Leprosy is one of the neglected tropical diseases, and its elimination remains a public health problem globally. This manuscript comprehensively explores the neurological manifestations of leprosy, offering clinical insights and implications for the diagnosis, management, and understanding of this disease. Beginning with a review of historical context, etiology, and epidemiology, we delve into the pathophysiology of leprosy neuropathy, highlighting mechanisms of nerve damage and immune response. Peripheral nerve involvement, including sensory and motor deficits, nerve enlargement, and deformities, are discussed in detail, along with the challenges in diagnosis and management. Psychological and social implications of neurological deficits in leprosy are addressed, emphasizing the importance of holistic care and support. Emerging trends in neuroimaging and molecular diagnostics offer promising avenues for improved diagnosis and therapeutic interventions. Novel therapeutic strategies are identified to enhance treatment efficacy and prevent disability in leprosy neuropathy by targeting immunomodulatory pathways, antibacterial agents, and a personalized medicine approach.