Neurological Impairement in Leprosy (For Professionnals)

Neurological Impairement in Leprosy (For Professionnals)

• 211903 new cases of leprosy were diagnosed worldwide in 2010

1. 94% of patients have nerve conduction involvement (more sensory than motor). Autonomic function can also be involved.
2. after 18 months: nerve problems got worse in 23% of cases and improvement in 9% of cases
3. asymtomatic but can be pain, tenderness and paresthesia

• Mechanism

1. nerve damage is more due to the presence of the bacteria than the immune reaction of the host
2. M leprae binds to the G domain of laminin alpha 2 on surface of Schwann axon units (The Schwann cell constitutes the nerve sheath which transmits the electric signal and thus enables nerve conduction). This is the first stage which leads to contact demyelinisation and axonal loss
3. Toll-like receptors 1 and 2 which protect against infection are expressed on Schwann cells more in Tuberculous Leprosy than in Lepromatous Leprosy

Kumar B, Leprosy – 22nd World Congress of Dermatology (WCD) – Seoul, South Korea