日本財団 図書館


5)Nerve Damage and Reactions

 

Chair: Dr. D. Lockwood

 

1) Nerve damage continues to be a major problem;

2) Nerve damage remains poorly understood;

3) Controlled trials of current & future therapies are urgently needed

 

The participants discussed the epidemiology and pathogenesis of neuritis and reactions, and the currently recommended therapies.

 

Epidemiologically, MB disease and age (15-44)  appear to be major risk factors for the development of reactions and nerve damage. The group noted the absence of good data relating to the relationship between reactions and endocrine alterations such as pregnancy and adolescence. Data were also presented showing that we may expect 40% of patients to now have their first reactional episodes after completing MDT. This has very important implications for management. Patients will need to be carefully warned about reactions advised to seek care promptly when symptoms develop. It was also noted with concern that neuritis may develop in some patients long after apparent cure.

 

The group noted success in the use of sensitive tests to evaluate sensory function in many centers. However, it is important that the reliability, diagnostic cut off, specificity and sensitivity of these tests is carefully considered. Scoring systems derived from these tests should be developed in a logical manner, such as ensuring that scores are recorded for individual nerves. Functional outcome is also an important measure that needs to be considered as well as motor and sensory function. It was also noted that occupation and resultant mechanical nerve stress may affected outcome.

 

Nerve injury may occur in three phases:

1. Localization of M. leprae to nerve, followed by

2. Active neuritis, and

3. Late nerve damage

 

Evidence was presented that armadillo nerves may be a useful model for lepromatous nerve involvement. Tuberculoid type nerve damage seems to occur in murine nerves directly injected with M. leprae.

 

Studies from Mumbai indicate that viable M. leprae can be recovered from the nerves of patients who have completed MDT. The clinical significance of this finding is not yet known.

 

The immunologic basis of reactions and neuritis were briefly reviewed, and several lines evidence indicate that TNF-alpha may play a key role in these processes. Other cytokines may also have critical roles in reactions.

 

 

 

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