{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T14:19:11Z","timestamp":1790432351221,"version":"4.1.0"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2021,10,19]],"date-time":"2021-10-19T00:00:00Z","timestamp":1634601600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100001807","name":"S\u00e3o Paulo Research Foundation","doi-asserted-by":"crossref","award":["465458\/2014\u20139"],"award-info":[{"award-number":["465458\/2014\u20139"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100003593","name":"National Council for Scientific and Technological Development","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100003593","name":"CNPq","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"crossref"}]},{"name":"National Institute for Science and Technology for translational medicine\u2014INCT","award":["2014\/50891\u20131"],"award-info":[{"award-number":["2014\/50891\u20131"]}]},{"DOI":"10.13039\/501100004901","name":"FAPEMIG","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004901","id-type":"DOI","asserted-by":"crossref"}]},{"name":"National Institute of Science and Technology in Theranostics and Nanobiotechnology-INCT-TeraNano-PhD to LRG","award":["465669\/2014\u20130"],"award-info":[{"award-number":["465669\/2014\u20130"]}]},{"name":"National Institute of Science and Technology in Theranostics and Nanobiotechnology-INCT-TeraNano-PhD to LRG","award":["CBB-APQ-03613\u201317"],"award-info":[{"award-number":["CBB-APQ-03613\u201317"]}]},{"name":"Clinical Hospital of Ribeir\u00e3o Preto"},{"DOI":"10.13039\/501100005639","name":"University of S\u00e3o Paulo","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005639","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100008353","name":"FAEPA","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100008353","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,5,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Disability in leprosy is a direct consequence of damage to the peripheral nervous system which is usually worse in patients with no skin manifestations, an underdiagnosed subtype of leprosy known as primary neural leprosy. We evaluated clinical, neurophysiological and laboratory findings of 164 patients with definite and probable primary neural leprosy diagnoses. To better understand the disease progression and to improve primary neural leprosy clinical recognition we compared the characteristics of patients with short (\u226412 months) and long (&amp;gt;12 months) disease duration.<\/jats:p>\n               <jats:p>Positive and negative symptoms mediated by small-fibres were frequent at presentation (\u223c95%), and symptoms tend to manifest first in the upper limbs (\u223c68%). There is a consistent phenotypic variability between the aforementioned groups. Deep sensory modalities were spared in patients evaluated within the first 12 months of the disease, and were only affected in patients with longer disease duration (\u223c12%). Deep tendon reflexes abnormalities were most frequent in patients with longer disease duration (P &amp;lt; 0.001), as well as motor deficits (P = 0.002). Damage to large fibres (sensory and motor) is a latter event in primary neural leprosy. Grade-2 disability and nerve thickening was also more frequent in cases with long disease duration (P &amp;lt; 0.001). Primary neural leprosy progresses over time and there is a marked difference in clinical phenotype between patients with short and long disease duration. Patients assessed within the first 12 months of symptom onset had a non-length-dependent predominant small-fibre sensory neuropathy, whilst patients with chronic disease presented an asymmetrical all diameter sensory-motor neuropathy and patchily decreased\/absent deep tendon reflexes.<\/jats:p>","DOI":"10.1093\/brain\/awab396","type":"journal-article","created":{"date-parts":[[2021,10,13]],"date-time":"2021-10-13T20:33:49Z","timestamp":1634157229000},"page":"1499-1506","source":"Crossref","is-referenced-by-count":26,"title":["Primary neural leprosy: clinical, neurophysiological and pathological presentation and progression"],"prefix":"10.1093","volume":"145","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1485-3771","authenticated-orcid":false,"given":"Pedro J","family":"Tomaselli","sequence":"first","affiliation":[{"name":"Division of Neuromuscular Disorders, Department of Neurology, Ribeir\u00e3o Preto School of Medicine, University of S\u00e3o Paulo, Ribeir\u00e3o Preto 14048-900, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diogo F","family":"dos Santos","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, National Reference Centre for Sanitary Dermatology and Leprosy, Clinical Hospital, Federal University of Uberl\u00e2ndia (CREDESH\/HC\/UFU), Uberl\u00e2ndia 38400-902, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9 C J","family":"dos Santos","sequence":"additional","affiliation":[{"name":"Division of Neuromuscular Disorders, Department of Neurology, Ribeir\u00e3o Preto School of Medicine, University of S\u00e3o Paulo, Ribeir\u00e3o Preto 14048-900, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas E","family":"Antunes","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, National Reference Centre for Sanitary Dermatology and Leprosy, Clinical Hospital, Federal University of Uberl\u00e2ndia (CREDESH\/HC\/UFU), Uberl\u00e2ndia 38400-902, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa D","family":"Marques","sequence":"additional","affiliation":[{"name":"Division of Neuromuscular Disorders, Department of Neurology, Ribeir\u00e3o Preto School of Medicine, University of S\u00e3o Paulo, Ribeir\u00e3o Preto 14048-900, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norma T","family":"Foss","sequence":"additional","affiliation":[{"name":"Division of Dermatology, Department of Internal Medicine, Ribeir\u00e3o Preto School of Medicine, University of S\u00e3o Paulo, Ribeir\u00e3o Preto, 14048-900, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina L","family":"Moreira","sequence":"additional","affiliation":[{"name":"Division of Neuromuscular Disorders, Department of Neurology, Ribeir\u00e3o Preto School of Medicine, University of S\u00e3o Paulo, Ribeir\u00e3o Preto 14048-900, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patr\u00edcia T B","family":"Nogueira","sequence":"additional","affiliation":[{"name":"Division of Neuromuscular Disorders, Department of Neurology, Ribeir\u00e3o Preto School of Medicine, University of S\u00e3o Paulo, Ribeir\u00e3o Preto 14048-900, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osvaldo J M","family":"Nascimento","sequence":"additional","affiliation":[{"name":"Department of Neurology, Antonio Pedro University Hospital (HUAP), Fluminense Federal University, Niter\u00f3i 24033-900, Brazil"},{"name":"Department of Pathology, Ribeir\u00e3o Preto School of Medicine, University of S\u00e3o Paulo, Ribeir\u00e3o Preto 14048-900, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciano","family":"Neder","sequence":"additional","affiliation":[{"name":"Department of Pathology, Ribeir\u00e3o Preto School of Medicine, University of S\u00e3o Paulo, Ribeir\u00e3o Preto 14048-900, Brazil"},{"name":"Department of Pathology, Molecular Oncology Research Center (CPOM), Barretos Cancer Hospital, Barretos 14784-400, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amilton A","family":"Barreira","sequence":"additional","affiliation":[{"name":"Division of Neuromuscular Disorders, Department of Neurology, Ribeir\u00e3o Preto School of Medicine, University of S\u00e3o Paulo, Ribeir\u00e3o Preto 14048-900, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco A","family":"Frade","sequence":"additional","affiliation":[{"name":"Division of Dermatology, Department of Internal Medicine, Ribeir\u00e3o Preto School of Medicine, University of S\u00e3o Paulo, Ribeir\u00e3o Preto, 14048-900, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabela M B","family":"Goulart","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, National Reference Centre for Sanitary Dermatology and Leprosy, Clinical Hospital, Federal University of Uberl\u00e2ndia (CREDESH\/HC\/UFU), Uberl\u00e2ndia 38400-902, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"Wilson","family":"Marques","sequence":"additional","affiliation":[{"name":"Division of Neuromuscular Disorders, Department of Neurology, Ribeir\u00e3o Preto School of Medicine, University of S\u00e3o Paulo, Ribeir\u00e3o Preto 14048-900, Brazil"},{"name":"Department of Neurosciences and Behavioral Sciences, National Insitute for Science and Technology for Translational Medicine, INCT, Ribeir\u00e3o Preto 14049-900, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,10,19]]},"reference":[{"issue":"35\/36","key":"2022052416111440400_awab396-B1","first-page":"389","article-title":"Global leprosy update, 2018: Moving towards a leprosy-free world","volume":"94","author":"World Health 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