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Nerve damage in leprosy and its management

Nature Clinical Practice Neurology volume 4, pages 656–663 (2008)Cite this article

Abstract

Leprosy is the most common treatable peripheral nerve disorder worldwide. Deformity and disability result from nerve-function impairment; however, early treatment is associated with good outcome. Leprosy is often diagnosed late as many physicians have little experience with the clinical picture. Recent research using nerve conduction and thermal threshold tests has identified that nerve impairment is detectable long before it turns clinical. This discovery could have important implications for treatment because steroid therapy for nerve-function impairment that is detected clinically is unsatisfactory. Evidence that clinical neuropathy represents only the 'tip of the iceberg' of nerve damage, together with an understanding that the underlying inflammatory immunological processes require longer, more-aggressive treatment, could help usher in new and more-successful approaches to the treatment of nerve-function impairment in leprosy. This Review focuses on the neurological manifestations of leprosy and the pathophysiology of nerve damage. Early detection and treatment of nerve-function impairment are crucial for outcome, so special emphasis is given to developments in detecting and treating nerve impairment in leprosy early.

Key Points

  • Leprosy can be confidently diagnosed by identifying the typical clinical features of the skin and nerves

  • In less than 10% of cases, leprosy affects only the nerves and requires histological confirmation

  • The most common clinical pattern of nerve damage is mononeuritis multiplex; less common is diffuse peripheral nerve involvement

  • Dynamic host immune responses to Mycobacterium leprae cause spontaneous clinical manifestations called leprosy reactions and often result in acute peripheral nerve damage

  • Patients with multibacillary leprosy and clinical nerve-function impairment have a high risk for further nerve-function impairment

  • Acute nerve damage requires treatment with corticosteroids

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Author information

Authors and Affiliations

  1. EP Wilder-Smith is Professor and Senior Consultant of Neurology and Director of the Neurology Diagnostic Laboratory, National University Singapore, Singapore,

    Einar P Wilder-Smith

  2. WH Van Brakel is Head of the KIT Leprosy Unit, Royal Tropical Institute, Amsterdam, The Netherlands.,

    Wim H Van Brakel

Authors
  1. Einar P Wilder-Smith
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  2. Wim H Van Brakel
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Corresponding author

Correspondence to Einar P Wilder-Smith.

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The authors declare no competing financial interests.

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Wilder-Smith, E., Van Brakel, W. Nerve damage in leprosy and its management. Nat Rev Neurol 4, 656–663 (2008). https://doi.org/10.1038/ncpneuro0941

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