Meng Ying, Zhuang Lei, Jiang Wenchen, Zheng Baosen, Yu Buwei
Department of Anesthesiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Pain Treatment, Tianjin First Center Hospital, Nankai University, Tianjin, China.
Pain Physician. 2021 May;24(3):253-261.
Herpes zoster is an acute infectious skin disease that is induced by the re-activation of the virus incubated in nerve ganglions following initial infection with varicella-zoster virus in childhood. Herpes zoster mainly affects sensory nerves, resulting in severe acute pain, which is also the most common reason for medical intervention in this patient group. The concurrent involvement of motor nerves could induce the symptoms of segmental zoster paresis, which is manifested by localized asymmetric myasthenia, whose range generally follows the distribution of myomere with skin rashes. Due to the low incidence and unspecific clinical manifestations, segmental zoster paresis has not been sufficiently recognized by clinicians, and can easily be misdiagnosed.
To summarize the previous studies on segmental zoster paresis and analyze the pathogeneses, diagnosis, and treatment of this disease, as well as stress the challenges in current treatment, which could provide useful evidence for the clinical diagnosis and better the treatment of patients with segmental zoster paresis in the future.
We conducted a narrative review.
Hospitals, neurology departments, pain departments, and private practices.
We searched PubMed and Chinese CNKI libraries using the terms "herpes zoster," "muscle paresis," "segmental zoster paresis," and "motor nerve." Clinical trials, reviews, and case reports were collected and reviewed.
As a rare complication following varicella-zoster virus infection, segmental zoster paresis has not been sufficiently recognized by clinicians, and there are still no guidelines available to guide the clinical treatments. The exact mechanism of segmental zoster paresis is still unclear. Electromyographic and magnetic resonance imaging examinations could be used as auxiliary diagnostic methods for segmental zoster paresis. Early regular anti-viral therapy could substantially decrease the risk of herpes zoster related complications. Combined application of glucocorticoids and some other physical therapy may also be useful in certain patients. The general prognosis of segmental zoster paresis is relatively good, with 67% patients achieving complete or almost complete recovery of the muscle function.
More clinical trials are needed to clarify the exact mechanisms and best treating methods.
As the symptom in most segmental zoster paresis patients is self-limited, and the patients' prognosis is generally good, early diagnosis of the disease is especially important, due to the avoidance of unnecessary diagnostic procedures and incorrect treatments. Standard treatment guidelines regarding the functional rehabilitation are still needed for patients with refractory segmental zoster paresis.
带状疱疹是一种急性感染性皮肤病，由儿童时期初次感染水痘-带状疱疹病毒后潜伏在神经节中的病毒再激活引起。带状疱疹主要影响感觉神经，导致严重的急性疼痛，这也是该患者群体进行医学干预的最常见原因。运动神经同时受累可诱发节段性带状疱疹性轻瘫症状，表现为局限性不对称肌无力，其范围通常与有皮疹的肌节分布一致。由于发病率低且临床表现不具特异性，节段性带状疱疹性轻瘫尚未得到临床医生的充分认识，容易误诊。
总结既往关于节段性带状疱疹性轻瘫的研究，分析该病的发病机制、诊断和治疗方法，并强调当前治疗面临的挑战，为未来节段性带状疱疹性轻瘫患者的临床诊断提供有用依据，改善治疗效果。
我们进行了一项叙述性综述。
医院、神经内科、疼痛科和私人诊所。
我们在PubMed和中国知网数据库中使用“带状疱疹”“肌肉轻瘫”“节段性带状疱疹性轻瘫”和“运动神经”等关键词进行检索。收集并回顾了临床试验、综述和病例报告。
作为水痘-带状疱疹病毒感染后的一种罕见并发症，节段性带状疱疹性轻瘫尚未得到临床医生的充分认识，目前仍没有指导临床治疗的指南。节段性带状疱疹性轻瘫的确切机制仍不清楚。肌电图和磁共振成像检查可作为节段性带状疱疹性轻瘫的辅助诊断方法。早期规律的抗病毒治疗可大幅降低带状疱疹相关并发症的风险。糖皮质激素与其他一些物理治疗联合应用对某些患者可能也有用。节段性带状疱疹性轻瘫的总体预后相对较好，67%的患者肌肉功能实现完全或几乎完全恢复。
需要更多的临床试验来阐明确切机制和最佳治疗方法。
由于大多数节段性带状疱疹性轻瘫患者的症状具有自限性，且患者预后总体良好，因此早期诊断该病尤为重要，可避免不必要的诊断程序和错误治疗。对于难治性节段性带状疱疹性轻瘫患者，仍需要关于功能康复的标准治疗指南。
