Saturday, January 7, 2017

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

Leprosy Mailing List – January 7,  2017

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

From:  Francesca Gajete, Manilla, Philippines



Dear Pieter,


Indeed, Dr. Grace Warren (LML, January 5, 2017) has made a good point in the use of ballpentip instead of MF in determining Nerve Function Impairment. In the Philippines, the  Series 1 eLearning Module in Basic Leprosy: Diagnosis and Management for Health Professionals has a Chapter on Nerve Function Assessment for the eyes, hands and feet, Dr. Hugh Cross gave a very graphic presentation on how to determine Silent Neuritis/Nerve Damage/Impairment of the Eyes, Hands and Feet. He also made emphasis on the importance of determining Grade 2 Disability in new cases among children. Even in our training institutions and (8) sanitaria, health workers were made aware of the need to use the Ballpen instead of the Graded MonoFilament which was found to be tricky and confusing to the examiner and the subject in determining NFI.

The importance of Nerve Function Assessment during the first visit and monthly till completion of treatment or every two weeks should there be an impairment noted must be recorded. Thereafter, yearly evaluation for three years among PB cases and for five years among MB cases should be a part of the Posttreatment Standard to determine leprosy complications particularly leprosy reactions including examination of household contacts. Most of the time, the latter, is no longer considered.


I believe there is a need for our leprosy experts to pool together and formulate again a comprehensive training/teaching/module for the Rehabilitation Prevention of Impairment  and Disability, including Footwear and Prosthesis making if we are aiming for Zero Disability and Zero Stigma.


Thank you for giving me the time and space in sharing for the LML

Yours in Leprosy Service,


Francesca Cando Gajete, MD, MHA,FPLS


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

LML blog link:

Contact: Dr Pieter Schreuder <<

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