Clinical evolution of neural function in a series of leprosy neuropathy cases after ulnar neurolysis

eprosy is a chronic infectious disease with a disabling otential due to the affinity of the agent, Mycobacterium eprae, for peripheral nerves and skin. Of the 208,619 new ases detected worldwide in 2018, a total of 11,323 cases lready had apparent deformities, of which 2,109 (18.6%) ere from Brazil, a figure that was second only to India, ith 3,666 new cases with deformities.1 Neuropathy in leprosy can occur insidiously, more commonofilament, which consists in a set of six nylon threads of different colors and thicknesses that, pressed against the skin, correspond to different weights (from 0.05 g to 300 g). The 0.05 g (green) and 0.2 g (blue) monofilaments were considered as normal sensibility and above that, as decreased sensibility.5 For the assessment of muscle strength, the abductor muscle of the fifth finger was assessed and the Medical Research Council scale was used, which ranks strength from zero (no muscle movement) to five (complete movement against gravity with maximum resistance).4 Levels four (full movement against gravity with partial resistance) and five were considered normal.5 The time between the first episode of neuritis and the performance of neurolysis was, on average, 25.3 months (SD = 63.3; Min. = 1; Max. = 303), with the procedure being performed after up to six months in 11 (50.0%) patients, which is related to the best results by other authors.5 For comparison purposes, the last neurological evaluation was considered in the present study, which ranged from three to 168 months, with 12 (54.5%) patients having more than one year of follow-up. Of 12 cases that already had altered sensibility before surgery, seven (58.3%) showed improvement and, of the six that had altered muscle strength, five (83.3%) maintained the same level, and only one (16.7% ) showed worsening. Fifteen (68.2%) patients did not have any neuritis in the operated nerve; however, three of these patients still had to use prednisone, because they had a leprosy reaction and/or neuritis in other nerves. Two patients had only a single episode of neuritis, which occurred three and four months after surgery. Another five patients (18.2%) had subentrant episodes of neuritis in the operated nerve, for an average of 52.6 months (SD = 63; Min. = 17; Max. = 172) after surgery, without necessarily developing loss of function (Table 1). This series of cases emphasizes the clinical importance of the results in a routine situation, where the greatest contribution of neurolysis associated with the clinical treatment of leprosy neuritis was the non-recurrence or non-chronicity of the condition. Neurolysis also prevents prolonged corticosteroid therapy and its consequences, in addition to the p s i o i t