Management of reactions and nerve damage in leprosy

Leprosy Mailing List, January 8th, 2009
Ref.: Management of reactions and nerve damage in leprosy
From: Srinivasan H., Chennai, India


Dear Dr Noto,

I do not agree with Dr Theuvenet (LML Dec. 30th 2009) that "no one has ever found a regimen that is really effective in restoring nerve function up to a functional level."

In my experience innumerable patients have had their nerve function restored to a 'functional level', although not all had been restored to absolute normalcy. The problem is two fold: 1) many patients are under-treated, with too small a dose, for too short a period and without the benefit of surgical nerve decompression at the optimal time even when it is attempted; 2) many times the nerve status is not assessed carefully until it is too late, by which time the nerve has been destroyed (irrecoverably damaged). A reason for this state of affairs is the “tyranny” of the necessity of "field management” which heavily dilutes the quality of management of this potentially difficult clinical condition.
The above statement does not mean that we do not need alternative and more effective treatments, drugs and programmes, of course we do. By all means, let us be on the look out for them. But we should also at the same time try much harder to find out ways of improving the efficiency of our existing treatment programmes so that they become more effective.
My New Year Greetings to all in the LML group.
H. SrinivasanReconstructive Surgeon (Retired)25 first Seaward RoadValmiki NagarChennai 600 041India