Monday, January 2, 2017

(LML) Silent neuritis. Nerve damage. Disability and deformity. Prevention and management.

Leprosy Mailing List – January 2,  2017

Ref: (LML) Silent neuritis. Nerve damage. Disability and deformity. Prevention and management.

From:  Robert Jerskey, California, USA

Dear Pieter,


As the final days of the year 2016 approach and fade, I am taking some time to read ---and for the most part, re-read--- several of the LML letters posted the past several months.  [I am grateful to be among the hundreds of recipients]


As my work includes identifying and monitoring nerve function impairment in those affected by leprosy, I was especially drawn to the posts discussing nerve damage: at one end of the spectrum, posts commenting about silent neuritis; and at another place in the spectrum, posts discussing the role of surgical intervention for those with considerable signs and symptoms.


Of the many narratives along the lines of nerve involvement that engaged my attention, I reference here the observation and alarm Joel Almeida raises in his cogent post [Nov 15, 2016], A day on the ground:

“Silent neuritis, without overt signs of inflammation, is responsible for 85% of nerve damage among South Asian populations on MDT. Even the person affected does not suspect the problem until it is too late. If we ignore this, and are content to focus on "reactions" with obvious signs of inflammation, then patients who develop silent neuritis during MDT can be condemned to avoidable visible deformity.

That is a huge percentage, among South Asian populations.  I imagine among other geographical populations, e.g, regions in Latin America and in Africa, silent neuritis might be responsible for a sizable percentage, though perhaps not so lofty, there as well.


That said, I would like to invite any interested LML reader who is involved “on the ground”, directly or indirectly, who would wish to stock up on graded nylon monofilaments (MF) for the purpose of identifying nerve function impairment (NFI) due to silent--- or acute neuritis--- to contact me.  (contact email below)

Most readers know that the MF are of helpful utility, especially when used properly and alongside other assessments for nerve involvement such as VMT and nerve palpation.  The MF are useful for both identifying AND monitoring nerve function impairment over the course of time.  Although there are scenarios such as busy urban clinics (as reported by Mr. Pankaj Gupta at the IAL conference in Hyderabad in 2015), or among the skilled front-line workers whom Joel Almeida references, where it might not be easily practical or possible to use MF, a suggestion: perhaps in lieu of a ball point pen, fewer of the 6 graded MF might be used as a screening tool, depending on the circumstances (I explored this in my poster presentation on the MF this past Sept at the 19th IAL Congress in Beijing)  Suspected cases could then be referred to a centre where a clinician can utilize a full set of MF to assess and monitor over the course of time.


I will be happy to mail--- at no cost to the recipient ---packets of all 6 graded MF, loose and ready to be mounted.  I will also include instructions for mounting, calibration, and protocol for application to the limb being tested. 


I want to close here acknowledging the memory of Judy Bell-Krotoski who passionately and persuasively championed the role of MF for helping to identify early NFI as well as monitoring nerve function changes over the course of time.  Thanks to her these loose MF are available---she sent me a carton of several quantities before she passed on from complications of cancer--- for use in endemic countries where most manufactured kits are too costly, at least at this time.  I would like to help follow through with this vision.


With kind New Year 2017 greetings to all LML readers and to the LML blog team,



Robert Jerskey, LOTR, consultant for prevention and management of impairments, disabilities, and multiple morbidities.

LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link:

Contact: Dr Pieter Schreuder <<

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