A eficácia das ferramentas de diagnóstico precoce de lesões neurais na hanseníase

Abstract

Leprosy can cause different lesions in peripheral nerves and inervatory structures. Objectives: Objectives: To analyze the effectiveness of evaluation protocols used to identify neural lesions in leprosy such as Grade Disability (GD); Simplified Neurological Evaluation (SNE); and Neurodynamic Evaluation (NDE). Method: Descriptive analytical study, associative, with 27 individuals treated in two outpatient leprosy clinics in the state of São Paulo, between 2017 and 2019; and 27 from the paired control group. Patients with Central Nervous System compressive syndromes, degenerative syndromes, stroke, and other diseases with sensitivity disorders were excluded. The Mann-Whitney U-test, Multivariate Linear Regression and association between variables and P<0.05 values were used. Results: Patients who had a positive result in the NDE reported more pain (moderate and intense). The test that most captured the neurological alterations was the SNE in 22 (81.48%) in the upper limbs; and 25 (92.59%) in the lower limbs, followed by the NDE, in which 20 (74.07%) in the upper limbs and 11 (40.74%) in the lower limbs. The GD showed handicap in the hands of 16 (59.26%) and of 17, in the feet (62.96%) and they have expressed the sensitivity. GD showed agreement with SNE in 21 (77.77%) of the cases in upper limb (p=0.010) and 19 (70,37%) of the cases in lower limbs (p=0.060). GD and NDE showed that in 19 (70.37%) of the patients evaluated, there was concordance of results in upper limb (p=0.143) and, in 9 (33.33%) in lower limbs. (p=0,125). SNE and the NDE in the upper limb found agreement in 21 (77.77%), and in the lower limbs showed agreement in 11 (40.74%) (p=0.786). NDE of the lower limbs had greater interference of the Visual Analogue Scale (VAS) at rest; followed by age. Conclusion: The three assessment instruments are specific and will hardly produce false positive tests. They can and should be used in association to extend the screening of neural lesions in leprosy, because there are some unnoticed changes in one instrument and observed by another. GD can produce more false negatives than SNE. If an instrument is chosen, this should be the SNE, since it is more sensitive, more accurate and less negative likelihood ratio. Neurodynamic tests were positive in some individuals while there were still no changes in the SNE and afterwards, these changes appeared. This is an open field for further studies to clarify whether the NDE can reveal the neural lesion earlier, providing initial treatment of these lesions, thus avoiding disabilities.