A case report

Herpes zoster,a sporadic disease, is the consequence of reactivation of latent VZV (Varicella Zoster Virus) from the dorsal root ganglion. Shingles or herpes zoster is characterised by a unilateral vesicular eruption within a dermatome often associated with severe pain. Most debilitating complication of herpes zoster is pain associated with acute neuritis and post herpetic neuralgia. Changes in sensation of the affected dermatome resulting in either hypo or hyper aesthesia is also reported.

Management of post herpetic neurological complications through conventional therapy is particularly difficult. It is often tried with the help of non narcotic, narcotic analgesics and antidepressants. Corticosteroids are also found effective if used early in the course of disease.

In this enigmatic situation, patients often opt for complimentary medicine seeking relief.

Case Report

A young male of 26 yr. reported with a H/O shingles 2.5 yrs back involving the maxillary branch of trigeminal nerve on the left side of face , clinically presenting with numbness and hypoaesthesia over the left side of face between the nasal bone and zygomatic prominence laterally extended downward from nasolabial fold to corner of left upper lip. Because of the involvement of nasal branches, there was a stuffy sensation in the nose on left side. This hypoaesthetic patch on the side of face developed after few days of resolution of shingles and led to a kind of obsessive disorder in the form of repeated manoeuvring to relieve the stuffiness (pressing or rubbing with finger) and simultaneously with an urge to feel for the sensation if there is any .This stereotyped behaviour became as frequent as around 40-50 times /day and was continued occasionally while asleep.

O/E there were left over marks of shingles over the face with no other physical signs. Neurological examination detected a gradual decrease in pin prick sensation from zygomatic prominence to a complete lack of sensation at the left side of nose. This was evaluated in three horizontal lines between nose and upper lip with the similar findings.

The patient underwent for a variety of treatments including long courses of neurotropics and steroids without any significant result.

Acupuncture treatment

After the proper clinical examination the patient was offered with a prescription of even needling for certain acupoints corresponding to the meridians involved according to TCM (Traditional Chinese Medicine ). 0.30 mm. thick stainless needles were used for the shallow puncture over the face after taking all the aseptic precautions. Needles were retained for 15 minutes. and then taken out The points used were Quanliao SI-18, Juliao ST-3, Dicang ST-4, Renzhong DU-26, Yingxiang L.I.-20Shang ying xiang (Ex HN 8Kouheliao L.I.-19, on the left side of face only. The whole of treatment was done under the guidance of a qualified acupuncturist.

The treatment was continued for 5 days. A pre treatment check up on 3 rd day revealed a regenerated patch of normal sensation in the mid of hypoaesthetic area. The frequency of obsessive manoeuvre of touching the face and nose was significantly reduced and turned to a minimal. A 5 day treatment resulted in 75- 80% regaining of normal sensation over the affected area and persisted without any regression in a 6 month follow up.

Discussion

Sensory abnormalities are one of the cardinal features of PHN (post herpetic neuralgia). Exact pathogenesis of PHN or sensory abnormality is not well understood but there are growing evidences that this is related with decreased density of epidermal neurites not only in the affected area but also in the contralateral area. Degeneration of sensory nerve endings in the affected dorsal nerve root ganglion as a complication of herpes infection is a recognised fact. Unfortunately till now , in the conventional medicine there is no satisfactory answer to degenerative neuropathies. Acupuncture ,though not under stood well for its reasoning on therapeutic grounds ,enjoys a dependable place in treating various neurological ailments.

Through repetitive stimulation of nervous system, unused or little used nerve circuits could possibly become effective after degeneration of other previously functional neural pathways; this is proposed as one explanation for the possible role of acupuncture in neuronal degenerative diseases .Sprouting of new synapses from nearby intact fiber is also observed after acupuncture therapy.

As the phenomena of PHN is also related to neuronal degeneration in the affected and contralateral area, pain relief in these cases after acupuncture therapy can also be correlated with the sprouting and reactivation of unused neuronal circuits.

Conclusion

Post herpetic complications can be prevented if the rational combination of steroids, analgesics and antivirals is started from the beginning. Unfortunately there is no specific answer to the condition if the complications are already set in. Complementory therapies give a ray of hope in these conditions. Acupuncture is found effective to treat post herpetic neurological symptoms in this case.

References

 

  1. Illis L.S :Regeneration in the central nervous system, Lancet, May 12 ,1973,1035-37
  2. Illis L.S :Brain 96 (1) 47-60, 1973
  3. Oaklander AL et.al. Unilateral post herpetic neuralgia associated with bilateral sensory neuron damage Ann.Neurol 1998;44 :789-795
  4. Sun j wang ( eds.) Science of acupuncture and moxibustion,Wuhan university press ,Wuhan, China,1995
  5. WhitleyRJ, Varicella zoster virus infection in Harrisons principles of internal medicine , 11th ed.,Mcgraw hill ,NewYork


Dr. Sanjeev Rastogi
Consulting Physician and acupuncturist, Body and mind clinic and research center, lucknow, indi

Phone: 0522264043
Email:


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