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Don't forget leprosy when doing neurological exam

The article on neurological examination (Clinical, 3 October) by Dr Giles Elrington was helpful and well presented. I would, however, like to add one point.

He says: ‘Isolated sensory signs are rarely relevant. The only time sensory examination is really important is in the demonstration of normal sensation in cases of possible motor neurone disease. Otherwise don't bother to screen sensation in detail.'

There is one other time when sensory testing is vitally important, and that is when there is any suspicion of leprosy, for instance in the presence of hypopigmented (or erythematous) skin patches, when there is tenderness or pain in peripheral nerves or when there are signs of lower motor neurone lesions in a patient who has lived in a leprosy-endemic area.

There are still a few casesin the UK – and there are often unjustifiable delays in diagnosis because of a lack of adequate clinical examination. Two signs that can be elicited easily are the characteristic impairment of sensation in skin lesions and the palpable thickening of peripheral nerves.

Early diagnosis of leprosy followed by adequate chemotherapy can prevent disability.

Neuropathy due to leprosy is an important cause of peripheral nerve function impairment, but can be effectively treated if it is recognised promptly.

From Dr Ruth Butlin, Polegate, East Sussex

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