Neurological changes in leprosy

Abstract

Objective: To describe current knowledge on neurological alterations in patients with leprosy.  Methods: This is an integrative review with an exploratory approach focusing on neurological alterations in leprosy. The inclusion criteria comprised full studies published between 2014 and 2024, in Portuguese and English, that aligned with the objective and guiding question of the present study. Results: A total of 21 studies were included. The results suggest that, despite atypical cases of leprosy involving fibrosis, ulcers, facial paralysis, myelitis, ganglionitis, and radiculitis, sensory neurological manifestations are common, particularly peripheral neuropathy. Additionally, hypopigmented skin lesions and sensory loss (tactile and thermal) are frequent, as well as thickening of peripheral nerves and multiple mononeuropathies. These alterations are primarily attributed to the affinity of Mycobacterium leprae for Schwann cells and to the dysregulated pro-inflammatory response. Final considerations: Neurological manifestations in leprosy, particularly peripheral neuropathy, represent central elements of the disease, reflecting the complex interaction between Mycobacterium leprae and Schwann cells, as well as the immune response, alongside atypical manifestations. Early diagnosis, a multidisciplinary and individualized approach, and the use of electrophysiological exams and inflammatory biomarkers are crucial to preventing irreversible damage and promoting functional recovery.