Wednesday, June 22, 2011

Treatment of reactions sometimes needs to be extended more than 6 months

Leprosy Mailing List – May 21st, 2011
Ref:    Treatment of reactions sometimes needs to be extended more than 6 months.
FromW. J. Theuvenet, Apeldoorn, The Netherlands

Dear Dr. Naafs,
Thank you for your valuable observation (LML May 18th, 2011) that reactions often need treatment longer than 6 months.  This covers my personal experience.  In my last borderline leprosy (BL) patient the neuritis of several nerves frequently recurred in the first 24 months after putting her on MDT/ Prednisone and an increased dosage of clofazimine.  Most of the nerve(s) function responded very well on this regimen and over this period she could never really do without varying dosages of the prednisone/clofazimine, this modulating with the severity of the neuritis.  The right tibial nerve was decompressed (by the "selective meshing of the epineurium" method) at the tarsal tunnel as it did not respond within 4 months on this regimen and sensation was restored within 2 weeks after operation!  From Semmes Weinstein Monofilament (SWM) test 6.65 negative to 4.31 positive at the vulnerable Hallux andfirst metatarsophalangeal (MTP) -1 area.
Personally I feel that more research is needed as the present neuritis treatment even when applied with a longer duration, often gives some "improvement" of nerve function, but this "improvement" is hardly ever back to a functional level, be it to full restoration of nerve function.  In this situation it is sad that there is very little attention paid to the alternative of a nerve decompression.  To operate on a nerve ("nerve decompression") seems to frighten the ignorant but it is not "brain surgery" and provides often a simple alternative for the restoration of nerve function where medical treatment fails.
TENLEP may offer valuable information and any new research is welcome, as nowadays permanent nerve function loss is often too easily accepted as a consequence of leprosy.  Without this nerve function loss there would hardly be any need for stigma reduction, community based rehabilitation, empowerment etc etc.  We therefore urgently need better tools to properly treat leprosy neuritis!

With best regards,

Willem J. Theuvenet.

No comments: