Leprosy Mailing List – August 20, 2013
Ref.: (LML) Nerve impairment, sensory testing and M.leprae immune status
From: W. Theuvenet, Apeldoorn, the Netherlands
Dear All,
I have followed with great interest the discussion on sensory testing and from all correspondence it may be happily concluded that the issue of the early detection of nerve function loss is still high on the agenda of many clinicians. In the field one is often forced to use alternative tools but there seems no discussion that , when available, the use of Semmes Weinstein Monofilaments has preference when testing loss of sensation. Still, there are some pitfalls to the use of SWM as well and for those who are interested I have attached an article on the influence of humidity and temperature on the SWM.
In my daily practice I have noticed that EMG investigations are not sensitive enough to pick up early nerve function loss. For instance, in 25% of the patients with classical symptoms of a CTS (carpal tunnel syndrome) (for other peripheral neuropathies it is even worse) the EMG shows no abnormalities while in those cases more than 90% will show function loss when using the SWM.
Dear Dr. Das, thank you again for your contribution. I am very much looking forward to hear of the results of your new study as conducted together with Drs Garbino, Barreto and Virmond.
Will you also use it for a prospective study on the effectiveness of nerve decompression? The need for such a nerve decompression study may come forward again in the next ILC in Brussels, unless a new magic bullet is presented to adequately treat (early) nerve function loss due to leprosy neuritis .
With best regards,
Willem Theuvenet, M.D., Ph.D
Plastic, Reconstructive and Hand Surgeon
Consultant for TLMI and NLR.
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
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