Comparative Effectiveness of Diagnosis of Neuritis in Leprosy Patients by Sensory Testing with Ball Pen and Monofilament
Article Sidebar
Main Article Content
Abstract
Background: Leprosy is a chronic infectious disease caused by Mycobacterium leprae.. It causes impairment of motor, sensory, or autonomic function. Nerve-functions impairment is the key pathological process leading to disability and handicap. Early detection and treatment of nerve function impairment is of paramount importance in leprosy.
Objective: To compare effectiveness of early detection of sensory nerve impairment by sensory testing with ball pen and monofilament.
Study design: Cross sectional study
Method: All data in this study are collected from 34 leprosy patients who attended the leprosy OPD Buriram hospital from 1st July 2008 to 30th April 2010. Ball pen and monofilament was applied to palm (10 points) and sole (12 points) on both sides. Data was analyzed and present by percentage and Exact Me neemar test.
Result: Sixty-seven percent of them were male eighty-eight percents were classified as multibacillary leprosy and age-distribution were 5.88 and 76.64 percent among age group below 16 years and 16-60 years respectively. As for their occupation, 58.82 percent were farmer while 26.47 percent were labor. Results of the study reveled that impairment of sensory function of median 1 ulnar and posterior tibial nerve tested by monofilament were 33.35, 35.29 and 38.34 percent respectively, meanwhile ball pen test yielded 5.55, 2.04 and 8.82 percent respectively. Overall findings indicated that effectiveness of diagnosis of neuritis tested by monofilament was 2.6 times higher than that by ball pen (47.06 vs 17.60 percent) with statistically difference (p=0.02).
Conclusion: The effectiveness and sensitivity of sensory testing by monofilament is higher than ball pen 2.6 folds. Substantial levels of underdiagnosis of sensory loss with the ball pen were observed.
Key words: leprosy, peripheral neuropathy, ball pen, monofilament, neuritis
Article Details
References
ธีระ รามสูต. ตำราโรคเรื้อน. กรุงเทพมหานคร : โรงพิมพ์นิวธรรมดาการพิมพ์, 2535.
World Health Organization. A Guide to leprosy control, 2nd ed. Geneva: World Health Organization ; 1988.
World Health Organization. Chemotherapy of leprosy for control program. Geneva: World Health Organization; WHO Technical Report Services No.675.
ธีระ รามสูต. ความก้าวหน้าและข้อควร ปฏิบัติเกี่ยวกับการใช้ยาเคมีบำบัดโรคเรื้อน ผสมแบบใหม่ตามข้อเสนอแนะขององค์การ อนามัยโลก. แพทยสภาสาร, 2530;10:5-13.
ธีระ รามสูต. ปัญหาทางกังคมของโรคเรื้อน. วารสารกังคมศาสตร์การแพทย์, 2525; 5:69-81.
Bekri พ, Gebre S, Mengisite A, et al. Delay in presentation and start of treatment in leprosy patients : A case control study of clinical and non-disable patients in three different setting in Ethiopia. Int J Lepr, 1998; 66:1-9.
Linda M, Robert Son, Peter G Nicholls, Ruth Butlin. Delay in presentation and start of treatment in leprosy : experience in an out patient clinic in Nepal. Lepr Rev, 2000;71:511-516.
Da Silva Souza C, Bacha JT. Delayed diagnosis of leprosy and the potential role of educational activities in Brazil. Lepr Rev, 2003; 74:248-58.
Natasja HJ, Van Veen, Abraham Meima, Jan H Richardson. The relationship between detection delay and impairment in leprosy control : a comparison of patient cohort from Bangradesh and Ethiopia. Lepr Rev, 2006; 77:356-60.
Brandema W. Basic nerve function assessment in leprosy patients. Lepr Rev, 1981;52: 161-70.
van Brakel WH, Khawas IB, Gurung KE, et al. Intra and inter-tester reliability of sensibility testing in leprosy. Int J Lepr, 1996;64:287-98.
Gruener G, Dyck PJ. Quantitative sensory testing: Methodology, applications and future directions. J Clin Neurophysiol, 1994; 11:568-83.
Owen BM, Stratford CJ. Assessment of the methods available for testing sensation in leprosy patients in a rural setting. Lepr Rev, 1995;66: 55-62.
Bell-Krotoski JA, Weinstein S, Weinstein C. Testing, sensibility, including touch pressure, two-point discrimination, point localization, and vibration. J Hand Ther, 1993; 6:114-23.
Yamitsky D, Sprecher E. Thermal testing normative-data and repeatability for various test algorithms. J Neurol Sci, 1994:125:39-45.
Birke JA, Brandsma JW, Schreuders TA, Preffer A. Sensory testing with monofilaments in Hansen’s Disease and normal control subjects. Int J Lepr, 2000; 68:291-98.
Bell-Krotoski JA, Tomancik E. The repeatability of testing with Semmes-Weinstein monofilament. J HandSurg, 1987;12A:155-61.
Bell- Krotoski JA. ‘Pocket’ monofilaments and specifications for the Semmes-Weinstein monofilaments. J Hand Ther, 1990;3:26-31.
de Rijk AJ, Byass P. Field comparison of 10-g and 1-g filaments for the sensory testing of hands in Ethiopian leprosy patients. Lepr Rev, 1994;65:333-40.
Koelewijn LF, Meima A, Broekhuis SM, et al. Sensory testing in leprosy: comparison of ballpoint pen and monofilaments. Lepr Rev, 2003;74:42-52.
ILEP. The interpretation of epidemiological indicators in leprosy. London : The ILEP Medico. Social Commission, 2001.
Watson JM. Essential action to minimize disability in leprosy patients. London : The Leprosy Mission International, 1986.
Arunthathi S, Satheesh KK. Does clofazimine have a prophylactic role against neuritis? Lepr Rev. 1997; 68:233-41.
Ridley DS. Reactions in leprosy. Lepr Rev, 1969; 40:77-81.
Waters MFR, Turk JL, Wemambu SNC. Mechanisms of reactions in leprosy. Int J Lepr Other Mycobact Dis, 1999; 39:417-28.
Becx-Bleumink M, Berhe D, Mannetjie WT. The management of nerve damage in leprosy control services. Lepr Rev, 1990:61:1-11.
Lienhardt C, Fine PEM. Type-1 reaction, neuritis and disability in leprosy. What is the current epidemiological situation? Lepr Rev, 1994; 65:9-33.
Bell-Krotoski JA, Buford WL, Jr. The force-time relationship of clinically used sensory testing instruments. J Hand Ther, 1997;10:297-309.
Croff RP, Richardus JH, Smith wcs. The effectiveness of corticosteroids in the treatment of long term nerve impairment. Lepr Rev, 1997;68:316-25.
Girdhar A, Chakma JK, Ravinderan A, et al. A comparative study of high vs. Low dose corticosteroid therapy in reversal reactions in leprosy. Indian J Lepr, 2005;77:350-51.
Yamitsky D. Quantitative sensory testing. Muscle Nerve, 1997; 20:198-204.
Zaslansky R, Yarnitsky D. Clinical applications of quantitative sensory testing (QST). J Neurol Sci, 1998; 153:215-18.
Van Brakel WH, Nichollis PG, Das L, et al. The INFIR cohort study: assessment of sensory and motor neuropathy in leprosy at baseline. Lepr Rev, 2005; 76: 277-95.
Kumar A, Girdhar A, Girdhar BK. Nerve thickening in leprosy patients and risk of paralytic deformity : a filed based study in Agra, India. Lepr Rev, 2004 : 75: 135-42.
monofilaments Wim H. VAN BRAKEL et al. The INFIR Cohort Study : assessment of sensory and motor neuropathy in leprosy at baseline. Lepr Rev(2005) 76, 294.
การใช้ปลายปากกา เอกสารประกอบการประชุม โครงการพัฒนาบุคลากรด้าน สาธารณสุขระดับเขตและจังหวัด 16-19 สิงหาคม 2552 โรงแรมดุสิตปรนเซส นครราชสีมา
