• Diane Tantia Sari Ilmu Kesehatan Kulit dan Kelamin Fakultas Kedokteran, Universitas Brawijaya, Malang
  • Dhelya Widasmara Ilmu Kesehatan Kulit dan Kelamin Fakultas Kedokteran, Universitas Brawijaya, Malang
  • Shahdevi Nandar Kurniawan Departemen Neurologi Fakultas Kedokteran, Universitas Brawijaya, Malang



Nerve conduction study, leprosy reaction


Leprosy reaction contributes to disability due to peripheral nerve damage. Nerve conduction study (NCS) provides a profound physiological description of peripheral nerves. This study aims to report a case of polyneuropathy in leprosy with type 2 reactions (T2R) which is evaluated using NCS. A 33-year-old woman complain of painful bumps in her arms and legs, fever, swollen feet since 2 days ago, and history of leprosy. Dermatologic examination on the right superior palpebra, right and left arms and legs revealed multiple tenderness erythematous nodules; right claw hand; and both legs oedema. Slit skin smear revealed positive result. Histopathologic examination supported T2R description. The NCS examination concluded severe axonal demyelinating motoric sensoric polyneurophaty, with left worse. She was treated with MDT-MB, bed rest, orally methylprednisolone, vitamin B, paracetamol, ferrous sulfas, and topical olive oil. Clinical improvement was achieved after 2 weeks. The NCS is used to assess the nerve impuls conduction along the peripheral nerves. In this case, it was found that NCS could showed early neuropathy in nerves that were clinically undetectable. It can be concluded that the NCS examination is an important diagnostic modalities for early detection of neuropathy and confirmed the diagnosis of clinical neuropathy in leprosy.


Sjamsoe-Daili E, Menaldi SL, Ismiarto SP, Nilasari H. Diagnosis Penyakit Kusta. Dalam: Kusta. Fakultas Kedokteran Universitas Indonesia. Jakarta; 2003. h.12-33

Lee DJ, Rea TH, Modlin RL. Leprosy. Dalam: Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell D (editor). Fitzpatrick’s Dermatology in General Medicine, 8th ed. New York: McGraw-Hill; 2012. h.2253-62

Zoulba E, Sjamsoe ES, Menaldi SL, Marissa M, Irawan Y. Failure to use routine prevention of disability (POD) assessment resulting In permanent disability. Journal of General-Procedural Dermatology & Venereology Indonesia; 2016. 1(2): 31-35

Suneetha SK, Rao PN, Jain S. Electrophysiological and Ultrasonographic Studies of Peripheral Nerve. Dalam: Kumar B, Kar HK (editor). IAL Textbook of Leprosy, 2nd edition; New Delhi: Jaypee Brothers Medical Publisher; 2016. h.152-69

Kahawita IP, Walker SL, Lockwood DN. Leprosy type 1 reactions and erythema nodosum leprosum. Anais brasileiros de dermatologia; 2008. Feb;83(1):75-82

Véras LS, Vale RG, Mello DB, Castro JA, Lima V, Silva KN, Trott A, Dantas EH. Degree of disability, pain levels, muscle strength, and electromyographic function in patients with Hansen's disease with common peroneal nerve damage. Revista da Sociedade Brasileira de Medicina Tropical; 2012. Jun;45(3):375-9

Jardim MR, Vital R, Hacker MA, Nascimento M, Balassiano SL, Sarno EN, Illarramendi X. Leprosy neuropathy evaluated by NCS is independent of the patient's infectious state. Clinical neurology and neurosurgery; 2015. Apr 30;131:5-10

Michell AW. Principles of Nerve Conduction; Nerve Conduction in Disease. Dalam: Understanding EMG. United Kingdom: Oxford University Press; 2013. p.14-86

Shetty PV. Patomechanism of Nerve Damage. Dalam: Kumar B, Kar HK (editor). IAL Textbook of Leprosy, 2nd edition; New Delhi: Jaypee Brothers Medical Publisher; 2016. h.170-81

Roche PW, Theuvenet WJ, Britton WJ. Risk factors for type-1 reactions in borderline leprosy patients. The Lancet; 1991. Sep 14; 338(8768):654-7

Thacker AK, Chandra S, Mukhija RD, Sarkari NB. Electro-physiological evaluation of nerves during reactions in leprosy. Journal of neurology; 1996. Jul 1;243(7):530-5

Naafs B, Pearson JM, Baar AJ. A follow-up study of nerve lesions in leprosy during and after reaction using motor nerve conduction velocity. International journal of leprosy and other mycobacterial diseases: official organ of the International Leprosy Association; 1975. Dec;44(1-2):188-97

Kinesya, B., Husna, M., Kurniawan, S., & Ridwan, M. Amplitudo Sensory Neuron Action Potential Using as Installation of Polyneuropathy Diagnosis. Malang Neurology Journal, 4(1), (2017). 7-11. doi:

Purbasari, B., Anggraini, V., Pratiwi, M., Husna, M., & Kurniawan, S. Diagnostic Test of Toronto and Modified Toronto Scoring, Monofilament Test, and Vibrate Sensation Test Using 128 HZ Tunning Fork for Diabetic Polyneuropathy. Malang Neurology Journal, 4(1), (2018). 25-34. doi:

Kurniawan, S., Husna, M., Rasyid, H., & Bilqis, N. The Relationship of Carpal Tunnel Syndrome Clinical Symptomps and Electroneuromyography Results in RSSA MNJ. Malang. Malang Neurology Journal, 2(1), (2016). 24-29. doi:

Van Brakel WH, Nicholls PG, Wilder-Smith EP, Das L, Barkataki P, Lockwood DN, INFIR Study Group. Early diagnosis of neuropathy in leprosy—comparing diagnostic tests in a large prospective study (the INFIR cohort study). PLoS Negl Trop Dis. 2008 Apr 2;2(4):e212

Samant G, Shetty VP, Uplekar MW, Antia NH. Clinical and electrophysiological evaluation of nerve function impairment following cessation of multidrug therapy in leprosy. Leprosy review. 1999. Mar;70(1):10-20






Case Report