PATTERN OF NERVE CONDUCTION STUDIES IN LEPROSY NEUROPATHY

Márcia R Jardim, Robson Vital, Salim L Balassiano,

Mariana A Hacker, Márcio Nascimento,

Euzenir N Sarno, Ximena Illarramendi

Methods

509 patients

364 NCS after RFT

228 NCS during MDT

230 NCS at DX

4%

20%

13%

22%

22%

19%

I

BT

BB

BL

L

PN

25%

3%

52%

20%

Clinical impairment

Sensory

Motor

Sensory andmotorNone

1023 NCS

201

NCS alteration Component At diagnosis (n=200)

mean=1.5mo

During MDT (n=201)

mean=5.5mo

After RFT (n=329)

mean=53.2mo

Median number of

nerves altered (IQR) Sensory 4 (2-6) 3 (2-6) 4 (2-6)

Motor 2 (1-3) 1 (1-3) 2 (1-3)

Nerve most affected Sensory Sural (68.3%) Sural (72.8%) Sural (79.9%)

Motor Ulnar (76.5%) Ulnar (68.4%) Ulnar (74.5%)

All nerves with no

conduction elicited Sensory 20 (10%) 13 (6.5%) 31 (9.4%)

Motor 1 (0.5%) 1 (0.5%) 4 (1.2%)

Predominant type of

lesion

Sensory Ax 56.0%) Ax (56.2%) Ax (56.2%)

Motor Dem.(68%) Dem. (64.2%) Dem. (61.4%)

Conduction block Motor 49 (24.5%) 46 (22.9%) 76 (23.1%)

Main Nerve conduction studies alterations found at the three periods of evaluation.

Conduction block

http://www.neurology.org/content/59/1/139/

Distribution of the impaired nerves at the three periods evaluated

0

200

400

600

800

1000

1200

1400

sensory motor sensory motor sensory motor

Diagnosis MDT RFT

112 112 194

202

123

187

99

354

192

172

79

160

81

311

144

247 279

485

131 105

164

Nu

mb

er

of

imp

aire

d n

erv

es

peroneal

sural

mediano

ulnar

radial

**

***

&&

&&&

* #

##

2= 87.14, p<<0.0001

2 = 136.3, p<<0.00001

2 = 291.4, p<<0.00001

Nerve function

Classification of nerve

impairment

At diagnosis During MDT After RFT

Sen

sory

ne

rve

s Normal 46 (20%) 43 (18.9%) 48 (13.2%)

Alt

ered

MNP 39 (17%) 29 (12.7%) 41 (11.3%)

MM 116 (50.4%) 126 (52.2%) 232 (63.7%)

PNP 29 (12.6%) 30 (13.2%) 43 (11.8%)

Total 230 (100%) 228 (100%) 364 (100%)

Mo

tor

ne

rve

s

Normal 77 (33.5%) 82 (36%) 135 (37.1%)

Alt

ered

MNP 68 (29.6%) 76 (33%) 90 (27.4%)

MM 75 (34.4%) 68 (29.8%) 130 (35.7%)

PNP 10 (4.3%) 2 (0.9%) 9 (2.5%)

Total 230 (100%) 228 (100%) 364 (100%)

2 (p-value) of comparison of altered NCS

2=23.26 (<0.00001)

2=59.1 (<<0.00001)

2=154.8 (<<0.00001)

Distribution of the alteration patterns observed in the NCS performed at diagnosis:

184 sensory NCS and 153 motor NCS NC NC+A+M+

DNC+M

NC+M+A

NC+M+D

NC+A

NC+M+A+

N

NC+M+D+

N

NC+M+N

NC+A +N

NC+D+N

NC+N

MM+A

M+D

M+A+D+N

M+A+N

M+D+N

M+N

A

A+D

A+D+N

A+N

D

D+N

0

10

20

30

40

50

60

Sensory

Motor

A: axonal D:demyelination M: mixed NC: no conduction

Distribution of the alteration patterns observed in the NCS performed during MDT:

185 sensory NCS and 146 motor NCS

0

10

20

30

40

50

60NC

NC+M

NC+M+A

NC+M+D

NC+A

NC+D

NC+M+A

+N

NC+M+D

+N

NC+A+D

+N

NC+M+N

NC+A +N

NC+D+NNC+N

M

M+A+D

M+D

M+A+N

M+D+N

M+N

A

A+D+N

A+N

D+N

Sensory

Motor

A: axonal D:demyelination M: mixed NC: no conduction

Distribution of the alteration patterns observed in the NCS performed after release from treatment:

306 sensory NCS and 229 motor NCS

0

20

40

60

80

100NC

NC+M

NC+M+A

NC+M+D

NC+A

NC+M+A+N

NC+M+D+N

NC+A+D+N

NC+M+N

NC+A +N

NC+D+N

NC+N

MM+A+D

M+A

M+D

M+A+D+N

M+A+N

M+D+N

M+N

A

A+D+N

A+N

D

D+N

Sensory

Motor

A: axonal D:demyelination M: mixed NC: no conduction

Conclusions

• NCS results must be performed in a standardized fashion evaluating all of its various components, and need to be examined systematically to yield reliable information.

• All of the peripheral nerves with consistent neurophysiologic data need to be evaluated in its various segments, when studying leprosy neuropathy.

Souza Araújo Leprosy Clinic

Thank You