Journal
INDIAN JOURNAL OF DERMATOLOGY VENEREOLOGY & LEPROLOGY
Volume 89, Issue 2, Pages 241-246Publisher
SCIENTIFIC SCHOLAR LLC
DOI: 10.25259/IJDVL_332_18
Keywords
Leprosy; sensory testing; nerve function impairment; disability; Semmes-Weinstein filament
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The aim of this study was to assess the fine sensation of palms and soles in field conditions for early detection of nerve function impairment in leprosy patients. A cross-sectional descriptive study was conducted at seven hospitals in India, and sensory testing using filaments was performed on 374 newly diagnosed patients. Among them, 106 patients showed sensory nerve function impairment, with 84 having no fine or protective sensation, and 22 having a loss of fine touch sensation with intact protective sensation. The study suggests the need for further research to introduce more sensitive sensory testing at leprosy centers.
Aim: To assess the fine sensation of palms and soles in field conditions, to enable early detection of nerve function impairment before the loss of protective sensation, thus preventing the development of disability. Methods: A cross-sectional descriptive study was conducted at seven tertiary referral hospitals located in different states in India. This study included all newly diagnosed patients affected by leprosy, who were registered during the period between March 2011 and April 2012. A detailed history was taken along with charting and voluntary muscle testing /sensory testing (VMT/ST) for the diagnosed patients. The sensation was measured using 0.2 gm Semmes-Weinstein filaments for palms and 4 gm for soles first, followed by 2 gm Semmes-Weinstein filaments for palms and 10 gm for soles. Results: Among the 374 patients, 106 were identified with sensory nerve function impairment. Of the 106 patients, 84 were identified with absence of both fine and protective sensation and 22 patients had a loss of fine touch sensation with protective sensation intact. Limitation: This study was conducted only among patients who were newly diagnosed with leprosy. Hence, future longitudinal studies in a larger population will add more validity to the study. Conclusion: The patients who had loss of fine sensation would have been missed by the normal leprosy programme protocol which uses 2 gm and 10 gm filaments for testing sensory loss before initiating steroid therapy. Further research is needed to determine whether testing for fine sensation with 0.2 gm Semmes-Weinstein filaments for palms and 4 gm for soles can be introduced at all specialized leprosy centres to detect nerve function impairment at an earlier stage followed by steroid therapy.
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