Leprosy, Nerves, and Surgery

Abstract

Leprosy is one of the most common and potentially treatable causes of peripheral neuropathy. Despite the effective antibiotics to cure the infection, the immune-mediated peripheral nerve damage can continue long after effective antimicrobial treatment has started, and patients continue to be stigmatized. The initial management of leprous neuritis is always medical, using bactericidal drugs and high doses of corticosteroids given systemically. If medical treatment fails, nerve decompression by external neurolysis or by transposition of the nerves is attempted with variable success. Indications for decompressive surgery for neuritis include pain, motor, and/or sensory deficits. Preventing nerve damage in leprosy remains a challenge, and it is better to overtreat leprosy than to undertreat it. We still need to define the role of surgery on nerves in leprosy. Recently, the role of portable devices in early detection of nerve damage has been recognized; however, who are the candidates for surgery, when to perform surgery, extent of surgery, and what kind of procedure will give the best results are yet to be defined.