Clinical Views of Neuropathies: In Relation to Leprosy

Abstract

Recently much attention has been focused on many neuropathies, of which some problems will be discussed.1) Some degenerative neuropathies including Dejerine-Sottas disease, Von Rechling-hausen disease etc. have similarities with leprosy in regard to tumorous swelling of the peripheral nerves. Since some neurinomas can be detected by X-ray and accoustic neurinoma can be demonstrated as positive shadow by CT scan, a new objective evaluation of swollen nerves should be eagerly looked for, from our experience it is quite hopeful.2) Guillain-Barre syndrome is regarded as an allergic neuritis. Some evidence for that is found in experimental allergic neuritis (EAN). Some humoral factors can also be found in these patients with G-B syndrome. Therefore some immunological processes play an important part in the pathogensis, like leprosy. We found a humoral factor in the serum of lepromatous leprosy which induced nerve damage in animals. The biopsied nerve of sarcoid neuropathy revealed granuloma in it, which is quite similar to that of tuberculoid leprosy.3) Herpes Zoster is induced by exacerbation of persistent varicella-zoster virus in ganglia. In fact lymphocyte infiltration could be found in 20% of the trigeminal ganglia in autopsied cases which suggests the latent presence of herpes virus. The onset of herpes zoster depends on the immunological situation of the host. This pathogenesis also has some similarity to leprosy.4) In some toxic neuropathies, the lesion of sensory receptor organs play a part in the pathogenesis of dysesthesia. This mechanism is also true in skin leprosy with patchy sensory loss.5) PEP syndrome (pigmentation, edema, polyneuritis & plasma cell dyscrasia) which is now prevalent in Japan, is now suggested to be induced by some biogen active substance which is excreted from osteosclerotic bone. In some reports concerning humoral factors, leprosy may have some common mechanism with PEP syndrome.6) Vitamin B dificiency is one of the neuropathies. We found a resurgence of beri-beri here and confirmed it to be due to thiamine deficiency. Nowadays the vitamin B group is not only effective to vitamine B deficiency but also has some pharmacological effect. In leprosy, methyl B12 was found to be quite effective for the treatment of neuralgia.7) In leprosy we found some vascular change by angiography. In this regard some ischemic neuropathies including collagen diseases, vasculitis and diabetic neuropathies have some common mechanism with leprosy.From these observations, it can be regarded that leprosy has a common mechanism with each type of neuropathy. Therefore as our conclusion leprosy should be the most cardinal thema in the study of neuropathies.