EVALUATION OF SENSIBILITY IN LEPROSY - COMPARISON OF VARIOUS CLINICALMETHODS

In order to determine whether various sensibility tests, not in common use at our hospital, are appropriate for the neurological screening o f leprosy patients, an extended nerve function assessment (NFA) was do ne on 50 in- and outpatients who had been diagnosed as suffering from leprosy (100 hands and feet). The nerve function assessment battery co nsisted of Semmes-Weinstein monofilament testing (SWMT), moving 2-poin t discrimination (M2PD), Pinprick (PP), position sense (PS), vibration sense (VS) and voluntary muscle testing (VMT). In addition the SWMT w as performed on 637 hands and 634 feet of 'field patients' in order to get a better indication of the prevalence of sensory impairment as me asured with the SWMT. The SWMT has been shown to be a sensitive test o f peripheral nerve function, therefore the other tests were compared w ith the SWMT. Results are reported separately for the ulnar, median an d posterior tibial nerve. Test sites were the pulp of the distal phala nx of the index finger, the little finger and the big toe. Correlation between the SWMT and each of the other tests proved statistically sig nificant; the closest correlations were between the SWMT, M2PD and PP for both ulnar and median nerves (r > 0.7, F test > 100, p < 0.0001). It is argued that the first tests to show nerve function impairment (N FI) are the M2PD and the SWMT. VS and PS were also absent in a signifi cant proportion of patients. Arguments are presented that this may ind icate advanced NFI. Results are compared with other data currently ava ilable in the literature.