Evaluation of testing modalities for peripheral neuropathy in lepromatous Hansen's disease

To assess methods for detecting peripheral neuropathy, 28 previously untreated patients with lepromatous Hansen's disease underwent upper extremity manual muscle testing, sensory testing by using monofilaments, and electrophysiological nerve conduction studies (motor and sensory) at their initial examination. All but three patients demonstrated some abnormality identified by at least one of the testing procedures. Sensory testing with monofilaments located the greatest number of abnormalities found in 24 of the 28 patients. Next, electrophysiological testing demonstrated neuropathy in 21 of the 28 patients tested; 20 of these patients had sensory abnormalities and 20 had motor irregularities. The least sensitive method was manual muscle testing, which detected abnormalities in only 12 patients. Furthermore, sensory testing with monofilaments revealed peripheral neuropathy in 5 patients whose electrophysiological studies showed normal sensory patterns, and electrophysiological testing detected abnormalities in 1 patient whose sensory monofilament examination was normal. The results of this study support the usefulness of all three testing modalities.