Study of VII Cranial Nerve Function in patients with Leprosy

Anu Sarah Philip, (2020) Study of VII Cranial Nerve Function in patients with Leprosy. Masters thesis, Christian Medical College, Vellore.


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INTRODUCTION: VII cranial nerve is one of the most commonly involved cranial nerves in leprosy and can result in debilitating features like facial palsy, lagophthalmos and corneal ulcers, which if left untreated can lead to permanent blindness. Early detection of nerve involvement is hence crucial to prevent irreversible damage. Previous studies have shown that nerve conduction studies can detect nerve dysfunction before they become apparent clinically. This study was undertaken to evaluate the prevalence and pattern of clinical/subclinical involvement of VII cranial nerve in leprosy patients and to correlate the clinical and electrophysiological findings. OBJECTIVE: The objectives were to study the prevalence and pattern of clinical and subclinical involvement of VII cranial nerve in leprosy patients and to correlate between the clinical and electrophysiologic findings. METHODS: A hospital based cross-sectional study was done in the department of Dermatology, Christian Medical College, Vellore, over a period of 16 months (January 2018 - April 2019) with approval from the Institutional Review Board. 95 patients diagnosed with leprosy were recruited after obtaining informed written consent. The patients’ history and clinical details were recorded in a standard proforma. The VII cranial nerve was examined clinically followed by electrophysiologic evaluation namely, nerve conduction study of VII cranial nerve trunk and branches, F wave study, blink reflex study and facial muscle synkinesis. RESULTS: 95 patients (69-males, 26-females) were included with a mean age of 39.4 years. The mean duration of disease was 2.6 years. Majority of patients belonged to the BL (41.05%) and BT (41.05%) spectrum. The most common initial presenting complaint was skin lesions in 63.1% followed by neuropathy (36.8%) predominantly sensory neuropathy in a glove and stocking pattern (85.7%). 49.5% were in reactional states (48.9% in type 1 reaction and 51% in type 2 reaction). Facial lesions were present in 21% and 15.8% gave history of facial lesions. Clinical VII nerve involvement was present in 6.3%, all belonging to BT spectrum and in type 1 reaction. The most common manifestation of VII nerve involvement was lagophthalmos (66.7%). Electrophysiological study of VII cranial nerve was done in 75 patients. 88% showed electrophysiological abnormalities, among them 6 (9.1%) had clinical VII nerve palsy and 60 (90.9%) had subclinical involvement of VII nerve. Majority (56.7%) of patients with subclinical VII nerve involvement belonged to the lepromatous spectrum. In patients with clinical VII nerve palsy, the most common abnormal parameter was NCS (nerve conduction study) of VII nerve (100%) followed by blink reflex study (83%). In patients with subclinical involvement, the most common abnormal parameter was NCS of mandibular branch (48%) followed by VII nerve trunk (37%). BT and BL spectrum were found to be associated with VII nerve involvement (p=0.03). Facial lesions (current/past) had a positive predictive value of 87.1% and negative predictive value of 11.4% with respect to VII cranial nerve involvement (clinical/subclinical). CONCLUSION: The prevalence of clinical VII nerve involvement in our study were comparable to previous studies. There was a higher prevalence of subclinical involvement of VII nerve predominantly in the lepromatous spectrum.

Item Type: Thesis (Masters)
Additional Information: 201730301
Uncontrolled Keywords: VII Cranial Nerve Function, patients, Leprosy.
Subjects: MEDICAL > Dermatology Venereology and Leprosy
Depositing User: Subramani R
Date Deposited: 05 Feb 2021 15:04
Last Modified: 05 Feb 2021 15:04

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