Dados do Trabalho

Título

Correlation of electroneuromiographic findings in leprosy, according to their clinical forms

Resumo

Introduction: Leprosy is the most frequent infectious cause of peripheral neuropathy in the world and can lead to sequelae and physical disabilities that perpetuate the prejudice and stigma linked to the condition, especially due to the delay in diagnosis.
Objective: To describe the electroneuromyographic findings in patients with leprosy, according to their clinical forms.
Methods: The study is a retrospective observational analysis of medical records of patients with leprosy, from a Tertiary Referral Center, between the years 2014 and 2021, to correlate their clinical, epidemiological, laboratory and electroneuromyographic findings.
Results: Among the 513 medical records analyzed, 71.7% patients (368/513) had neural thickening, 73.3% (376/513) had sensory symptoms, 49.3% (253/513) had motor symptoms and 50.5 % (259/513) had leprosy reaction, being 34.9% (179/513) type I and 15.6% (80/513) type II. Regarding electroneuromyographic characteristics, the most affected sensory nerve was the superficial fibular nerve (15.5%), while the most affected motor nerve was the ulnar (12.6%). Regarding neural involvement, 126 patients had normal electroneuromyography (ENMG) and, among the 387 with abnormalities in ENMG, 13.2% (51/387) had mononeuropathy (MN) and 86.8% (336/387) had multiple mononeuropathy (MMN). Among the patients with the indeterminate (I) form (4.9%), 8% had abnormal ENMG and none had sensory/motor axonal impairment. In the primary neural leprosy (PNL) (20.3%), 96.2% had abnormal ENMG, being 88% with MMN and 6.9 (± 5.3) abnormal nerve/patient. In the tuberculoid (T) form (1%), 80% had abnormal ENMG, 50% with MMN and 3.0 (±2.1) abnormal nerve/patient. In the borderline-tuberculoid (BT) form (49.3%), 68% had altered ENMG, 80.8% had MNM and mean number of altered nerves was 5.9 (± 5.2). In the borderline-dimorphic (BD) form (6.2%), 78.1% had altered ENMG, being 96% with MMN and 8.7(± 5.5) abnormal nerve/patient. In the dimorpho-virchowian (DV) form (7.2%), 91.9% had altered ENMG, all of whom had MNM, with 10.1 (±4.1) abnormal nerve/patient. Among lepromatous (LL) form (11.1%), 98.2% had altered ENMG, with 98.2% MNM and 7.8 (± 4.3) abnormal nerve/patient. Axonal involvement was more frequent in the PNL, DT, DV and LL.
Conclusion: Leprosy is a spectral disease, characterized by a balance between host immunity and bacillary load. Therefore, the impairment and neurophysiological characteristics are distinct and may vary according to the clinical form.