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Electrophysiological Evaluation of Peripheral and Autonomic Involvement in Leprosy

Published online by Cambridge University Press:  02 December 2014

Aysun Soysal ,
Turan Atay ,
Tacettin Ozu  and
Baki Arpaci
Aysun Soysal
Affiliation:
Bakirkoy State Hospital for Neurological and Psychiatric Diseases, Neurology Department, Istanbul, Turkey
Turan Atay
Affiliation:
Bakirkoy State Hospital for Neurological and Psychiatric Diseases, Neurology Department, Istanbul, Turkey
Tacettin Ozu
Affiliation:
Bakirkoy State Hospital for Neurological and Psychiatric Diseases, Neurology Department, Istanbul, Turkey
Baki Arpaci
Affiliation:
Bakirkoy State Hospital for Neurological and Psychiatric Diseases, Neurology Department, Istanbul, Turkey
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Abstract

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Objective:

Motor and sensory nerve conductions, F responses, sympathetic skin responses and R-R interval variations (RRIV) were studied to determine the type of peripheral neuropathy among patients with leprosy.

Methods:

Twenty-nine consecutive patients with leprosy (25 male, 4 female) hospitalized in the “Istanbul Leprosy Hospital'' between January - December, 1999 were included in this study. Ten patients had borderline lepromatous leprosy, and 19 had lepromatous leprosy. None of the patients studied had the tuberculoid form. The mean age was 55±12 years. The control group consisted of 30 (26 male, 4 female) healthy volunteers (mean age: 58.1±7.8 years). All subjects included in the study underwent neurological examination and electrophysiological evaluation. Standard procedures were performed for evaluating sensory and motor conduction studies. Motor studies were carried out on both left and right median, ulnar, tibial and common peroneal nerves while median, ulnar, sural and superficial peroneal nerves were examined for sensory studies. Sympathetic skin response recordings on both hands and RRIV recordings on precordial region were done in order to evaluate the autonomic involvement.

Results:

The lower extremity was found to be more severely affected than the upper, and sensory impairment predominated over motor. Of 58 upper limbs examined, no sympathetic skin responses was recorded in 46 (79.3%). Compared with the controls, the RRIVs of the leprosy patients were found to be reduced during both resting and deep forced hyperventilation.

Conclusion:

Our results indicate that leprosy causes a predominantly axonal polyneuropathy that is more severe in the lower extremities. Sensory nerve damage is accompanied by autonomic involvement.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 31 , Issue 3 , August 2004 , pp. 357 - 362
Copyright
Copyright © The Canadian Journal of Neurological 2004

References

1.Kimura, J.The F wave. In: Kimura, J (Ed). Electrodiagnosis in Diseases of Nerve and Muscle: Principles and Practice. Philadelphia: F.A.Davis Company, 1989: 332–355.Google Scholar
2.Sabin, TD, Swift, TR, Jacobson, RR.Leprosy. In: Dyck, PJ, Thomas, PK, Griffin, JW, Low, PA, Poduslo, JF, (Eds.) Peripheral Neuropathy. Philadelphia: W.B. Saunders Company, 1993: 1354–1379.Google Scholar
3.Sabin, TD, Swift, TD.Neurologic complications of leprosy. In: Aminoff, MJ, (Ed). Neurology and General Medicine. The Neurological Aspects of Medical Disorders. New York: Churchill Livingstone, 1995: 717–729.Google Scholar
4.Bosch, EP, Smith, BE.Disorders of peripheral nerves. In: Bradley, WG, Daroff, RB, Fenichel, GM, Marsden, CD, (Eds.) Neurology in Clinical Practice. Boston: Butterworth-Heinemann, 2000: 2045–2130.Google Scholar
5.Solbrig, MV, Healy, JF, Jay, CA.Bacterial infections. In: Bradley, WG, Daroff, RB, Fenichel, GM, Marsden, CD, (Eds.) Neurology in Clinical Practice. Boston: Butterworth-Heinemann, 2000: 1332–1334.Google Scholar
6.Amato, AA, Dumitru, D.Acquired neuropathies. In: Dumitru, D, Amato, AA, Zwarts, MJ, (Eds.) Electrodiagnostic Medicine. Philadelphia: Hanley & Belfus, Inc, 2002: 971–973.Google Scholar
7.Tzourio, C, Said, G, Millan, J.Asymptomatic nerve hypertrophy in lepromatous leprosy: a clinical, electrophysiological and morphological study. J Neurol 1992; 239: 367–374.CrossRefGoogle ScholarPubMed
8.Abbot, NC, Beck, JS, Mostofi, S, Weiss, F.Sympathetic vasomotor dysfunction in leprosy patients: comparison with electrophysiological measurement and qualitative sensation testing. Neurosci Lett 1996; 206: 57–60.CrossRefGoogle Scholar
9.Wilder-Smith, A, Wilder-Smith, E.Electrophysiological evaluation of peripheral autonomic function in leprosy patients, leprosy contacts and controls. Int J Leprosy 1996; 64: 433–440.Google ScholarPubMed
10.Bordet, R, Benhadjali, J, Destee, A, et al.Sympathetic skin response and R-R interval variability in multiple system atrophy and idiopathic Parkinson’s disease. Mov Disord 1996; 11: 268–272.CrossRefGoogle Scholar
11.Toyokura, M, Murakami, K.Reproducibility of sympathetic skin response. Muscle Nerve 1996; 19: 1481–1483.3.0.CO;2-W>CrossRefGoogle ScholarPubMed
12.Aramaki, S, Kira, Y, Hirasawa, Y.A study of normal values and habituation phenomenon of sympathetic skin response. Am J Phys Med Rehabil 1997; 76: 2–7.CrossRefGoogle ScholarPubMed
13.Cacciatori, V, Dellera, A, Bellavere, F, et al.Comparative assessment of peripheral sympathetic function by postural vasoconstriction arteriolar reflex and sympathetic skin response in NIDDM patients. Am J Med 1997; 102: 365–370.CrossRefGoogle ScholarPubMed
14.Wilder-Smith, E, Wilder-Smith, A, Egger, M.Peripheral autonomic nerve dysfunction in asymptomatic leprosy contacts. J Neurol Sci 1997; 150: 33–38.CrossRefGoogle ScholarPubMed
15.Wilder-Smith, EP, Wilder-Smith, AJ, Nirkko, AC.Skin and muscle vasomotor reflexes in detecting autonomic dysfunction in leprosy. Muscle Nerve 2000; 23: 1105–1112.3.0.CO;2-A>CrossRefGoogle ScholarPubMed
16.Mendis, S, Somasiri, KG, Chularatna, W.Effect of drug treatment on electroneurological measures of peripheral nerve function in leprosy patients. Ceylon Med J 1993; 38: 174–177.Google ScholarPubMed
17.Rao, SP, Taori, GM, Desikan, KV, Nayar, S.Clinical and electroneurophysiological assessment of leprosy patients on dapsone monotherapy-- a two year follow-up study. Indian J Lepr 1995; 67: 167–176.Google ScholarPubMed
18.Samant, G, Shetty, VP, Uplekar, MW, Antia, NH.Clinical and electrophysiological evaluation of nerve function impairment following cessation of multidrug therapy in leprosy. Lepr Rev 1999; 70: 10–20.Google ScholarPubMed
19.Jacobs, JM, Shetty, VP, Antia, NH.Myelin changes in leprous neuropathy. Acta Neuropathol 1987; 74: 75–80.CrossRefGoogle ScholarPubMed
20.Kanzato, N, Komine, Y, Fukiyama, K.Sympathetic skin responses of the hand in normal subjects: shorter latency at distal phalanx. Electroenceph Clin Neurophysiol 1997; 105: 165–170.CrossRefGoogle ScholarPubMed
21.Deltombe, T, Hanson, P, Jamart, J, Clèrin, M.The influence of skin temperature on latency and amplitude of the sympathetic skin response in normal subjects. Muscle Nerve 1998; 21: 34–39.3.0.CO;2-H>CrossRefGoogle ScholarPubMed
22.Matsunaga, K, Uozumi, T, Tsuji, S, Murai, Y.Sympathetic skin responses recorded from non-palmar and non-plantar skin sites: their role in the evaluation of thermal sweating. Electroenceph Clin Neurophysiol 1998; 108: 482–489.CrossRefGoogle ScholarPubMed
23.Toyokura, M.Waveform and habituation of sympathetic skin response. Electroenceph Clin Neurophysiol 1998; 109: 178–183.CrossRefGoogle ScholarPubMed
24.Parisi, L, Valente, G, Serrao, M, et al.RR interval variation, sympathetic skin reflex and QT dispersion in the assessment of autonomic function in peripheral neuropathy. Electromyogr Clin Neurophysiol 1999; 39: 461–468.Google ScholarPubMed
25.Wilder-Smith, A, Wilder-Smith, E.Effect of steroid therapy on parameters of peripheral autonomic dysfunction in leprosy patients with acute neuritis. Int J Leprosy 1997; 65: 20–27.Google Scholar
26.Gupta, BK, Kochar, DK.Study of nerve conduction velocity, somatosensory-evoked potential and late responses (H-reflex and F-wave) of posterior tibial nerve in leprosy. Int J Leprosy 1994; 62: 586–593.Google ScholarPubMed
27.Oh, SJ.Uncommon nerve conduction studies. In: Oh, SJ (Ed.) Clinical Electromyography: Nerve Conduction Studies. Baltimore: Williams & Wilkins, 1993: 149–276.Google Scholar
28.Pandya, SS, Bhatki, WS.Severe pan-sensory neuropathy in leprosy. Int J Leprosy 1994; 62: 24–31.Google ScholarPubMed
29.Kaplan, M, Gelber, RH.Evaluation of testing modalities for peripheral neuropathy in lepromatous Hansen’s disease. Phys Ther 1985; 65: 1662–1665.CrossRefGoogle ScholarPubMed
30.Ramakrishnan, AG, Srinivasan, TM.Electrophysiological correlates of hanseniasis. Int J Lepr 1995; 63: 395–408.Google ScholarPubMed
31.Brown, TR, Kovindha, A, Wathanadilokkol, U, et al.Leprosy neuropathy: correlation of clinical and electrophysiological tests. Indian J Lepr 1996; 68: 1–14.Google ScholarPubMed
32.Shahani, BT.Late responses and the “silent period”. In: Aminoff, MJ, (Ed). Electrodiagnosis in Clinical Neurology. New York: Churchill Livingstone, 1980: 355–367.Google Scholar