Post-herpetic neuralgia: 208 cases

Watson, C. Peter N.; Evans, R. J.; Watt, Verna R.; Birkett, Nicholas

doi:10.1016/0304-3959(88)90139-x

Cited by 153 publications

(44 citation statements)

References 27 publications

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“…The following distinct clinical syndromes have been described [16,19,39,40,43,62,63]: encephalitis, myelitis, multifocal leukoencephalitis, ophthalmic zoster with contralateral hemiparesis, brainstem vascular syndrome (locked in syndrome) with herpes zoster in the upper cervical segments, cranial and peripheral nerve palsies, acute retinal necrosis, post herpetic neuralgia.…”

Section: Neurological Complications Of Herpes Zostermentioning

confidence: 99%

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Viral infections of the CNS with special emphasis on herpes simplex infections

Schmutzhard¹

2001

J Neurol

119

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Within the past decade the management of acute HSV I encephalitis has been improved dramatically by the advent of the polymerase chain reaction (PCR), a method which has become the gold standard of diagnosis of HSV I encephalitis, replacing diagnostic uncertainties and, avoiding, in particular, invasive brain biopsy. Early detection of HSV II in the neonate is mandatory; however, prevention by Caesarean section and/or prenatal therapy of the mother are for this the best option. Very recently the causative agent of Mollaret's meningitis has proved to be, at least in part, HSV I or II. So far prospective randomized therapeutic trials are awaited for the treatment of Mollaret's meningitis using intravenous acyclovir or the more modern oral forms of virostatics (famciclovir, valaciclovir). For decades the causative agent of facial palsy (Bell's palsy) has been sought; only with the advent of PCR has this question been answered. Although one single study indicates the superiority of a combination of acyclovir plus prednisone, this finding has to be confirmed by a large scale prospective randomised double blind study. Nevertheless, if other causes for the clinical/neurological syndrome of peripheral facial palsy have been excluded, a combination therapy with acyclovir plus prednisone seems to be indicated in a patient with Bell's palsy.

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Section: Neurological Complications Of Herpes Zostermentioning

confidence: 99%

“…The antiviral therapy reduces the duration of viral shedding, limits the duration of new lesion-formation, accelerates the cutaneous healing and is superior to placebo in reducing the duration of postherpetic neuralgia [62,63]. All these 3 drugs are safe and well tolerated for short term administration.…”

Section: Treatmentmentioning

confidence: 99%

Viral infections of the CNS with special emphasis on herpes simplex infections

Schmutzhard¹

2001

J Neurol

119

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“…An early therapeutic approach using a low-dose capsaicin cream formulation to defunctionalize nerve endings in human skin required repeated daily applications over weeks [11]. Although pain arising from such topical capsaicin applications is mild, mucous membranes are highly sensitive to the effects.…”

Section: Introductionmentioning

confidence: 99%

Capsaicin for Neuropathic Pain: Linking Traditional Medicine and Molecular Biology

Haanpää

Treede

2012

Eur Neurol

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Capsaicin has long been used as a traditional medicine to treat pain and, recently, its mechanism of analgesic action has been discovered. This review article documents the clinical development of capsaicin to demonstrate that pharmacognosy still has a profound influence on modern-day drug development programs. Capsaicin is a highly selective agonist for the transient receptor potential channel vanilloid-receptor type 1 (TRPV1), which is expressed on central and peripheral terminals of nociceptive primary sensory neurons. Knockout studies have revealed the importance of TRPV1 as a molecular pain integrator and target for novel analgesic agents. Topical application of capsaicin at the peripheral terminal of TRPV1-expressing neurons superficially denervates the epidermis in humans in a highly selective manner and results in hypoalgesia. In three recent randomized controlled trials, a patch containing high-concentration capsaicin demonstrated meaningful efficacy and tolerability relative to a low-concentration capsaicin control patch in patients with peripheral neuropathic pain. Data from clinical practice will determine if the high-concentration capsaicin patch is effective in real-world settings.

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“…Pain which persists beyond healing of the rash is one such definition (Watson et al, 1988), whereas others have suggested that only patients whose pain continues beyond some arbitrary cut-off point (such as 30 days or 2 months from rash onset) have PHN (Sauer, 1955;Eaglstein, Katz & Brown, 1970). Given its uncertain definition, estimates of the incidence of PHN have varied.…”

Section: The Clinical Picturementioning

confidence: 99%

How should zoster trials be conducted?

Balfour²,

Beutner³

et al. 1995

J Antimicrob Chemother

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In 1994, an international group of interested clinicians and biostatisticians met to discuss the design of clinical trials in herpes zoster. They agreed that trials in herpes zoster should have prospectively agreed definitions of all outcome measures and plans for data analysis. In immunocompetent individuals, in whom pain is the major outcome measure, trials should only include patients over the age of 50 years, and for those recruited within 72 h of rash onset, should be designed to demonstrate superiority of any new therapy over existing antivirals. The primary endpoint should be time to cessation of pain for at least 4 weeks and, for the purposes of statistical analysis of its duration, the pain associated with herpes zoster ought to be considered as a continuum. All other variables, including the incidence of post-herpetic neuralgia and effects upon quality of life should be considered as secondary end-points. Evaluation of treatment effects on primary endpoints should be based upon an intent-totreat (ITT) analysis and subgroup analysis should be used only to support the findings of the ITT analysis. These elements of good study design should be borne in mind in the evaluation of current and future trails of antiviral drugs in herpes zoster.

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Post-herpetic neuralgia: 208 cases

Cited by 153 publications

References 27 publications

Viral infections of the CNS with special emphasis on herpes simplex infections

Viral infections of the CNS with special emphasis on herpes simplex infections

Capsaicin for Neuropathic Pain: Linking Traditional Medicine and Molecular Biology

How should zoster trials be conducted?

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