CLINICAL NEUROPHYSIOLOGY APPROACH TO LEPROSY NEUROPATHY

1
Leprosy Mailing List May 2008
CLINICAL NEUROPHYSIOLOGY APPROACH TO LEPROSY
NEUROPATHY
José A Garbino Instituto Lauro de Souza
Lima Bauru, SP, Brazil
2
Introduction

• This presentation was carried out at the 17th
  International Leprosy Congress (Hyderabad, India,
  2008) in the Training Session Clinical
  neurophysiology approach to leprosy neuropathy.
• Dr. Salvatore Noto suggested to circulate the
  contents in the leprosy mailing list that makes
  me too proud and involved. I tried to do few
  improvements in order to make it more
  comprehensive, as it was an oral presentation,
  which could fill some lacks during the slides
  view. So, some difficulties may happen but after
  all we will have the Lets share our knowledge
  Session using this notable media.
• The contents will be sent separately, divided in
  8 chapters.
• Thank you in advance for all your comments and
  suggestions and, I hope you will enjoy it.
• José Antônio Garbino

3
Contents

• Part I (slides 1-6)
• Introduction
• Contents
• List of abbreviations
• Part II
• Neurophysisologic method. Routine
  electroneuromiography (slides 1-6)
• Nerve conduction (2,3)
• Needle electromiography (4)
• Electromiography (5)
• Clinical neurophysiology evaluation features (6)
• Part III
• General picture of leprosy neuropathy (slides
  1-10)
• The evolutive periods of the leprosy neuropathy
  (2)
• Multiple mononeuropathy pattern in the skin (3)
• General picture and particularities in LN (4)
• Frequecy of nerve involvement using the graded
  sensory test assessment (5)
• Neuropathies (6-8)
• Nerve biopsy (9)

4
Contents

• Part IV
• Neuritis and reactions (slides 1-14)
• Two major types of reactions RR and ENL (1-2)
• Epidemiology of reactions (3)
• Ulnar nerve as a model (4-14)
• Part V
• Primarily Neural Leprosy (slides 1-6)
• Frequency (2-3)
• MGGL (4-6)
• Part VI
• Entrapment (slides 1-7)

5
Contents

• Part VII
• Neuropatic pain (slides 1-8)
• Acute and chronic pain (2-3)
• Underline mechanisms (4)
• A-wave (5-8)
• Part VIII
• Late nerve impairment (slides 1-7)
• Intarneural fibrosis (2)
• Late nerve impairment versus CN (3)
• Monitoring leprosy neuropathy (4-7)

6
List of abbreviations

• CAMP compound motor action potential
• CS clinical score
• CV conduction velocity
• CV elb conduction velocity at the elbow ?
• DL Distal latency
• ENL reaction erythema nodosum leprosum (or type
  2 ) reaction
• GST graded sensory testing
• LN leprosy neuropathy
• MGGL abbreviation of a patients name
• MM multiple mononeuropathy
• MU motor unit
• NC nerve conduction
• PNL primarily neural leprosy

• RR reversal (or type 1) reaction
• T1 R reversal (or type 1) reaction
• T2 R erythema nodosum leprosum (or type 2 )
  reaction
• TD temporal dispersion
• VMT voluntary muscle testng

7
Neurophysiologic methodroutine
electroneuromiography
Neurophysiology of leprosy, part II
8
Nerve conduction large fibres
1. motor CMAP, DL, Conduction Velocity (CV
distancy/L2-L1m/s) and F wave (late latencies)
Compound Motor Action Pontential sum of MU
potentials motor axons in one nerve
9
2. sensory CV distancy/ L1 m/s
Sensory potential sum of sensory fibre
potentials sensory axons in one nerve
10
Needle Electromiography
Motor unit potential Shape, polyphasia,
amplitude and duration will define the neurogenic
and miopathic patterns
11
Electromiography denervation vs reinervation
Neuropathic (neuronal or axonal) and myopathic
patterns and its distribution
12
Clinical neurophysiology evaluation features

• specificity and high sensibility for the
  peripheral nervous system large fibres
• Muscles and nerves mapping
• Distribution in the body
• Localization in the nerve
• Assess the severity (quanty)
• Identify the underlining neuropathology (qualy)
• objective clues to prognosis