Among the 12 (55%) patients with sensory impairment, all had thermal and/or pain impairment in at least one impaired

sensory nerve; and four (33%) also had tactile impairment in at least one of the affected nerves. Regarding motor strength, impairments were detected in only three (14%) patients (all MB). In addition, most patients recovered autonomic function, as represented by the SVMR (n= 4) and SSR (n= 7). Four patients (three PB) (18%) had a normal NCS. Among the 18 patients (39% PB and 61% MB) with an abnormal NCS, 17 (94%) Inhibitors,research,lifescience,medical had an abnormal sensory NCS (35% PB and 65% MB), and 17 (94%) had an abnormal motor NCS (41% PB and 59% MB). Except for one MB patient, all patients recovered from temporal dispersion. Nerve conduction was recovered in most nerves, but particularly in the radial, median, and common peroneal nerves. Yet, no conduction was obtained from Inhibitors,research,lifescience,medical 13 sural and three ulnar nerves. As to the number of affected nerves, a significant improvement (χ2= 6.3, P= 0.012) was observed Inhibitors,research,lifescience,medical in MB patients while PB patients remained about the same (Table 3). However, even though the axonal lesions of most PB patients (n= 3) improved, those of MB patients (n= 4) worsened. Conversely, three PB patients had demyelination while eight MB patients recovered

from demyelination (P= 0.029). Five MB patients (21%) developed type 2 reaction, four had erythema nodosum leprosum during MDT, and one had multiform erythema after release from treatment. Since the patients had exclusively cutaneous lesions without clinical signs or symptoms Inhibitors,research,lifescience,medical of neuritis, they were treated with thalidomide for an average of 13 chemical structure months (3–27 months). The one patient with multiform erythema also received oral prednisone for nine months. However, nerve function worsened in two of these patients later diagnosed to be without clinical symptoms. On admission, all but one patient enduring leprosy reaction had an altered neurological examination. Discussion

Leprosy neuropathy Inhibitors,research,lifescience,medical is a particularly complex ailment in view of the superposition of acute and chronic sensory, motor, and/or autonomic events. It is important to recognize that, in many leprosy patients, nerve damage may occur with or without symptoms from the very beginning of infection. It has been reported that NFI at diagnosis varies from 9.8% in a cohort of 315 PB patients from Bangladesh (Richardus Anacetrapib et al. 1996) to 55% in Ethiopia (Van Brakel et al. 2005). In the present sample, the use of additional clinical parameters to evaluate NFI may have contributed to the higher rate of NFI than has been customarily found. Likewise, a high prevalence of abnormality in NCS parameters has been reported by various authors at the moment of diagnosis, of up to 92% in MB patients (Capadia et al. 2010) and even in clinically unaffected nerves (McLeod et al. 1975).