Leprosy Mailing List Blog: (LML) To differentiate between diabetic neuropathy and pure neuritic leprosy neuropathy

Leprosy Mailing List – April 23, 2018

Ref.: (LML) To differentiate between diabetic neuropathy and pure neuritic leprosy neuropathy

From: Atul Shah, Mumbai; VP Shetty, Mumbai; Wim van Brakel, Amsterdam

Dear sir,

The basic question of role of nerve biopsy to rule in or rule out leprosy has not been addressed. Need more clarification on this as well as the site of biopsy.

Whether only electrical methods can conclusively define the DM as the aetiology particularly when all limbs show decreased sensory conduction and one upper limb also has partial motor affection grade 3+ .

Hope to get an insight in these interesting cases.

Thanks. Best regards,

Dr. Atul Shah

Plastic surgeon

President, The Research Society,

Grant Medical College and Sir J J Group of Hospitals, Mumbai

Dear Pieter,

In our experience doing a biopsy of an involved sensory cutaneous nerve and histopathology is the most reliable in diagnosis of suspected pure neural cases of leprosy.

We also find doing a nerve conduction velocity study prior to biopsy helps in selecting the right nerve for biopsy. Sural nerve is the most frequently involved nerve in pure neural cases.

With regards,

VP Shetty

Dear Pieter,

Perhaps to add to what Dr Theuvenet has already written:

· In diabetic neuropathy deep vibration sense is often lost (tuning fork or vibrometer on a bony prominence at the ankle or wrist). In our experience in leprosy, the deep sensation was usually intact.

· In diabetic small fibre neuropathy, cold sensation is affected before warm sensation; our findings in the INFIT cohort study showed that, in persons affected by leprosy, warm detection thresholds were affected more often and earlier than cold sensation.

With kind regards,

Wim van Brakel

----------------------

Wim van Brakel, MD MSc PhD

Head Technical Department

Netherlands Leprosy Relief (NLR)

Wibautstraat 137k

1097DN Amsterdam

Netherlands

Tel. +31 20 5950529

Email: w.v.brakel@leprastichting.nl

URL: www.leprosyrelief.org