Monitoring the Outcome of Leprosy Using Leprosy Neuropathy Scale: A Preliminary Study

The disability and progress of leprosy patients is monitored by the WHO disability grading system which has limited sensitivity in leprous neuropathy. This study aims to report the spectrum of leprosy patients at a tertiary care neurology service and compare WHO grading, modified Rankin Scale (mRS) and Leprosy Neuropathy Scale (LNS) in monitoring the treatment outcome. The patients with leprosy diagnosed as per WHO criteria were subjected to medical history and clinical examination. Their disability was graded as per WHO grading scale, modified Rankin scale (mRS) and LNS. These parameters were repeated and compared after six months of multiple drug therapy (MDT). Thirty-eight patients with leprosy, aged 40 (`5-80) years, 33 of whom were males have been evaluated. The duration of symptoms was 24 (91-120) months. Mononeuropathy was present in 14, mononeuropathy multiplex in 24, trophic ulcer in two, claw hand in 11, wrist drop in two, foot drop in four, facial palsy in one, Charcot’s joint in one and lepra reaction in seven patients. Their disability as per WHO grade 1 and 2 was in 19 patients each. After 6 months of MDT, WHO grade improved in two patients, mRS revealed improvement in seven and LNS in nine patients. LNS- a clinical scale, seems more effective and easier to use for monitoring the progress/ outcome of neuropathy in leprosy patients and may complement the WHO grading scale

Sensory Ganglionopathy in Hansen’s Disease: Report of a Patient and Review of Literature

Hansen’s neuropathy usually affects cooler parts of the body, but presentation with poly-ganglionopathy is rare. We report a patient with ganglionopathy associated with pure neuritic Hansen’s disease and discuss it in the light of the reported literature. A 42-year-old male presented with painful distal paraesthesia and ataxia for three months. His sensory nerve conduction was unrecordable. Thyroid hormones, vasculitis profile, HIV serology and hepatitis workup were normal. MRI of nerves and whole-body positron emission tomography were also normal. Slit smear examination of the affected skin after appropriate staining and microscopic examination showed the presence of AFB (M. leprae). He was treated with rifampicin, clofazimine, dapsone and prednisolone, and at six-month follow-up, he was asymptomatic. We conclude that leprosy should be considered in the differential diagnosis of sensory poly-ganglionopathy, especially in tropical countries, as it is amenably treatable