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

Leprosy Mailing List – April 22,  2018

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

From:  Eric Slim, Utrecht, the Netherlands

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Dear Peter,

 

I agree with Wim important remarks concerning the difference between Diabetes andLeprosy related neuropathy (LML, April 21, 2018)

However, I would like to add some remarks.

1. Leprosy related neuropathy involves (more) often (significant) motor function impairment compared to diabetes related neuropathy.

2. Concerning Wim's comment:  "DM neuropathy will manifest itself after a much longer duration after the onset of the disease":

I would like to add: Diabetes often is diagnosed (to) late and neuropathy is already present at time of diagnose in a huge amount of diabetes patients (up to 60%).

3. Nerve enlargement can also be seen in diabetes related neuropathy but structural differences between diabetes and leprosy nerve impairment can be seen on ultrasound.

4. Neuropathy related muscle atrophy can be seen in both diabetes and leprosy and may result in both cases also in loss of strength. The distribution may differ (symmetrical versus asymmetrical) but also a symmetrical pattern can also be found in leprosy patients. However, significant motor function impairment is less found in diabetes (as mentioned in remark 1). 

5. I don't have much experience with tendon transfers in leprosy nor in diabetes but the risk of complication may be higher in patient with both diseases. This emphasizes the importance of an adequate diagnosis. However, the work done by dr Dellon suggests that also in diabetes, nerve repair and transplantation in the neuropathic foot is optional.  

 

6. Concerning the neuropathic foot: for ulcer prevention, treatment, use of orthoses and footwear, the expertise of both leprosy and diabetes is both applicable

 

With regards,

 

Erik Slim

 

MD, PhD, Physical Medicine and Rehabilitation.

St Antonius Hospital Nieuwegein/Utrecht The Netherlands.

 

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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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