The treatment of acute nerve function impairment in leprosy: results from a prospective cohort study in Bangladesh

In this paper, the outcome of 132 patients having acute nerve function impa irment (NFI) is reported at 4 and 12 months after the start of prednisolone treatment. In all, 68% of sensory nerves and 67% of motor nerves showed im provement at 12 months, with no statistical difference in responsiveness of various nerves to prednisolone. Duration and severity of impairment were n ot found significant predictors of treatment outcome. A core of 32% of impa ired nerves did not respond to prednisolone, and 12% of impaired nerves had functional deterioration despite treatment. The mean eye-hand-foot (ENF) s core improved from 2.02 to 1.33 in the treatment group (median score improv ed from 2 to 1). Approximately one-third of all patients requiring predniso lone treatment did not receive it, an important reason being that some pati ents developed new NFI against a background of chronic impairment, and were thus overlooked. The 'unjustly untreated' group of patients had a spontane ous sensory nerve function improvement rate of 62% and a motor nerve functi on improvement rate of 33% at 12 months from onset of NFI. The EHF score sh owed no statistically significant improvement.