PATTERN OF NERVE CONDUCTION STUDIES IN LEPROSY NEUROPATHY
Márcia R Jardim, Robson Vital, Salim L Balassiano,
Mariana A Hacker, Márcio Nascimento,
Euzenir N Sarno, Ximena Illarramendi
Methods
509 patients
364 NCS after RFT
228 NCS during MDT
230 NCS at DX
4%
20%
13%
22%
22%
19%
I
BT
BB
BL
L
PN
25%
3%
52%
20%
Clinical impairment
Sensory
Motor
Sensory andmotorNone
1023 NCS
201
NCS alteration Component At diagnosis (n=200)
mean=1.5mo
During MDT (n=201)
mean=5.5mo
After RFT (n=329)
mean=53.2mo
Median number of
nerves altered (IQR) Sensory 4 (2-6) 3 (2-6) 4 (2-6)
Motor 2 (1-3) 1 (1-3) 2 (1-3)
Nerve most affected Sensory Sural (68.3%) Sural (72.8%) Sural (79.9%)
Motor Ulnar (76.5%) Ulnar (68.4%) Ulnar (74.5%)
All nerves with no
conduction elicited Sensory 20 (10%) 13 (6.5%) 31 (9.4%)
Motor 1 (0.5%) 1 (0.5%) 4 (1.2%)
Predominant type of
lesion
Sensory Ax 56.0%) Ax (56.2%) Ax (56.2%)
Motor Dem.(68%) Dem. (64.2%) Dem. (61.4%)
Conduction block Motor 49 (24.5%) 46 (22.9%) 76 (23.1%)
Main Nerve conduction studies alterations found at the three periods of evaluation.
Conduction block
http://www.neurology.org/content/59/1/139/
Distribution of the impaired nerves at the three periods evaluated
0
200
400
600
800
1000
1200
1400
sensory motor sensory motor sensory motor
Diagnosis MDT RFT
112 112 194
202
123
187
99
354
192
172
79
160
81
311
144
247 279
485
131 105
164
Nu
mb
er
of
imp
aire
d n
erv
es
peroneal
sural
mediano
ulnar
radial
**
***
&&
&&&
* #
##
2= 87.14, p<<0.0001
2 = 136.3, p<<0.00001
2 = 291.4, p<<0.00001
Nerve function
Classification of nerve
impairment
At diagnosis During MDT After RFT
Sen
sory
ne
rve
s Normal 46 (20%) 43 (18.9%) 48 (13.2%)
Alt
ered
MNP 39 (17%) 29 (12.7%) 41 (11.3%)
MM 116 (50.4%) 126 (52.2%) 232 (63.7%)
PNP 29 (12.6%) 30 (13.2%) 43 (11.8%)
Total 230 (100%) 228 (100%) 364 (100%)
Mo
tor
ne
rve
s
Normal 77 (33.5%) 82 (36%) 135 (37.1%)
Alt
ered
MNP 68 (29.6%) 76 (33%) 90 (27.4%)
MM 75 (34.4%) 68 (29.8%) 130 (35.7%)
PNP 10 (4.3%) 2 (0.9%) 9 (2.5%)
Total 230 (100%) 228 (100%) 364 (100%)
2 (p-value) of comparison of altered NCS
2=23.26 (<0.00001)
2=59.1 (<<0.00001)
2=154.8 (<<0.00001)
Distribution of the alteration patterns observed in the NCS performed at diagnosis:
184 sensory NCS and 153 motor NCS NC NC+A+M+
DNC+M
NC+M+A
NC+M+D
NC+A
NC+M+A+
N
NC+M+D+
N
NC+M+N
NC+A +N
NC+D+N
NC+N
MM+A
M+D
M+A+D+N
M+A+N
M+D+N
M+N
A
A+D
A+D+N
A+N
D
D+N
0
10
20
30
40
50
60
Sensory
Motor
A: axonal D:demyelination M: mixed NC: no conduction
Distribution of the alteration patterns observed in the NCS performed during MDT:
185 sensory NCS and 146 motor NCS
0
10
20
30
40
50
60NC
NC+M
NC+M+A
NC+M+D
NC+A
NC+D
NC+M+A
+N
NC+M+D
+N
NC+A+D
+N
NC+M+N
NC+A +N
NC+D+NNC+N
M
M+A+D
M+D
M+A+N
M+D+N
M+N
A
A+D+N
A+N
D+N
Sensory
Motor
A: axonal D:demyelination M: mixed NC: no conduction
Distribution of the alteration patterns observed in the NCS performed after release from treatment:
306 sensory NCS and 229 motor NCS
0
20
40
60
80
100NC
NC+M
NC+M+A
NC+M+D
NC+A
NC+M+A+N
NC+M+D+N
NC+A+D+N
NC+M+N
NC+A +N
NC+D+N
NC+N
MM+A+D
M+A
M+D
M+A+D+N
M+A+N
M+D+N
M+N
A
A+D+N
A+N
D
D+N
Sensory
Motor
A: axonal D:demyelination M: mixed NC: no conduction
Conclusions
• NCS results must be performed in a standardized fashion evaluating all of its various components, and need to be examined systematically to yield reliable information.
• All of the peripheral nerves with consistent neurophysiologic data need to be evaluated in its various segments, when studying leprosy neuropathy.
Souza Araújo Leprosy Clinic
Thank You