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Successful management of segmental zoster paresis on the upper arm with temporally burst spinal cord stimulation

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Abstract

Segmental zoster paresis (SZP) of the limbs is characterized by a focal, asymmetric neurogenic weakness that may occur in an extremity affected by herpes zoster (HZ). In this case report, we describe the case of a patient with SZP who presented with these problems and responded well to temporary spinal cord stimulation (SCS) and systematic rehabilitation. A 62-year-old female patient was referred for right upper limb pain, weakness, and insomnia due to pain. After completing the 14-day trial stimulation, the pain numerical rating scale of the patient in the right upper extremity decreased from 8/10 to 2/10. The Athens insomnia scale score decreased from 15/24 to 10/24. Furthermore, the grip strength of the right hands increased from 6.7 to 16.8 kg at discharge. We induced temporal SCS and rehabilitation of the right upper limb SZP and successfully reduced the pain. An in-depth understanding of the neurological complications secondary to HZ should be emphasized, with temporal SCS and rehabilitation expected to play a crucial role in the motor recovery of patients with SZP.

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References

  1. Merchut MP, Gruener G. Segmental zoster paresis of limbs. Electromyogr Clin Neurophysiol. 1996;36:369–75.

    CAS  PubMed  Google Scholar 

  2. Liu Y, Wu BY, Ma ZS, Xu JJ, Yang B, Li H. A retrospective case series of segmental zoster paresis of limbs: clinical, electrophysiological and imaging characteristics. BMC Neurol. 2018;18:121. https://doi.org/10.1186/s12883-018-1130-4.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kennedy PG, Barrass JD, Graham DI, Clements GB. Studies on the pathogenesis of neurological diseases associated with Varicella-zoster virus. Neuropathol Appl Neurobiol. 1990;16:305–16. https://doi.org/10.1111/j.1365-2990.1990.tb01265.x.

    Article  CAS  PubMed  Google Scholar 

  4. Yaszay B, Jablecki CK, Safran MR. Zoster paresis of the shoulder. Case report and review of the literature. Clin Orthop Relat Res. 2000;377:112–8. https://doi.org/10.1097/00003086-200008000-00016.

    Article  Google Scholar 

  5. Song JJ, Popescu A, Bell RL. Present and potential use of spinal cord stimulation to control chronic pain. Pain Phys. 2014;17:235–46.

    Google Scholar 

  6. Yanamoto F, Murakawa K. The effects of temporary spinal cord stimulation (or spinal nerve root stimulation) on the management of early postherpetic neuralgia from one to six months of its onset. Neuromodulation. 2012;15:151–4. https://doi.org/10.1111/j.1525-1403.2012.00438.x (discussion 154).

    Article  PubMed  Google Scholar 

  7. Liu B, Yang Y, Zhang Z, Wang H, Fan B, Sima L. Clinical study of spinal cord stimulation and pulsed radiofrequency for management of herpes zoster-related pain persisting beyond acute phase in elderly patients. Pain Phys. 2020;23:263–70.

    Google Scholar 

  8. Chen GB, Tuan SH, Liou IH, Huang HY, Hu YC, Wu SY. Segmental zoster paresis of unilateral upper extremity: a case report and literature review. Med (Baltim). 2020;99: e20466. https://doi.org/10.1097/MD.0000000000020466.

    Article  Google Scholar 

  9. Yoleri O, Ölmez N, Öztura I, Şengül I, Günaydin R, Memiş A. Segmental zoster paresis of the upper extremity: a case report. Arch Phys Med Rehabil. 2005;86:1492–4. https://doi.org/10.1016/j.apmr.2004.09.032.

    Article  PubMed  Google Scholar 

  10. Kawajiri S, Tani M, Noda K, Fujishima K, Hattori N, Okuma Y. Segmental zoster paresis of limbs: report of three cases and review of literature. Neurologist. 2007;13:313–7. https://doi.org/10.1097/NRL.0b013e31811e9d6d.

    Article  PubMed  Google Scholar 

  11. Ruppert LM, Freeland ML, Stubblefield MD. Segmental zoster paresis of the left upper limb in a pediatric patient. Am J Phys Med Rehabil. 2010;89:1024–9. https://doi.org/10.1097/PHM.0b013e3181e7204b.

    Article  PubMed  Google Scholar 

  12. Katz J, Cooper EM, Walther RR, Sweeney EW, Dworkin RH. Acute pain in herpes zoster and its impact on health-related quality of life. Clin Infect Dis. 2004;39:342–8. https://doi.org/10.1086/421942.

    Article  PubMed  Google Scholar 

  13. Oster G, Harding G, Dukes E, Edelsberg J, Cleary PD. Pain, medication use, and health-related quality of life in older persons with postherpetic neuralgia: results from a population-based survey. J Pain. 2005;6:356–63. https://doi.org/10.1016/j.jpain.2005.01.359.

    Article  PubMed  Google Scholar 

  14. Kuner R. Central mechanisms of pathological pain. Nat Med. 2010;16:1258–66. https://doi.org/10.1038/nm.2231.

    Article  CAS  PubMed  Google Scholar 

  15. Dong DS, Yu X, Wan CF, Liu Y, Zhao L, Xi Q. Efficacy of short-term spinal cord stimulation in acute/subacute zoster-related pain: a retrospective study. Pain Phys. 2017;20:E633–45.

    Google Scholar 

  16. Gewandter JS, Dworkin RH, Turk DC, Farrar JT, Fillingim RB, Gilron I. Research design considerations for chronic pain prevention clinical trials: IMMPACT recommendations. Pain. 2015;156:1184–97. https://doi.org/10.1097/j.pain.0000000000000191.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Moriyama K. Effect of temporary spinal cord stimulation on postherpetic neuralgia in the thoracic nerve area. Neuromodulation. 2009;12:39–43. https://doi.org/10.1111/j.1525-1403.2009.00186.x.

    Article  PubMed  Google Scholar 

  18. Al-Kaisy A, Vajramani G, Love-Jones S, Patel NK, Royds J, Palmisani S. Multicentre, clinical trial of burst spinal cord stimulation for neck and upper limb pain NU-BURST: a trial protocol. Neurol Sci. 2021;42:3285–96. https://doi.org/10.1007/s10072-020-04907-3.

    Article  PubMed  Google Scholar 

  19. Kriek N, Groeneweg JG, Stronks DL, Huygen FJPM. Comparison of tonic spinal cord stimulation, high-frequency and burst stimulation in patients with complex regional pain syndrome: a double-blind, randomised placebo controlled trial. BMC Musculoskelet Disord. 2015;16:222. https://doi.org/10.1186/s12891-015-0650-y.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Deer TR, Falowski SM, Moore GA, Hutcheson JK, Peña I, Candido K. Passive Recharge Burst Spinal Cord Stimulation provides sustainable improvements in pain and psychosocial function: 2-year results from the TRIUMPH study. Spine (Phila Pa 1976). 2021. https://doi.org/10.1097/BRS.0000000000004283.

    Article  Google Scholar 

  21. Herman R, He J, D’Luzansky S, Willis W, Dilli S. Spinal cord stimulation facilitates functional walking in a chronic, incomplete spinal cord injured. Spinal Cord. 2002;40:65–8. https://doi.org/10.1038/sj.sc.3101263.

    Article  CAS  PubMed  Google Scholar 

  22. Calvert JS, Grahn PJ, Zhao KD, Lee KH. Emergence of epidural electrical stimulation to facilitate sensorimotor network functionality after spinal cord injury. Neuromodulation. 2019;22:244–52. https://doi.org/10.1111/ner.12938.

    Article  PubMed  Google Scholar 

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Acknowledgements

Written informed consent was obtained from the patient. We are grateful to the patient described in this case report.

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Authors and Affiliations

  1. Department of Anesthesiology, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20 Shinsuna, Koto-ku, Tokyo, 136-0075, Japan

    Keisuke Yamaguchi, Chika Kawabe-Ishibashi, Shie Iida & Takayuki Saito

  2. Department of Rehabilitation Medicine, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20 Shinsuna, Koto-ku, Tokyo, 136-0075, Japan

    Tomokazu Takakura

Authors
  1. Keisuke Yamaguchi
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  2. Chika Kawabe-Ishibashi
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  3. Shie Iida
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  4. Takayuki Saito
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  5. Tomokazu Takakura
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Contributions

KY was responsible for obtaining consent, discussion with ethics committee, acquiring the data and drafting the manuscript. CI, SI, and TS established the clinical diagnosis with KY and assisted in drafting and critically revised the manuscript. TT helped performing the rehabilitation therapy and critically revised the manuscript. All authors approved the final version of the manuscript.

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Correspondence to Keisuke Yamaguchi.

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Yamaguchi, K., Kawabe-Ishibashi, C., Iida, S. et al. Successful management of segmental zoster paresis on the upper arm with temporally burst spinal cord stimulation. J Anesth 36, 323–326 (2022). https://doi.org/10.1007/s00540-022-03056-5

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  • DOI: https://doi.org/10.1007/s00540-022-03056-5

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