1923. No. 16. THF. NEUROLOGICAL ASPECT OF LEPROSY. 



It is a striking feature of the facial paralysis in leprosy that the indi- 

 vidual muscle is often affected in a variable degree in its different parts. Thus 

 it is not rare to see the frontalis muscle strongly paretic or even paralytic 

 in its medial part, whilst the more lateral parts of the muscle have retained 

 a comparatively good function. When in such a case the patient is made to 

 raise his eyebrows, this often 

 results in a characteristic reac- 

 tion consisting of an elevation of 

 the lateral parts of the eyebrows 

 only. 



When the orbicularis oris is 

 affected, a peculiar configuration 

 of the mouth, highly characteristic 

 of leprosy, often occurs. Corres- 

 ponding to some of the radial 

 muscles of the mouth (e. g. 

 zygomaticus) which have not yet 

 succumbed to the paralysis and 

 which have retained their nor- 

 mal tonus, a retraction is seen 

 in the lips, which are otherwise 

 flabby, swollen, and "ectropic". 



(Cpr. the following rough 

 sketches fig. 4—8). 



As will be seen from the 

 above table, fibrillary contractions 

 are often to be seen in the 

 paretic muscles. In some cases 

 these "fibrillary contractions" 

 only occurred on exertion, and 

 then rather made the impression 

 of being temporary fibrillarv 

 relaxations of the contracted 

 muscle ^ — 



It will easily be seen that only 

 lesions of the most peripheral 

 (terminal) branches of the facial nerve can explain the clinical picture outlined 

 above. I am therefore strongly opposed to Nonne's views of the central 

 origin of the facial paralysis in leprosy. Not only must the paralysis be 

 due to a peripheral lesion of the nerve ; but to the most peripheral nerve 

 lesion viz. a lesion of the facial branches. Only thus can one explain the 



Fig. 4. (Case No. 21 K. P.) Typical defiguration of 

 the mouth due to leprous facial paralysis in a 

 woman, suffering from the maculo-anaesthetic form. 

 There is double lagophtalmus and ectropion ; also 

 "ectropion of the mouth". In the left supraoral 

 region hovever the radial muscles (zygomaticus) 

 have retained their tonus. Corresponding to this 

 a retraction of the upper lip may be seen. In 

 this region frequent fibrillary tsvitchings occur. 

 When she speaks the other side of the supraoral 

 region flaps like a loose sail. 



' In case No. 58 I J. A.I one could produce these "fibrillary contractions" in the left supra- 

 oral region by continuous irritation of the left facial trunk with a weak tarradic current. 



