Leprosy still remains a major cause of peripheral neuropathy, particularly in Asia, Africa, and immigrants from these endemic regions of the world. Lepromatous neuropathy can manifest as mononeuropathies, mononeuropachy multiplex, or as a generalized sensorimotor polyneuropathy. The electrophysiologic studies reveal a primarily axoral process, although there may be demyeltnating features as well. Long-term treatment with dapsone, rifampin, and clofazimine is required, A potential complication of therapy, particularly in the borderline patient, is the reversal reaction, a condition caused by upregulation of the cellular immune response. In this condition, patients may develop an exacerbation of their skin lesions and neuropathy, Because lepromatous neuropathy is not rare, neurologists need to be aware of the complex nature of the clinical manifestations, pathogenesis, and treatment of leprosy