Focal slowing of nerve conduction velocity in leprosy patients unveiled through multisegmented nerve analysis

IF 3.9 3区 医学 Q1 CLINICAL NEUROLOGY
Vanessa Daccach, Pedro José Tomaselli, Juliana Secchin Algemiro, Patricia Toscano, André Cleriston José dos Santos, Marco Andrey Cipriano Frade, Wilson Marques Jr.
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引用次数: 0

Abstract

Background and Aims

Leprosy is a chronic infectious disease caused by Mycobacterium leprae (M. leprae), an intracellular bacillus that systematically invades the peripheral nerves. Diagnosing leprosy neuropathy is still a defying skill, and late diagnosis and treatment are still a reality. Based on the biological characteristics of M. leprae, particularly its preference for invading the Schwann cells localized at the coldest areas of human body, we hypothesized that these areas have focal demyelination that may escape detection through standard nerve conduction studies (NCSs) protocols.

Methods

Twenty-five patients with confirmed multibacillary leprosy and 14 controls were accessed. A multisegmented NCS protocol (MP) was performed, targeting short segments through the coldest areas, to identify focal areas of slowed conduction velocity. The effectiveness of this multisegmented protocol was compared to the standard protocol (SP) to detect abnormalities.

Results

All leprosy patients presented an abnormal study with the MP, contrasting to 19 with the SP. The most frequent NCS pattern was an asymmetric neuropathy with focal slowing of conduction velocity, found in 23 out of 25 leprosy patients. Significant differences favoring the proposed method were observed when comparing the MP with the SP. Notably, the MP increased the sensitivity to detect abnormalities by 122%, 133%, and 257% for the median, peroneal, and tibial nerves, respectively. MP also increases sensitivity to detect focal abnormalities in the ulnar nerve.

Interpretation

The MP protocol significantly increases the sensitivity of NCSs to detect neurophysiological abnormalities in leprosy neuropathy.

通过多节神经分析揭示麻风病人神经传导速度的灶性减慢。
背景和目的:麻风病是由麻风分枝杆菌(M. leprae)引起的一种慢性传染病,麻风分枝杆菌是一种细胞内杆菌,可系统性地侵犯周围神经。麻风病神经病变的诊断仍是一门高难度技术,晚期诊断和治疗仍是现实。根据麻风杆菌的生物学特性,尤其是其偏好侵袭人体最寒冷部位的许旺细胞,我们推测这些部位存在局灶性脱髓鞘,可能无法通过标准神经传导研究(NCS)方案检测出来:方法:我们访问了 25 名确诊为多疱性麻风病的患者和 14 名对照组患者。采用多分段神经传导检查方案(MP),以通过最冷区域的短节段为目标,识别传导速度减慢的病灶区域。结果显示,所有麻风病人均出现传导速度异常:所有麻风病人在使用 MP 时均出现异常,而使用 SP 时只有 19 人出现异常。最常见的 NCS 模式是不对称神经病变,伴有局灶性传导速度减慢,25 名麻风病人中有 23 人出现这种情况。在将 MP 与 SP 进行比较时,观察到了有利于拟议方法的显著差异。值得注意的是,MP 对正中神经、腓肠神经和胫神经的异常检测灵敏度分别提高了 122%、133% 和 257%。MP 还能提高检测尺神经局灶性异常的灵敏度:MP方案大大提高了NCS检测麻风病神经病变神经电生理异常的灵敏度。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.10
自引率
7.90%
发文量
45
审稿时长
>12 weeks
期刊介绍: The Journal of the Peripheral Nervous System is the official journal of the Peripheral Nerve Society. Founded in 1996, it is the scientific journal of choice for clinicians, clinical scientists and basic neuroscientists interested in all aspects of biology and clinical research of peripheral nervous system disorders. The Journal of the Peripheral Nervous System is a peer-reviewed journal that publishes high quality articles on cell and molecular biology, genomics, neuropathic pain, clinical research, trials, and unique case reports on inherited and acquired peripheral neuropathies. Original articles are organized according to the topic in one of four specific areas: Mechanisms of Disease, Genetics, Clinical Research, and Clinical Trials. The journal also publishes regular review papers on hot topics and Special Issues on basic, clinical, or assembled research in the field of peripheral nervous system disorders. Authors interested in contributing a review-type article or a Special Issue should contact the Editorial Office to discuss the scope of the proposed article with the Editor-in-Chief.
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