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no n&#237;vel do cotovelo e&#47;ou do punho&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> &#201; realizada principalmente nos casos de abscesso de nervo&#44; neurite n&#227;o responsiva ao tratamento cl&#237;nico por quatro semanas&#44; epis&#243;dios de neurites recorrentes ou subentrantes&#44; neurites deficit&#225;rias cr&#244;nicas com dor&#44; e neurites em pacientes com comorbidades que contraindicam o uso de corticoides nas doses adequadas&#44; e nos casos de contraindica&#231;&#227;o absoluta de corticoides&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Com o objetivo de descrever a evolu&#231;&#227;o cl&#237;nica da fun&#231;&#227;o neural e da recorr&#234;ncia da neurite em pacientes com neurite hans&#234;nica submetidos &#224; neur&#243;lise&#44; apresentamos uma s&#233;rie de 22 casos de cirurgia do nervo ulnar&#44; 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m&#237;n&#46;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#59; m&#225;x&#46;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>303&#41;&#59; em 11 &#40;50&#44;0&#37;&#41; pacientes o procedimento foi realizado em at&#233; seis meses&#44; o que &#233; relacionado com os melhores resultados por outros autores&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Para fins de compara&#231;&#227;o&#44; no presente estudo foi considerada a &#250;ltima avalia&#231;&#227;o neurol&#243;gica&#44; que variou de tr&#234;s a 168 meses&#44; tendo 12 &#40;54&#44;5&#37;&#41; pacientes com mais de um ano de seguimento&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">De 12 casos que j&#225; tinham sensibilidade alterada antes da cirurgia&#44; sete &#40;58&#44;3&#37;&#41; apresentaram melhora e&#44; de seis que tinham altera&#231;&#227;o da for&#231;a muscular&#44; 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necessariamente&#44; evolu&#237;rem com perda da fun&#231;&#227;o &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Com esta s&#233;rie de casos&#44; ressalta&#8208;se a import&#226;ncia cl&#237;nica dos resultados em situa&#231;&#227;o de rotina&#44; em que a maior contribui&#231;&#227;o da neur&#243;lise associada ao tratamento cl&#237;nico da neurite hans&#234;nica foi a n&#227;o recorr&#234;ncia ou cronifica&#231;&#227;o do quadro&#44; evitando a corticoterapia prolongada e suas consequ&#234;ncias&#44; al&#233;m da poss&#237;vel evolu&#231;&#227;o para incapacidades f&#237;sicas&#44; inclusive com ganho da fun&#231;&#227;o sensitiva para a maioria dos casos apresentados&#46; Faz&#8208;se necess&#225;rio&#44; contudo&#44; a realiza&#231;&#227;o de estudos com metodologia apropriada para avaliar a efic&#225;cia da neur&#243;lise ou seus benef&#237;cios em compara&#231;&#227;o ao tratamento cl&#237;nico isolado&#44; mesmo diante das publica&#231;&#245;es existentes ao longo de d&#233;cadas&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Suporte financeiro</span><p id="par0045" class="elsevierStylePara elsevierViewall">Funda&#231;&#227;o de Amparo &#224; Pesquisa do Estado do Amazonas &#8211; bolsa de inicia&#231;&#227;o cient&#237;fica&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Contribui&#231;&#227;o dos autores</span><p id="par0050" class="elsevierStylePara elsevierViewall">Juliana Barroso&#8208;Freitas&#58; Concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica da literatura&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Pedro Arthur da Rocha Ribas&#58; Revis&#227;o cr&#237;tica da literatura&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Paula Frassinetti Bessa Rebello&#58; Concep&#231;&#227;o e planejamento do estudo&#59; revis&#227;o cr&#237;tica da literatura&#59; an&#225;lise dos dados&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Silmara Navarro&#8208;Pennini&#58; Concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; an&#225;lise dos dados&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflito de interesses</span><p id="par0070" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">N&#176; ordem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col">Sexo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col">Idade no diagn&#243;stico &#40;anos&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col">Forma cl&#237;nica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tempo em meses entre</th><th class="td" title="\n
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sensibilidade<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">For&#231;a muscular<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a></th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Tempo com recorr&#234;ncias &#40;meses&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Neurite e neur&#243;lise&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Neur&#243;lise e avalia&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Inicial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Final&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Inicial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Final&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">BL&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;05 g&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;05 g&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">BL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 g&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">LL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">300 g&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">300 g&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">300 g&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;2 g&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">300 g&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">300 g&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;05 g&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;05 g&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">22<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10 g&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10 g&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "identificador" => "tblfn0015"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">M&#234;s da ocorr&#234;ncia do &#250;nico um epis&#243;dio de neurite&#46;</p>"
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          "pt" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas dos casos de hansen&#237;ase submetidos &#224; neur&#243;lise do nervo ulnar</p>"
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      "titulo" => "Refer&#234;ncias"
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              "identificador" => "bib0030"
              "etiqueta" => "1"
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                  "referenciaCompleta" => "World Health Organization &#8211; WHO &#91;Internet&#93;&#46; Weekly Epidemiological Record &#40;WER&#41; &#91;Acesso em 20 jan&#46; 2020&#93;&#46; Dispon&#237;vel em&#58; &#60;<span class="elsevierStyleHsp" style=""></span>https&#58;&#47;&#47;www&#46;who&#46;int&#47;wer&#47;2019&#47;wer9435&#95;36&#47;en&#47;&#62;&#46;"
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Journal Information
Vol. 96. Issue 4.
Pages 500-502 (1 July 2021)
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6329
Vol. 96. Issue 4.
Pages 500-502 (1 July 2021)
Carta ‐ Investigação
Open Access
Evolução clínica da função neural em série de casos de neuropatia hansênica após neurólise ulnar
Visits
6329
Juliana Barroso‐Freitasa,
Corresponding author
freitassjuliana@hotmail.com

Autor para correspondência.
, Pedro Arthur da Rocha Ribasb, Paula Frassinetti Bessa Rebelloc, Silmara Navarro‐Penninic
a Hospital Universitário Getúlio Vargas, Manaus, AM, Brasil
b Universidade Nilton Lins, Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Fundação de Amparo à Pesquisa do Estado do Amazonas, Manaus, AM, Brasil
c Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, AM, Brasil
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Tabela 1. Características dos casos de hanseníase submetidos à neurólise do nervo ulnar
Full Text
Prezado Editor,

A hanseníase é uma doença infecciosa crônica com potencial incapacitante pela afinidade do agente, Mycobacterium leprae, pelos nervos periféricos e pele. Dos 208.619 novos casos detectados mundialmente em 2018, 11.323 já apresentavam deformidades aparentes; 2.109 (18,6%) casos eram do Brasil, número que esteve abaixo apenas da Índia, com 3.666 casos novos com deformidades.1

A neuropatia na hanseníase pode ocorrer de maneira insidiosa, mais comumente na forma de mononeuropatia múltipla, com o acometimento simultâneo de dois ou mais nervos periféricos em regiões distintas do corpo; os nervos ulnar e tibial posterior são os mais envolvidos. Com frequência, o dano neural também pode ocorrer durante episódios agudos de reações imunológicas contra antígenos bacilares, que podem surgir no decorrer da doença ou mesmo após o tratamento poliquimioterápico, na forma de neurite com edema, obstrução vascular, isquemia e estrangulamento na passagem pelos canais osteofibrosos dos membros, levando à dor e ao déficit de função, principal causa das incapacidades físicas e estigma da doença.2,3

A base do tratamento da neurite é a prednisona, utilizada para o controle do processo inflamatório e da dor, evitando o dano neural permanente. A neurólise é a cirurgia para descompressão do nervo por meio de uma incisão do epineuro e abertura do canal osteofibroso para liberação do mesmo, no nível do cotovelo e/ou do punho.3 É realizada principalmente nos casos de abscesso de nervo, neurite não responsiva ao tratamento clínico por quatro semanas, episódios de neurites recorrentes ou subentrantes, neurites deficitárias crônicas com dor, e neurites em pacientes com comorbidades que contraindicam o uso de corticoides nas doses adequadas, e nos casos de contraindicação absoluta de corticoides.4

Com o objetivo de descrever a evolução clínica da função neural e da recorrência da neurite em pacientes com neurite hansênica submetidos à neurólise, apresentamos uma série de 22 casos de cirurgia do nervo ulnar, realizadas em 2015 e 2016 na Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, na cidade de Manaus (AM).

Imediatamente antes da neurólise e após a mesma (30, 90 dias e na data do retorno), foi realizada a avaliação neurológica simplificada segundo o Ministério da Saúde do Brasil.4 A avaliação da sensibilidade foi realizada com estesiômetro ou monofilamento de Semmes‐Weinstein, composto por um conjunto de seis fios de nylon de diferentes cores e espessuras que, pressionados contra a pele, correspondem a diferentes pesos (de 0,05g a 300g). Foram considerados os monofilamentos de 0,05g (verde) e 0,2g (azul) como sensibilidade normal, e acima destes, diminuída.5 Para a avaliação da força muscular foi examinado o músculo abdutor do quinto dedo e utilizada a escala do Medical Research Council, que gradua a força de 0 (ausência de movimento muscular) a 5 (movimento completo contra a gravidade com resistência máxima).4 Os níveis 4 (movimento completo contra a gravidade com resistência parcial) e 5 foram considerados normais.5

O tempo entre o primeiro episódio de neurite e a realização da neurólise foi em média 25,3 meses (Dp=63,3; mín.=1; máx.=303); em 11 (50,0%) pacientes o procedimento foi realizado em até seis meses, o que é relacionado com os melhores resultados por outros autores.5 Para fins de comparação, no presente estudo foi considerada a última avaliação neurológica, que variou de três a 168 meses, tendo 12 (54,5%) pacientes com mais de um ano de seguimento.

De 12 casos que já tinham sensibilidade alterada antes da cirurgia, sete (58,3%) apresentaram melhora e, de seis que tinham alteração da força muscular, cinco (83,3%) mantiveram o mesmo nível e apenas um (16,7%) piorou. Quinze (68,2%) pacientes não tiveram mais neurite no nervo operado, porém três destes ainda tiveram que usar prednisona por apresentarem reação hansênica e/ou neurite de outros nervos. Dois pacientes tiveram apenas um único episódio de neurite, que ocorreu três e quatro meses após a cirurgia. Outros cinco (18,2%) tiveram neurites subentrantes do nervo operado, com média de 52,6 meses (Dp=63; mín.=17; máx.=172) após a cirurgia, sem, necessariamente, evoluírem com perda da função (tabela 1).

Tabela 1.

Características dos casos de hanseníase submetidos à neurólise do nervo ulnar

N° ordem  Sexo  Idade no diagnóstico (anos)  Forma clínica  Tempo em meses entreSensibilidadeaForça muscularbTempo com recorrências (meses) 
        Neurite e neurólise  Neurólise e avaliação  Inicial  Final  Inicial  Final   
31  BL  01  03  0,05 g  0,05 g  – 
22  BL  02  20  10 g  21 
34  LL  02  05  0,05 g  0,2 g  – 
TT  02  44  300 g  10 g  – 
20  BT  02  08  300 g  – 
26  BL  02  18  0,05 g  300 g  03c 
13  BT  03  34  300 g  300 g  – 
35  LL  04  14  0,2 g  0,2 g  – 
39  LL  04  30  4 g  – 
10  49  LL  05  24  0,2 g  0,2 g  – 
11  51  BL  03  300 g  – 
12  24  LL  09  26  300 g  0,2 g  – 
13  24  LL  10  02  0,2 g  0,2 g  – 
14  11  BL  12  21  0,05 g  0,05 g  21 
15  36  BL  16  17  300 g  10 g  17 
16  15  LL  17  04  0,05 g  0,05 g  – 
17  57  BT  20  08  300 g  0,2 g  – 
18  18  BL  20  168  300 g  172 
19  17  LL  31  10  0,05 g  0,2 g  32 
20  12  BT  36  04  300 g  4 g  04c 
21  19  BL  49  135  0,05 g  0,05 g  – 
22d  26  LL  303  03  10 g  10 g  – 
a

Monofilamento: 0,05g (verde) e 0,2g (azul)=sensibilidade normal; 2,0g (violeta)=diminuiçãoo da sensibilidade protetora, com discriminação de forma e temperatura diminuída; 4,0g (vermelho escuro)=sensibilidade protetora diminuída; 10,0g (laranja)=pode sentir pressão profunda e dor; 300,0g (vermelho magenta)=perda da sensação de pressão profunda, podendo sentir dor; e 0=não sente nenhum monofilamento ou ausência de sensibilidade à pressão ou dor.

b

Escala do Medical Research Council.

c

Mês da ocorrência do único um episódio de neurite.

d

Esse paciente apresentou reicidiva.

Com esta série de casos, ressalta‐se a importância clínica dos resultados em situação de rotina, em que a maior contribuição da neurólise associada ao tratamento clínico da neurite hansênica foi a não recorrência ou cronificação do quadro, evitando a corticoterapia prolongada e suas consequências, além da possível evolução para incapacidades físicas, inclusive com ganho da função sensitiva para a maioria dos casos apresentados. Faz‐se necessário, contudo, a realização de estudos com metodologia apropriada para avaliar a eficácia da neurólise ou seus benefícios em comparação ao tratamento clínico isolado, mesmo diante das publicações existentes ao longo de décadas.5

Suporte financeiro

Fundação de Amparo à Pesquisa do Estado do Amazonas – bolsa de iniciação científica.

Contribuição dos autores

Juliana Barroso‐Freitas: Concepção e planejamento do estudo; elaboração e redação do manuscrito; obtenção, análise e interpretação dos dados; revisão crítica da literatura.

Pedro Arthur da Rocha Ribas: Revisão crítica da literatura; obtenção, análise e interpretação dos dados.

Paula Frassinetti Bessa Rebello: Concepção e planejamento do estudo; revisão crítica da literatura; análise dos dados; revisão crítica do manuscrito.

Silmara Navarro‐Pennini: Concepção e planejamento do estudo; elaboração e redação do manuscrito; revisão crítica da literatura; análise dos dados.

Conflito de interesses

Nenhum.

Agradecimentos

Agradecimento a todos os profissionais que atuam no setor de prevenção de incapacidades físicas da Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, em nome da chefe do serviço, fisioterapeuta Isabelle Nóbrega Oliveira.

Referências
[1]
World Health Organization – WHO [Internet]. Weekly Epidemiological Record (WER) [Acesso em 20 jan. 2020]. Disponível em: <https://www.who.int/wer/2019/wer9435_36/en/>.
[2]
P. Saunderson, S. Gebre, K. Desta, P. Byass, D.N. Lockwood.
The pattern of leprosy‐related neuropathy in the AMFES patients in Ethiopia: definitions, incidence, risk factors and outcome.
Lepr Rev., 71 (2000), pp. 285-308
[3]
Brasil. Ministério da Saúde. Diretrizes para vigilância, atenção e eliminação da Hanseníase como problema de saúde pública: Manual técnico‐operacional. Brasília: Ministério da Saúde; 2016.
[4]
W.H. Van Brakel, P.G. Nicholls, L. Das, P. Barkataki, S.K. Suneetha, R.S. Jadhav, et al.
The INFIR Cohort Study: investigating prediction, detection and pathogenesis of neuropathy and reactions in leprosy. Methods and baseline results of a cohort of multibacillary leprosy patients in North India.
Lepr Rev., 76 (2005), pp. 14-34
[5]
N.H.J. Van Veen, T.A.R. Schreuders, W.J. Theuvenet, A. Agrawal, J.H. Richardus.
Decompressive surgery for treating nerve damage in leprosy.
A Cochrane review., 12 (2012), pp. CD006983

Como citar este artigo: Barroso‐Freitas J, Ribas PAR, Rebello PFB, Navarro‐Pennini S. Clinical evolution of neural function in a series of leprosy neuropathy cases after ulnar neurolysis. An Bras Dermatol. 2021;96:500–2.

Trabalho realizado na Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta Manaus, AM, Brasil.

Projeto aprovado pelo Comitê de Ética em Pesquisa da Instituição (CEP‐FUAM) sob o número CAE 03242218.5.0000.0002.

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