Neuroscience and Behavior Sciences Department, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
Dermatology, Clinical Medicine Department, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
J Peripher Nerv Syst. 2024 Sep;29(3):356-362. doi: 10.1111/jns.12649. Epub 2024 Aug 20.
Leprosy is a chronic infectious disease caused by Mycobacterium leprae (M. leprae), an intracellular bacillus that systematically invades the peripheral nerves. Diagnosing leprosy neuropathy is still a defying skill, and late diagnosis and treatment are still a reality. Based on the biological characteristics of M. leprae, particularly its preference for invading the Schwann cells localized at the coldest areas of human body, we hypothesized that these areas have focal demyelination that may escape detection through standard nerve conduction studies (NCSs) protocols.
Twenty-five patients with confirmed multibacillary leprosy and 14 controls were accessed. A multisegmented NCS protocol (MP) was performed, targeting short segments through the coldest areas, to identify focal areas of slowed conduction velocity. The effectiveness of this multisegmented protocol was compared to the standard protocol (SP) to detect abnormalities.
All leprosy patients presented an abnormal study with the MP, contrasting to 19 with the SP. The most frequent NCS pattern was an asymmetric neuropathy with focal slowing of conduction velocity, found in 23 out of 25 leprosy patients. Significant differences favoring the proposed method were observed when comparing the MP with the SP. Notably, the MP increased the sensitivity to detect abnormalities by 122%, 133%, and 257% for the median, peroneal, and tibial nerves, respectively. MP also increases sensitivity to detect focal abnormalities in the ulnar nerve.
The MP protocol significantly increases the sensitivity of NCSs to detect neurophysiological abnormalities in leprosy neuropathy.
麻风病是一种由麻风分枝杆菌（M. leprae）引起的慢性传染病，这种胞内杆菌会系统性地侵犯外周神经。诊断麻风病神经病变仍然是一项具有挑战性的技能，迟诊和治疗不足仍然是现实问题。基于麻风分枝杆菌的生物学特性，尤其是其偏爱侵犯人体最冷部位的雪旺细胞这一特性，我们假设这些部位存在局灶性脱髓鞘，可能通过标准神经传导研究（NCS）方案无法检测到。
共纳入 25 例确诊的多菌型麻风病患者和 14 例对照者。进行多节段 NCS 方案（MP），针对最冷区域的短节段，以识别传导速度缓慢的局灶区域。将该多节段方案与标准方案（SP）进行比较，以评估其检测异常的效果。
所有麻风病患者的 MP 检查均表现出异常，而 SP 检查则有 19 例异常。最常见的 NCS 模式是具有局灶性传导速度减慢的不对称性神经病，在 25 例麻风病患者中有 23 例出现。与 SP 相比，MP 具有显著优势。值得注意的是，MP 分别使正中神经、腓总神经和胫神经检测异常的敏感性增加了 122%、133%和 257%。MP 还增加了对尺神经局灶性异常的敏感性。
MP 方案显著提高了 NCS 检测麻风病神经病变神经生理学异常的敏感性。
