Primary neural leprosy: clinical, neurophysiological and pathological presentation and progression.

التفاصيل البيبلوغرافية
العنوان:	Primary neural leprosy: clinical, neurophysiological and pathological presentation and progression.
المؤلفون:	Tomaselli PJ; Division of Neuromuscular Disorders, Department of Neurology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto 14048-900, Brazil., Dos Santos DF; Department of Internal Medicine, National Reference Centre for Sanitary Dermatology and Leprosy, Clinical Hospital, Federal University of Uberlândia (CREDESH/HC/UFU), Uberlândia 38400-902, Brazil., Dos Santos ACJ; Division of Neuromuscular Disorders, Department of Neurology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto 14048-900, Brazil., Antunes DE; Department of Internal Medicine, National Reference Centre for Sanitary Dermatology and Leprosy, Clinical Hospital, Federal University of Uberlândia (CREDESH/HC/UFU), Uberlândia 38400-902, Brazil., Marques VD; Division of Neuromuscular Disorders, Department of Neurology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto 14048-900, Brazil., Foss NT; Division of Dermatology, Department of Internal Medicine, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14048-900, Brazil., Moreira CL; Division of Neuromuscular Disorders, Department of Neurology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto 14048-900, Brazil., Nogueira PTB; Division of Neuromuscular Disorders, Department of Neurology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto 14048-900, Brazil., Nascimento OJM; Department of Neurology, Antonio Pedro University Hospital (HUAP), Fluminense Federal University, Niterói 24033-900, Brazil.; Department of Pathology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto 14048-900, Brazil., Neder L; Department of Pathology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto 14048-900, Brazil.; Department of Pathology, Molecular Oncology Research Center (CPOM), Barretos Cancer Hospital, Barretos 14784-400, Brazil., Barreira AA; Division of Neuromuscular Disorders, Department of Neurology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto 14048-900, Brazil., Frade MA; Division of Dermatology, Department of Internal Medicine, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, 14048-900, Brazil., Goulart IMB; Department of Internal Medicine, National Reference Centre for Sanitary Dermatology and Leprosy, Clinical Hospital, Federal University of Uberlândia (CREDESH/HC/UFU), Uberlândia 38400-902, Brazil., Marques W; Division of Neuromuscular Disorders, Department of Neurology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto 14048-900, Brazil.; Department of Neurosciences and Behavioral Sciences, National Insitute for Science and Technology for Translational Medicine, INCT, Ribeirão Preto 14049-900, Brazil.
المصدر:	Brain : a journal of neurology [Brain] 2022 May 24; Vol. 145 (4), pp. 1499-1506.
نوع المنشور:	Journal Article; Research Support, Non-U.S. Gov't
اللغة:	English
بيانات الدورية:	Publisher: Oxford University Press Country of Publication: England NLM ID: 0372537 Publication Model: Print Cited Medium: Internet ISSN: 1460-2156 (Electronic) Linking ISSN: 00068950 NLM ISO Abbreviation: Brain Subsets: MEDLINE
أسماء مطبوعة:	Publication: Oxford : Oxford University Press Original Publication: London.
مواضيع طبية MeSH:	Leprosy/complications , Leprosy/diagnosis , Leprosy/pathology , Leprosy, Tuberculoid/diagnosis , Leprosy, Tuberculoid/pathology , Peripheral Nervous System Diseases/diagnosis, Humans
مستخلص:	Disability in leprosy is a direct consequence of damage to the peripheral nervous system which is usually worse in patients with no skin manifestations, an underdiagnosed subtype of leprosy known as primary neural leprosy. We evaluated clinical, neurophysiological and laboratory findings of 164 patients with definite and probable primary neural leprosy diagnoses. To better understand the disease progression and to improve primary neural leprosy clinical recognition we compared the characteristics of patients with short (≤12 months) and long (>12 months) disease duration. Positive and negative symptoms mediated by small-fibres were frequent at presentation (∼95%), and symptoms tend to manifest first in the upper limbs (∼68%). There is a consistent phenotypic variability between the aforementioned groups. Deep sensory modalities were spared in patients evaluated within the first 12 months of the disease, and were only affected in patients with longer disease duration (∼12%). Deep tendon reflexes abnormalities were most frequent in patients with longer disease duration (P < 0.001), as well as motor deficits (P = 0.002). Damage to large fibres (sensory and motor) is a latter event in primary neural leprosy. Grade-2 disability and nerve thickening was also more frequent in cases with long disease duration (P < 0.001). Primary neural leprosy progresses over time and there is a marked difference in clinical phenotype between patients with short and long disease duration. Patients assessed within the first 12 months of symptom onset had a non-length-dependent predominant small-fibre sensory neuropathy, whilst patients with chronic disease presented an asymmetrical all diameter sensory-motor neuropathy and patchily decreased/absent deep tendon reflexes. (© The Author(s) (2021). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
فهرسة مساهمة:	Keywords: Mycobacteria leprae; leprosy; peripheral neuropathy; primary neural leprosy
تواريخ الأحداث:	Date Created: 20211019 Date Completed: 20220526 Latest Revision: 20220627
رمز التحديث:	20231215
DOI:	10.1093/brain/awab396
PMID:	34664630
قاعدة البيانات:	MEDLINE

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تدمد:	1460-2156
DOI:	10.1093/brain/awab396