Local immune responses and systemic cytokine responses in zoster: relationship to the development of postherpetic neuralgia

Varicella zoster virus (VZV) causes varicella (chickenpox) as the primary infection and zoster (shingles) on reactivation from latency, often many years later. One of the most common and most severe sequela of zoster is postherpetic neuralgia (PHN). Apart from age, factors which predispose towards PHN are unknown. In the present study, the concentration of a variety of Th1 and Th2 cytokines in the serum of 30 zoster patients at the time of the acute disease were correlated with the subsequent development of PHN in nine of these patients, but no association was found. In addition, although some cytokines such as IFN-gamma, IL-6 and IL-8 were slightly raised in the zoster group compared with a group of normal healthy subjects of a similar age distribution, these differences only verged on significance. Antibody titres to VZV were raised in the zoster group compared with the controls but these did not differ between the patients who developed PHN and those who did not. Biopsies of zoster lesions were collected from nine patients. There were significantly fewer infiltrating lymphocytes in the lesions of the three patients who subsequently developed PHN compared with the six who did not, although the expression of the neuropeptide, substance P, did not differ between the two groups. It is possible that the poor inflammatory response at the time of the acute zoster may result in less effective containment of the VZV and more damage in the dermatome, thus contributing to the persistence of the neuralgia.     

细胞外信号调节激酶在三叉神经痛动物模型中的表达

为了研究细胞外信号调节激酶(ERK)信号转导通路在三叉神经痛动物模型中的表达,将24只雄性SD大鼠分为三叉神经痛模型组和对照组两组,模型组大鼠以铬制羊肠线疏松结扎大鼠一侧眶下神经,对照组大鼠眶下神经不结扎。应用免疫组化和免疫荧光染色方法,分别检测大鼠三叉神经节(TG)和三叉神经脊束核尾侧亚核(Vc)中磷酸化ERK(p-ERK)的表达。本研究发现p-ERK在模型组和对照组大鼠的TG和Vc中均有不同程度的表达,但模型组大鼠中p-ERK表达明显高于对照组(P<0.05)。提示ERK可能参与了三叉神经痛(TGN)痛觉信号的传导,在三叉神经痛的发病机制中发挥重要的作用。     

强化三叉神经痛对因治疗的临床意义

三叉神经感觉根入髓区血管压迫是三叉神经痛的主要病因,显微血管减压手术是治疗三叉神经痛的有效手段,有效率高,复发率低,针对三叉神经痛的主要病因进行治疗,能够完好保留三叉神经的正常功能。在熟练的显微外科技术的基础上,显微血管减压手术是一种安全的治疗方法。因此,显微血管减压手术是外科治疗三叉神经痛的最佳手段。     

局部药物注射与口服药治疗三叉神经痛的疗效对比

目的：观察局部注射药物与口服药治疗三叉神经痛的疗效差异。方法：选择门诊三叉神经痛的患者,并随机分成两组,即口服药物组给予卡马西平100mg1-2次/天,若不能止痛每天增加100mg ,直到控制疼痛为止,将最小有剂量作为维持量,一般为600-800mg/d,共36例。局部药物注射组以4%氢羟强的松龙0.5ml加2%利多卡因1.5ml混合后准确地注射到罹患神经通过的骨孔处,共32例。结果：口服药物组6个月有效27例,有效率75%,局部药物注射组6个月有效30例,有效率94%。结论：局部药物注射组的疗效明显优于口服药物组。     

阿霉素注射神经干治疗原发性三叉神经痛

对 6 8例原发性三叉神经痛患者施行阿霉素神经干注射治疗。全部病例均在术后 2周内三叉神经痛症状消失 ,其中 6 3.2 %在术后 2 4h内痛疼消失 ;2 8.9%在术后 1周内疼痛消失 ;7.9%在术后 2周内疼痛消失。随访结果显示 ,3年内复发率为 10 .3% ,3～ 5年复发率为 15 .4%。该方法具有复发率低、疗效肯定、安全、微创等特点。     

Endoscopic-assisted microvascular decompression for trigeminal neuralgia secondary to vertebrobasilar dolichoectasia: A case report

Introduction and importanceTrigeminal neuralgia (TN) secondary to vertebrobasilar dolichoectasia (VBD) was a rare condition. This paper reported a successful endoscopic-assisted microvascular decompression (MVD) for TN secondary to VBD.Case presentationA 53-year-old male with a history of myocardial infarction and heart failure complained of left refractory facial pain three years prior to admission. His pain was intermittent, electrical-like, severe, sharp, and radiated along the maxillary and mandibular branches. He used carbamazepine 600 mg daily. Brain magnetic resonance imaging revealed a neurovascular conflict between VBD and the left trigeminal nerve. The endoscopic-assisted MVD was indicated. The shredded neurosurgical sponges were interposed between VBD and trigeminal nerve. The 0° and 30° rigid rod-lens endoscope was used to explore and confirm the complete decompression. Postoperatively, TN was disappeared entirely. At a three-month postoperative, no facial pain and paraesthesia were found. The patient discontinued carbamazepine permanently.Clinical discussionMVD was still the most effective treatment. An inspection of root entry zone (REZ) and complete MVD with a solely operating microscope were challenging due to the massive diameter of VBD and multiple offending arteries behind the VBD. However, the wide viewing field and high-quality resolution of endoscopes allowed better visualization of REZ and neurovascular conflicts behind neural structures and least cerebellar retraction. This is essential in case of less potential space created by VBD.ConclusionEndoscope-assisted MVD allowed better visualization of REZ and neurovascular conflicts behind neural structures and least cerebellar retraction in management of trigeminal neuralgia secondary to VBD.     

Epileptiform activity in the somatosensory cortex of rats with trigeminal neuralgia

Laboratory of Pathophysiology of Pain, Research Institute of General Pathology and Pathological Physiology, Russian Academy of Medical Sciences, Moscow. Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 114, No. 8, pp. 126–128, August, 1992.     

Metformin use and the risks of herpes zoster and postherpetic neuralgia in patients with type 2 diabetes

Herpes zoster and postherpetic neuralgia cause substantial pain in patients. Persons with type 2 diabetes (T2D) are prone to zoster infection and postherpetic neuralgia due to compromised immunity. We conducted this study to evaluate the risks of herpes zoster and postherpetic neuralgia between metformin users and nonusers. Propensity score matching was utilized to select 47 472 pairs of metformin users and nonusers from Taiwan's National Health Insurance Research Database between January 1, 2000, and December 31, 2017. The Cox proportional hazards models were used for comparing the risks of herpes zoster and postherpetic neuralgia between metformin users and nonusers in patients with T2D. Compared with no-use of metformin, the adjusted hazard ratios (95% confidence interval) for metformin use in herpes zoster and postherpetic neuralgia were 0.70 (0.66, 0.75) and 0.510 (0.39, 0.68), respectively. A higher cumulative dose of metformin had further lower risks of herpes zoster and postherpetic neuralgia than metformin no-use. This nationwide cohort study demonstrated that metformin use was associated with a significantly lower risk of herpes zoster and postherpetic neuralgia than metformin no-use. Moreover, a higher cumulative dose of metformin was associated with further lower risks of these outcomes.     

继发性三叉神经痛12例临床分析

目的：探讨桥小脑角占位性病变引起的继发性三叉神经痛的临床特征。方法：回顾分析了12例继发性三叉神经痛患者的临床资料，MRI检查7例为桥小脑角胆脂瘤所致，5例为桥小脑角脑膜瘤所致；均经乙状窦后进路显微手术切除肿瘤。结果：肿瘤切除术后无并发症发生；12例三叉神经痛全部治愈。随访3～18个月，无复发。结论:MRI检查是诊断继发性三叉神经痛的主要依据；乙状窦后进路显微手术是治疗继发性三叉神经痛的首选方法.     

THERAPEUTIC EFFECTS OF ACUPUNCTURE TREATMENTIN 96 CASES OF TRIGEMINAL NEURALGIA

Thetrigeminalnervebranchesofftheoph-thalmic,mandibularandmaxillarybranchesfromthesemilunarganglion,whicharemainsensorynerveslnnervatingtheheadandtheface.Ifanyonebranchoftheminthedistribu-tionregionsofthetrigeminalnerveisaffectedbywind-cold,pressureorinflammatorystimulation,etc.,abnormalsensationorpainwillbeinducedinthecorrespondinginnervatedregion.Clinical-ly,patholOgicchangeoftheophthalmicbranchismorecommonandmaycausepainoftheorbitandtheforehead,andlacrimation;Patientswithpainofthemaxillarybr…