy can be acute or chronic, and neural involvement can occur before, during, or after multidrug therapy, and especially during reactional episodes when neuritis occurs. Neuritis causes loss of function in the nerves and can be irreversible if left untreated. The recommended treatment is corticosteroids, usually through an oral regimen at an immunosuppressive dose. However, patients with clinical conditions that restrict corticosteroid use or that have focal neural involvement may benefit from the use of ultrasound-guided perineural injectable corticosteroids. In this study, we report two cases that demonstrate how the treatment and follow-up of patients with neuritis secondary to leprosy, using new techniques, can be provided in a more individualized way. Nerve conduction studies in association with neuromuscular ultrasound were used to monitor the response to treatment with injected steroids, focusing on neural inflammation. This study provides new perspectives and options for this profile of patients.
麻风病的主要表现之一是周围神经损伤。早期诊断和治疗对于减轻神经损伤的影响非常重要,神经损伤可导致畸形和身体残疾。麻风性神经病变可以是急性或慢性的,神经受累可发生在多药治疗之前、期间或之后,尤其是在发生神经炎的反应期。神经炎会导致神经功能丧失,如果不治疗可能会不可逆转。推荐的治疗方法是使用皮质类固醇,通常采用免疫抑制剂量的口服方案。然而,有临床情况限制使用皮质类固醇或有局灶性神经受累的患者可能会受益于超声引导下神经周围注射皮质类固醇。在本研究中,我们报告了两例病例,展示了如何采用新技术以更个体化的方式为麻风病继发神经炎患者提供治疗和随访。将神经传导研究与神经肌肉超声相结合,用于监测注射类固醇治疗的反应,重点关注神经炎症。本研究为这类患者提供了新的视角和选择。