Decompressive surgery for treating nerve damage in leprosy

Van Veen NHJ, Schreuders TAR, Theuvenet WJ, Agrawal A, Richardus JH

Published Online:

September 8, 2010

Leprosy is a chronic infectious disease. Leprosy bacteria cause damage to skin and peripheral nerves which may result in nerve function impairment and disability. Decompressive surgery is used for treating nerve damage although its effect is uncertain. Two randomised controlled trials were included in the review and examined the added benefit of surgery over prednisolone for treatment of nerve damage of less than six months duration. Two years from the start there was no significant difference in nerve function improvement between people treated with surgery plus prednisolone or with prednisolone alone. Adverse effects of decompressive surgery were not adequately described.

Abstract (click to read)

Background:

Leprosy causes nerve damage which may result in nerve function impairment and disability. Decompressive surgery is used for treating nerve damage, although the effect is uncertain.

Objectives:

To assess the effects of decompressive surgery on nerve damage in leprosy.

Search strategy:

We searched the Cochrane Neuromuscular Disease Group Specialized Register (4 August 2010), the Cochrane Central Register of Controlled Trials (Issue 3, 2010 in The Cochrane Library), MEDLINE (January 1966 to July 2010), EMBASE (January 1980 to July 2010), AMED (January 1985 to July 2010), CINAHL Plus (January 1937 to July 2010) and LILACS (from January 1982 to July 2010). We checked reference lists of the studies identified, the Current Controlled Trials Register (www.controlled-trials.com) (February 2010), conference proceedings and contacted trial authors.

Selection criteria:

Randomised and quasi-randomised controlled trials of decompressive surgery for nerve damage in leprosy.

Data collection and analysis:

The primary outcome was improvement in sensory and motor nerve function after one year. Secondary outcomes were improvement in nerve function after two years, change in nerve pain and tenderness, and adverse events. Two authors independently extracted data and assessed trial quality. We contacted trial authors for additional information. We collected adverse effects information from the trials and non-randomised studies.

Main results:

We included two randomised controlled trials involving 88 participants. The trials examined the added benefit of surgery over prednisolone for treatment of nerve damage of less than six months duration. After two years follow-up there was no significant difference in nerve function improvement between participants treated with surgery plus prednisolone or with prednisolone alone. Adverse effects of decompressive surgery were not adequately described.

Authors' conclusions:

Decompressive surgery is used for treating nerve damage in leprosy but the available evidence from randomised controlled trials was of very low quality and does not show a significant added benefit of surgery over steroid treatment alone. Well-designed randomised controlled trials are needed to establish the effectiveness of the combination of surgery and medical treatment compared to medical treatment alone.

This record should be cited as:

Van Veen NHJ, Schreuders TAR, Theuvenet WJ, Agrawal A, Richardus JH. Decompressive surgery for treating nerve damage in leprosy. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD006983. DOI: 10.1002/14651858.CD006983.pub2

Assessed as up to date:

August 4, 2010

Find the research

Get full text at The Cochrane Library

Primary Review Group:

Neuromuscular Disease Group

Health topics:

Infectious disease > Neglected tropical diseases > Leprosy

Infectious disease > Skin > Leprosy

Skin > Infections > Leprosy

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Decompressive surgery for treating nerve damage in leprosy

More like this

Copyright © 2011 - The Cochrane Collaboration