Lepr Rev (2000) 71, 285-308 The pattern of leprosy-related neuropathy in the AMFES patients in Ethiopia: defnitions, incidence, risk factors and outcome PAUL SAUNDERSON 1 , SHIBRU GEBRE 1 , KETSELA DEST A I , PETER BY ASS 2 & DIANA N. J. LOCKWOOD 3 1 ALERT PO Box 1 65, Addis Ababa, Ethiopia 2 School of Communit Health Science, Nottingham Universit, Nottingham, UK and Department of Public Health and Clinical Medicine, Umea Universit, Umea, Sweden 3 London School of Hygiene and Tropical Medicine, Keppel Street, London, UK Accepted for publication 12 July 2000 Summar The ALERT MDT Field Evaluation Study (AMFES) began in 1988 and followed patients prospectively for up to 10 years afer release from treatment (R). This paper presents the fndings fom this cohort with regard to neuropathy and nerve damage. Five hundred and ninety-four new cases of leprosy are included in the study, 300 multibacillary (MB) and 294 paucibacillary (PB) cases. Fifty- fve percent of patients had some degree of impairment at diagnosis and a frther 73 (12%) developed new nerve function impairment (NFl) after starting multiple drug therapy (MDT). The overall incidence rate for neuropathy was 39 episodes per 1 00 PYAR in the frst year after diagnosis, gradually declining to 12 episodes per 1 00 PYAR in the sixth year. In those patients without impairment at diagnosis, the incidence rate of neuropathy was 25 episodes per 1 00 PYAR for MB cases and 11 per 1 00 PYAR for PB cases in the frst year; in 33% of MB cases whose frst episode of neuropathy occured after diagnosis, that frst episode took place after the frst year, or afer the normal period of treatment with MDT. Seventy-three patients with neuropathy developing afer diagnosis are reported more fully: 34 (47%) had only one nerve involved and of these 25 (73%) had a single, acute episode of neuropathy. Nine (27%) had further episodes. Thirty-nine (53%) had more than one nerve involved and of these 16 (41 %) had a single, acute episode, while 23 (59%) had further episodes. The terms 'chronic' and 'recurrent' neuropathy are defned and used to describe the patter of neuropathy in those with repeated attacks. In patients with no impairment at the start of the study, treatment with steroids resulted in full recovery in 88% of nerves with acute neuropathy but only 51 % of those with chronic or recurent neuropathy. The median time to full recovery from acute neuropathy was approxi mately 6 months, but in a few cases recovery occurred gradually over 2-3 years. Correspondence to: P. Saunderson, ALM, 1 ALM Way, Greenville SC 29601 , USA (e-mail : psaunderson@ leprosy.org) 0305-7518/00/07l285+24 $1.00 © Lepra 285