Do we forget the problem of neuritis?

Leprosy Mailing List – January 25th, 2011

Ref.:    Do we forget the problem of neuritis?

From:  Theuvenet W., Apeldoorn, The Netherlands

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Dear Colleagues,

Today one of the around 230.000 new leprosy patients that we can expect to be registered in 2011, may present in one of our offices.  What do we have to offer this patient?

When we take the liberty to extrapolate data from publications of the past 11 years we may expect that this patient can be one of the 15% of all new patients presenting with WHO disability grade 1 or 2., and when MB leprosy is diagnosed, the likelihood that he/she may present with a disability rises to above 45% (1).  In this latter category the risk of developing additional nerve function impairment within 2 year of registration is around 65% (2)!  The question that I would like to pose to you is the following:

Have we made any real progress in the treatment of neuritis due to leprosy in these past 25 years, how successful can we treat this neuritis, and is there any reason for concern / action ?

Without neuritis, leprosy would be a rather harmless disease.  The neuritis in leprosy is responsible for nerve damage, impairment, disability, deformity and stigmatization!  In the previous millennium most attention was focussing on the implementation of MDT while millions were spent on the development of a vaccine.  And now, one decade further in the New Millennium, there seems less a threat to "The Public Health situation" and most projects prioritize on self help, the reduction of stigma, empowerment, and the improvement of social participation.  All these issues are important but would perhaps not be on the agenda if we had been more succesful in the treatment of neuritis.

What do we have to offer our newly detected patients when it comes to neuritis ?

With best regards,

Dr. Willem Theuvenet, M.D., Ph.D.

Dept. Plastic, Reconstructive, Esthetic and Hand Surgery.

Regional Hospitals of Apeldoorn , Deventer and Zutphen, The Netherlands

Consultant for TLMI and NLR

  

(1)

Nerve function impairment in leprosy : design, methodology, and intake status of a prospective cohort study of 2664 new leprosy cases in Bangladesh (The Bangladesh Acute Nerve Damage study),  

Croft R.P. et al., Lepr.Rev., 1999, vol. 70, n^o2, pp. 140-159.

(2)

A clinical  prediction rule for nerve impairment in leprosy patients,

Croft R.P. et al, Lancet, 2000, vol.355, iss.9215, pp.1603-1606