Estudo da função dos nervos periféricos de pacientes com hanseníase,acompanhados por um período médio de 18 anos após o início dapoliquimioterapia

Abstract

The main objective of the present study was to carry out a nerve function status evaluation and compare it with those carried out at the beginning of MDT and at release from treatment (RFT), as well as compare it to WHO disability grade in these three moments. Another objective was to identify variables which could explain the worsening of nerve function status. The mean follow-up time was 18 years, varying from 14 to 20years. 85 patients which started MDT from February 1987 to May 1990 at Citrolândia Basic Health Unit/Betim were included in the study. Of these, 89.5% were classified as multibacillary (MB). At data collection the following situation was verified: 63 patients were RFT, one had abandoned treatment, 7 were deceased, and 14 had no information. Ofthe 63 patients, 49 were submitted to a simplified nerve function evaluation of hands and feet, which included inspection, nerve palpation, sensory testing and voluntary muscle testing, besides the WHO disability grade. The following scales were also used: SF-36, which evaluates quality of life in health; the Participation Scale, which measures theseverity of participation restriction; Beck Depression Inventory (BDI) to evaluate depressive symptoms and the CAGE questionnaire for screening of alcoholism according to standardized criteria of each instrument. Despite the improvement of disability grade in the various analyses, when we compare this instrument with the presence of impairments in peripheral nerves (thickening and/or pain, impairment in sensibility and/or muscle strength) great differences were verified between disability grade and the presence of impairments. In the evaluation at the beginning of MDT, among the patients with disabilitygrade zero, 24 (86%) presented impairment in sensibility, even though they did not have loss of protective sensation, 2 (7%) had muscle weakening and 16 (57%) had at least one nerve with thickening and/or pain. These alterations were also observed at RFT and in January 2007. Patients classified as grade 1 (beginning of treatment, RFT and Janyary2007) which should present only loss of protective sensation, also presented muscle weakening. These differences in the simplified neurological examination make it difficult to determine the intervention which should be undertaken. Uni and multivariate analyses were carried out to detect variables which were associated with worsening of nervefunction comparing the evaluation of January 2007 with the beginning of treatment and comparing the evaluation of January 2007 with RFT. The variables which were associated to worsening in arms in January 2007 in relation to the beginning of treatment and RFT were: sex, number of nerves with impairment in sensibility and/or muscle strength and/ornerve thickening and/or pain, reaction during treatment, reaction in the period of January 2006 to January 2007, impairment in sensibility and muscle strength at the beginning of treatment and RFT and disability grade at the beginning and RFT. In the legs the variables were: disability grade in feet at the beginning of treatment, number of nerves withimpairment in sensibility and/or muscle force and/or nerve thickening and/or pain at RFT, reaction in the period of January 2006 to January 2007 and muscle weakeing at RFT. The analyses using a decision tree with the CART algorithm was similar to the data obtained in the uni and multivariable analyses.