NERVE FUNCTION IMPAIRMENT IN LEPROSY - AN EPIDEMIOLOGIC AND CLINICAL-STUDY .2. RESULTS OF STEROID TREATMENT

This restrospective cohort study aimed to determine the progress of se nsory and motor function during and after steroid treatment, and to id entify 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 f our 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 prog nostic factors was evaluated with logistic regression. At 3 months, th e 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 o f 'good' recovery (prognosis) for both sensibility and motor function was directly related to the severity of the nerve damage at the beginn ing of treatment. Although nerve function improved in 30-84% (dependin g on the type of nerve) of patients, an active search for better metho ds of treatment and improved regimens is justified. The need for early assessment and treatment is stressed.