Pure neural leprosy: steroids prevent neuropathy progression

• Published in: Arquivos de neuro-psiquiatria Vol. 65; no. 4A; pp. 969 - 973
• Main Authors: Jardim, Márcia R, Illarramendi, Ximena, Nascimento, Osvaldo J M, Nery, Jose Augusto C, Sales, Anna M, Sampaio, Elizabeth P, Sarno, Euzenir N
• Format: Journal Article
• Language: English
• Published: Brazil Academia Brasileira de Neurologia - ABNEURO 01.12.2007
• Subjects: Adult; Aged; Clofazimine - administration & dosage; Dapsone - administration & dosage; Drug Therapy, Combination; Electrophysiology; Female; Follow-Up Studies; Glucocorticoids - administration & dosage; Humans; Leprostatic Agents - administration & dosage; Leprosy, Tuberculoid - drug therapy; Longitudinal Studies; Male; Middle Aged; NEUROSCIENCES; Peripheral Nervous System Diseases - prevention & control; Prednisone - administration & dosage; Prospective Studies; PSYCHIATRY; Rifampin - administration & dosage; Treatment Outcome; steroids; corticosteróides; peripheral neuropathy; forma neural pura da hanseníase; neuropatia periférica; pure neural leprosy
• ISSN: 0004-282X; 1678-4227; 0004-282X
• DOI: 10.1590/S0004-282X2007000600009

Multidrug therapy (MDT), with rifampicin, dapsone, and clofazimine, treats leprosy infection but is insufficient in arresting or preventing the nerve damage that causes impairments and disabilities. This case-series study evaluates the benefits of the combined use of steroids and MDT in preventing nerve damage in patients with pure neural leprosy (PNL). In addition to MDT, 24 patients (88% male aged 20-79 years, median=41) received a daily morning dose of 60 mg prednisone (PDN) that was gradually reduced by 10 mg during each of the following 5 months. PNL was clinically diagnosed and confirmed by nerve histopathology or PCR. A low prevalence (8.3%) of reaction was observed after release from treatment. However, most of the clinical parameters showed significant improvement; and a reduction of nerve conduction block was observed in 42% of the patients. The administration of full-dose PDN improved the clinical and electrophysiological condition of the PNL patients, contributing to the prevention of further neurological damage.