Avaliação sensitivo-motora e eletromiográfica da face na hanseníase

Abstract

Introduction: Leprosy is a disease with late diagnosis, which makes treatment difficult and causes deformities and disability. Changes in the face evidence the disease, impairing social inclusion and increasing prejudice. Objectives: This thesis was subdivided into two studies, aiming to compare healthy individuals with clinical forms of leprosy through electromyographic evaluation and facial skin sensibility. Methodology: Of 90 subjects, 19 were healthy and 71 had leprosy patients at the national referral center in leprosy, period 2014, 2016, submitted to face electromyography and cutaneous sensibility analysis. Study 1, the facial muscles investigated by electromyography were: frontal, orbicularis of the eyes, zygomatic, masseters, and orbicularis of the lips. It was used the Intan Electromyograph and disposable electrodes with adapted sensors. Three isometric contractions were performed with each muscle for 20 seconds with a 5 second interval and the characteristics of the Root Mean Square (RMS) and Fmean frequency signal were analyzed. The RMS characteristic is associated with the intensity with which the skeletal muscle was contracted and the Fmean refers to the number of times the motor units were activated in a contraction. Study 2, in the evaluation of the sensibility was used the Semmes-Weinstein, with 7 nylon monofilaments with different colors and diameters exerting force of 0.05g up to 300g, applied in the facial regions corresponding to the ophthalmic, maxillary and mandibular ramifications of the trigeminal nerve. Results: In study 1, considering all the muscles of the face, the tuberculoid and borderline clinical forms differed from the controls while the lepromatous group did not. The muscles that most evidenced an asymmetric neuropathy were the frontal, followed by the zygomatic and the masseter, the asymmetry being predominant in the borderline group. In study 2, the lepromatous clinical form (LL) was predominant in terms of changes in the cutaneous sensation of the face, followed by the borderline-borderline (BB), and borderline-lepromatous (BL) when compared to healthy individuals. The most affected distal branches were: zygomatic (28.2%; 20/71), buccal (23.9%; 17/71) and nasal (22.5%; 16/71). There was an asymmetric sensory impairment of the face in 62.5% (20/32) of cases. Conclusion: In study 1, the absence of alteration in LL can be explained by a predominantly sensory and autonomic neuropathy and not muscular, with weak host inflammatory response and preserved function of mixed nerves until advanced stages of the disease. Tuberculoids and borderline are responsible for disabilities and deformities in leprosy due to the high immunity and immunological instability leading to devastating neuropathies. In study 2, it was concluded that the face is as impaired in leprosy as the feet, hands and eyes, but this condition is underdiagnosed. The evaluation of the different sensorial branches and the evidence of an asymmetric impairment in the face reinforce the classically described pattern in leprosy neuropathy - an asymmetric and predominantly sensitive peripheral neuropathy.