The Effectiveness of Early Investigative Tools for Neural Lesions in Leprosy: An Observational Cohort Study

ABSTRACT

Leprosy can cause different lesions in peripheral nerves and inervatory structures. This study aims to analyze the effectiveness of evaluation protocols used to identify neural lesions in leprosy, such as Degree of Physical Disability (DPD), Simplified Neurological Assessment (SNA) and propose to use Neuro Dynamic Assessment (NDA). A descriptive analytical study was carried out in 27 individuals treated in two outpatient leprosy clinics in São Paulo State, between 2017 and 2019. A control group of age and sex matched 27 people, chosen from the population without a diagnosis of leprosy, was also evaluated. The Mann-Whitney, Multivariate Linear Regression, association between variables, and P<0.05 values were used. The test that most captured the neurological alterations was the SNA, with 22 (81.5%) in the upper limbs (ULs) and 25 (92.6%) in the lower limbs (LLs), followed by the NDA, with 20 (74.1%) in the ULs and 11 (40.7%) in the LLs. The DPD showed handicap in the hands of 16 (59.2%) individuals and in the feet of 17 (62.9%) individuals. The three assessment instruments can and should be used in combination to expand the monitoring of neural lesions in leprosy, as there are changes that are not perceptible with one instrument but can be confirmed by another. If there is an instrument to be chosen, it should be the SNA, because it identifies subtle changes that suggest neural distress.