A Delphi Exercise was undertaken with two objectives: (1) To ascertain whether operational defini... more A Delphi Exercise was undertaken with two objectives: (1) To ascertain whether operational definitions for WHO Disability Grading could be formulated by consensus. (2) To develop a set of simple guidelines based on those definitions for the guidance of health workers. Fifteen people with general expertise in prevention of disability due to leprosy were invited to participate as Delphi panel members, twelve responded positively. Eight issues that commonly cause confusion provided foci for the exercise. Operational definitions aimed at resolving those issues were developed by consensus. Simple guidelines for health workers, based on those definitions were also created and supported by consensus. This paper presents the process followed and the outcomes gained from the endeavour.
Background: In a multi-centre study titled ‘Treatment of Early Neuropathy in Leprosy’ (‘TENLEP’),... more Background: In a multi-centre study titled ‘Treatment of Early Neuropathy in Leprosy’ (‘TENLEP’), monofilament testing (MFT) was used for the detection of touch pressure sensibility impairment (TPSI). It was recommended to use three test sites each for median, ulnar, radial cutaneous, sural and posterior tibial nerves. Aim: To assess the possible increase in detection rate of TPSI by increasing test sites for ulnar, median and posterior tibial nerves. Method and subjects: For the ulnar nerve, two sites were added in the area supplied by its dorsal cutaneous branch. For the median and posterior tibial nerve, one site each was added on dorsum of the index finger and heel respectively. Bilateral nerves were tested in a total of 70 leprosy patients. Findings: The addition of two extra test sites on the ulnar nerve resulted in the detection of TPSI in an additional 41 (29%) of the 140 nerves tested. Similarly for the median and posterior tibial nerves, the addition of one test site each detected TPSI in an additional 21 (15%) and 23 (16%) nerves respectively. Conclusion: The study showed that the addition of five test sites divided over three nerves, the ulnar, median and posterior tibial nerves, improved the detection of TPSI by 20%.
While prednisolone is commonly used to treat recent nerve function impairment (NFI) in leprosy pa... more While prednisolone is commonly used to treat recent nerve function impairment (NFI) in leprosy patients, the optimal treatment duration has not yet been established. In this "Treatment of Early Neuropathy in Leprosy" (TENLEP) trial, we evaluated whether a 32-week prednisolone course is more effective than a 20-week course in restoring and improving nerve function. In this multi-centre, triple-blind, randomized controlled trial, leprosy patients who had recently developed clinical NFI (<6 months) were allocated to a prednisolone treatment regimen of either 20 weeks or 32 weeks. Prednisolone was started at either 45 or 60 mg/day, depending on the patient's body weight, and was then tapered. Throughout follow up, NFI was assessed by voluntary muscle testing and monofilament testing. The primary outcome was the proportion of patients with improved or restored nerve function at week 78. As secondary outcomes, we analysed improvements between baseline and week 78 on the R...
Early detection and treatment of neuropathy in leprosy is important to prevent disabilities. A re... more Early detection and treatment of neuropathy in leprosy is important to prevent disabilities. A recent study showed that the Nerve Conduction Studies (NCS) and Warm Detection Thresholds (WDT) tests can detect leprosy neuropathy the earliest. These two tests are not practical under field conditions, however, because they require climate-controlled rooms and highly trained staff and are expensive. We assessed the usefulness of alternative test methods and their sensitivity and specificity to detect neuropathy at an early stage. Through a literature search we identified five alternative devices that appeared user-friendly, more affordable, portable and/or battery-operated: the Neuropad®, Vibratip™, NC-Stat®DPNCheck™, NeuroQuick and the Thermal Sensibility Tester (TST), assessing respectively sweat function, vibration sensation, nerve conduction, cold sensation and warm sensation. In leprosy patients in Bangladesh, the posterior tibial and sural nerves that tested normal for the monofila...
Pain can be a significant problem for treated leprosy patients. It can be nociceptive due to tiss... more Pain can be a significant problem for treated leprosy patients. It can be nociceptive due to tissue inflammation occurring during episodes of immune mediated reactions, or neuropathic due to leprosy affecting the somatosensory system. There are sparse epidemiological data on the prevalence and impact of neuropathic pain in treated leprosy patients. Tools for assessing neuropathic pain have not been validated in leprosy. We have examined nature of pain in a cross-sectional study to determine the prevalence of neuropathic pain (NP) in 80 recently treated leprosy patients in Ethiopia. Pain and depression were evaluated using the General Health Questionnaire (GHQ-12) and the Brief Pain Inventory (BPI) questionnaire. The Douleur Neuropathique en 4 Questions (DN4) and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) were used as screening tools for NP. Pain of any type was experienced by 60% of the patients. Pure nociceptive pain was experienced by 43%, pure NP by 11%, and mixed pain by 6%. Of the 14 patients who had NP either alone or in combination with nociceptive pain, 12 had high GHQ-12 scores, indicating possible depression. The DN4 had sensitivity and specificity of 100% and 45%, whereas the LANSS had 85% and 42%, respectively. This is the first study to differentiate nociceptive from NP in leprosy patients. The prevalence of NP is high in recently treated Ethiopian leprosy patients. We have validated the use of DN4 in leprosy and it is easier to use than LANSS. Depression is a common co-morbidity in patients with NP. The high prevalence and morbidity of NP in treated leprosy patients warrant clinical trials to assess the efficacy of pain therapies for leprosy-associated NP.
Leprosy is mainly a disease of the skin and nerves. The involvement of nerves may lead to impairm... more Leprosy is mainly a disease of the skin and nerves. The involvement of nerves may lead to impairments that have, contributed to the fact that leprosy is often still seen as a disease to be feared. In non-leprosy-endemic Western countries, beliefs continue to prevail about the inevitability of deformities and the lack of a cure. I review the pathogenesis of deformity and to present a discourse on how deformities can, to a very large extent, be prevented and corrected.
A Delphi Exercise was undertaken with two objectives: (1) To ascertain whether operational defini... more A Delphi Exercise was undertaken with two objectives: (1) To ascertain whether operational definitions for WHO Disability Grading could be formulated by consensus. (2) To develop a set of simple guidelines based on those definitions for the guidance of health workers. Fifteen people with general expertise in prevention of disability due to leprosy were invited to participate as Delphi panel members, twelve responded positively. Eight issues that commonly cause confusion provided foci for the exercise. Operational definitions aimed at resolving those issues were developed by consensus. Simple guidelines for health workers, based on those definitions were also created and supported by consensus. This paper presents the process followed and the outcomes gained from the endeavour.
Background: In a multi-centre study titled ‘Treatment of Early Neuropathy in Leprosy’ (‘TENLEP’),... more Background: In a multi-centre study titled ‘Treatment of Early Neuropathy in Leprosy’ (‘TENLEP’), monofilament testing (MFT) was used for the detection of touch pressure sensibility impairment (TPSI). It was recommended to use three test sites each for median, ulnar, radial cutaneous, sural and posterior tibial nerves. Aim: To assess the possible increase in detection rate of TPSI by increasing test sites for ulnar, median and posterior tibial nerves. Method and subjects: For the ulnar nerve, two sites were added in the area supplied by its dorsal cutaneous branch. For the median and posterior tibial nerve, one site each was added on dorsum of the index finger and heel respectively. Bilateral nerves were tested in a total of 70 leprosy patients. Findings: The addition of two extra test sites on the ulnar nerve resulted in the detection of TPSI in an additional 41 (29%) of the 140 nerves tested. Similarly for the median and posterior tibial nerves, the addition of one test site each detected TPSI in an additional 21 (15%) and 23 (16%) nerves respectively. Conclusion: The study showed that the addition of five test sites divided over three nerves, the ulnar, median and posterior tibial nerves, improved the detection of TPSI by 20%.
While prednisolone is commonly used to treat recent nerve function impairment (NFI) in leprosy pa... more While prednisolone is commonly used to treat recent nerve function impairment (NFI) in leprosy patients, the optimal treatment duration has not yet been established. In this "Treatment of Early Neuropathy in Leprosy" (TENLEP) trial, we evaluated whether a 32-week prednisolone course is more effective than a 20-week course in restoring and improving nerve function. In this multi-centre, triple-blind, randomized controlled trial, leprosy patients who had recently developed clinical NFI (<6 months) were allocated to a prednisolone treatment regimen of either 20 weeks or 32 weeks. Prednisolone was started at either 45 or 60 mg/day, depending on the patient's body weight, and was then tapered. Throughout follow up, NFI was assessed by voluntary muscle testing and monofilament testing. The primary outcome was the proportion of patients with improved or restored nerve function at week 78. As secondary outcomes, we analysed improvements between baseline and week 78 on the R...
Early detection and treatment of neuropathy in leprosy is important to prevent disabilities. A re... more Early detection and treatment of neuropathy in leprosy is important to prevent disabilities. A recent study showed that the Nerve Conduction Studies (NCS) and Warm Detection Thresholds (WDT) tests can detect leprosy neuropathy the earliest. These two tests are not practical under field conditions, however, because they require climate-controlled rooms and highly trained staff and are expensive. We assessed the usefulness of alternative test methods and their sensitivity and specificity to detect neuropathy at an early stage. Through a literature search we identified five alternative devices that appeared user-friendly, more affordable, portable and/or battery-operated: the Neuropad®, Vibratip™, NC-Stat®DPNCheck™, NeuroQuick and the Thermal Sensibility Tester (TST), assessing respectively sweat function, vibration sensation, nerve conduction, cold sensation and warm sensation. In leprosy patients in Bangladesh, the posterior tibial and sural nerves that tested normal for the monofila...
Pain can be a significant problem for treated leprosy patients. It can be nociceptive due to tiss... more Pain can be a significant problem for treated leprosy patients. It can be nociceptive due to tissue inflammation occurring during episodes of immune mediated reactions, or neuropathic due to leprosy affecting the somatosensory system. There are sparse epidemiological data on the prevalence and impact of neuropathic pain in treated leprosy patients. Tools for assessing neuropathic pain have not been validated in leprosy. We have examined nature of pain in a cross-sectional study to determine the prevalence of neuropathic pain (NP) in 80 recently treated leprosy patients in Ethiopia. Pain and depression were evaluated using the General Health Questionnaire (GHQ-12) and the Brief Pain Inventory (BPI) questionnaire. The Douleur Neuropathique en 4 Questions (DN4) and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) were used as screening tools for NP. Pain of any type was experienced by 60% of the patients. Pure nociceptive pain was experienced by 43%, pure NP by 11%, and mixed pain by 6%. Of the 14 patients who had NP either alone or in combination with nociceptive pain, 12 had high GHQ-12 scores, indicating possible depression. The DN4 had sensitivity and specificity of 100% and 45%, whereas the LANSS had 85% and 42%, respectively. This is the first study to differentiate nociceptive from NP in leprosy patients. The prevalence of NP is high in recently treated Ethiopian leprosy patients. We have validated the use of DN4 in leprosy and it is easier to use than LANSS. Depression is a common co-morbidity in patients with NP. The high prevalence and morbidity of NP in treated leprosy patients warrant clinical trials to assess the efficacy of pain therapies for leprosy-associated NP.
Leprosy is mainly a disease of the skin and nerves. The involvement of nerves may lead to impairm... more Leprosy is mainly a disease of the skin and nerves. The involvement of nerves may lead to impairments that have, contributed to the fact that leprosy is often still seen as a disease to be feared. In non-leprosy-endemic Western countries, beliefs continue to prevail about the inevitability of deformities and the lack of a cure. I review the pathogenesis of deformity and to present a discourse on how deformities can, to a very large extent, be prevented and corrected.
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