Field treatment of acute nerve function impairment in leprosy using a standardized corticosteroid regimen - First year's experience with 100 patients

Abstract

In this study, a fixed regimen of prednisolone for the treatment of acute nerve function impairment (NFI) in leprosy patients was developed and introduced at field level in one area (Thakurgaon) of the Danish-Bangladesh Leprosy Mission's field in NW Bangladesh. The assessment, management and follow-up of patients was undertaken by leprosy control supervisors and physiotechnicians. One hundred patients were treated and followed up 6-8 months after completion of a 4-month course of prednisolone. At a level of change of 2 points (where a change of at least 2 points in the motor/sensory score was taken to indicate a change of status, i.e. full or partial recovery, or deterioration), 42/65 (64.6%) patients with sensory loss experienced some sensory recovery at completion of prednisolone treatment, and 40/65 (61.5%) at 6-8 months' follow-up. 41/85 (48.3%) of patients with motor loss experienced improvement, and 42/85 (49.4%) at follow-up. Analysis of the mean scores at start of prednisolone treatment, completion and at follow-up using Student's t-test showed highly significant (p < 0.001) differences between scores before and after treatment. The benefit is maintained as seen after a period of 6-8 months follow-up. It was concluded that treatment of acute nerve function impairment at field level by paramedical workers, using a standardized regimen of prednisolone is feasible, practical and effective.