Nerve function impairment in leprosy: an epidemiological and clinical study--Part 2: Results of steroid treatment

This retrospective cohort study aimed to determine the progress of sensory and motor function during and after steroid treatment, and to identify any prognostic factors for the outcome of treatment. The study used one hundred and sixty-eight leprosy patients registered at Green Pastures Hospital, Pokhara, West Nepal, who were treated with one of four different corticosteroid regimens for impairment of nerve function. The function of the main peripheral nerve trunks affected in leprosy was assessed with a nylon filament to test touch thresholds (TST) and a manual voluntary muscle test (VMT) to quantify muscle strength. The TST and VMT scores at 3 months after initiation of steroid treatment served as the main outcome measure. The significance of potential prognostic factors was evaluated with logistic regression. At 3 months, the sensory and motor function of the majority of patients with 'recent' impairment ( = less than 6 months duration) had improved significantly (p < 0.01, Wilcoxon matched pairs signed-ranks test). The likelihood of 'good' recovery (prognosis) for both sensibility and motor function was directly related to the severity of the nerve damage at the beginning of treatment. Although nerve function improved in 30-84% (depending on the type of nerve) of patients, an active search for better methods of treatment and improved regimens is justified. The need for early assessment and treatment is stressed.