Proprioceptive loss in leprous neuropathy: A study of 19 patients

Background: Leprosy presents commonly with mononeuritis multiplex, affecting mainly the exteroceptive sensations. Neuropathy with a significant afferent large fiber element is considered to be an uncommon manifestation of leprous neuropathy. Aims: To evaluate the clinical and neurophysiologic aspects of a subset of patients with leprous neuropathy having clinical proprioceptive loss. Settings and Design: Prospective study of patients with a diagnosis of peripheral neuropathy secondary to leprosy having proprioceptive loss. Materials and Methods: Consecutive patients seen during a two-year period (2004 and 2005) diagnosed to have leprous neuropathy with proprioceptive abnormalities on clinical examination were included. The diagnosis of leprosy was achieved by clinical features along with positive skin biopsy, split skin smears or nerve biopsy. Their clinical and electrophysiological characteristics were studied. Statistical Methods : The results were analyzed using Chi-Square test. Values less than 0.05 were considered to be statistically significant . Results and Conclusions: We observed predominance (68.42%) of multibacillary of leprosy. Symmetrical neuropathies outnumbered mononeuritis multiplex (12:7). The pan sensory neuropathy had a mean duration of 24.32 months, but sometimes appeared early in the course of the disease. Areflexia and electrophysiological evidence of proximal affection was common, reflecting proximal spread of neuropathic process. Such patients have a higher incidence of developing deformities and ulcerations and they represent a vulnerable subset of patients with leprosy.

Keywords
Electrophysiology, leprosy, mononeuritis multiplex, multibacillary, polyneuropathy, proprioception