A field trial of detection and treatment of nerve function impairment in leprosy - Report from national POD pilot project

As part of a collaborative project between the Ministry of Health of China (MOH) and The Leprosy Mission International (TLMI) on leprosy rehabilitatio n and prevention of disability (POD), a total of 1407 patients was monitore d for possible nerve function impairment (NFI) through standardized clinica l nerve function assessment between May 1995 and February 1998. Of these, 1 91 patients were found to have NFI and were put on a fixed regimen of predn isolone. In this study, 36.7% of NFI occurred before diagnosis of leprosy, 35.6% developed during MDT and 25.7% after their release from MDT. Overall, 7.5% (105 out of 1407) of all patients, or 55.9% of patients with NFI, suf fered from silent neuropathy. Of the affected nerves, 62.6% had silent neur opathy. Sensory impairment responded to prednisolone satisfactorily, giving a recovery rate of 73.8%, 76.5% and 81.0% in ulnar, median and posterior t ibial nerve, respectively. Sensibility in patients even with a NFI duration longer than 6 months made significant improvement (p < 0.05). Motor functi on improvement was less satisfactory, especially in ulnar and c. popliteal nerve. The possible reasons are analysed. Our findings with regard to sensi bility changes confirm that once it becomes clinically detectable, NFI is n o longer at the 'early' stage. More sensitive tests are necessary to detect real 'early' sensory impairment in the field. Our study also indicates tha t with well-trained field staff and proper equipment for nerve function ass essment, early detection and treatment of NFI can be practical and effectiv e.