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Case Report

The combined treatment of manual acupuncture, electro-acupuncture and low-level laser therapy in the management of Herpes Zoster complicated by right side facial palsy By: Dr. Emad Tukmachi (MBChB, DTM, PhD) (2001), The Journal of Chinese Medicine , 66: 12-20.

Introduction

Herpes Zoster (HZ) or shingle is a common presenting problem in both general practice and pain clinics, particularly when it is associated with one or more complications such as post-herpetic neuralgia and facial paralysis.

Typically, the shingles occurs only along the distribution of a single spinal nerve appearing in a band or a patch round the trunk; or down the arm, or on the buttock, or down the leg. Not like chicken pox, shingles can be very severe infection that could cause long lasting pain (post-herpetic neuralgia). The case presentation here reports a successful us of a treatment combination (manual, electro-acupuncture and low-level laser therapy) in the management of Herpes Zoster complicated by right side facial palsy. After 6 combined acupuncture treatments over 2-week period, the patient was clinically cured.

Case History And Clinical Presentation

A 71-year old male, sought acupuncture treatment for HZ on the right neck and post-auricular regions associated with facial paralysis on that side. He first complained of prodromal influenza-like symptoms for two days. Then he started to develop an odd sensation in the skin over the right side of the neck ascending to behind the right ear that gradually turned into pain.

The skin lesion of an extensive vesicular rash began as a series of well-circumscribed, erythematous, maculopapular skin eruptions that follow sensory dermatomes. Twenty-four hours after the rash appeared he noticed the right ear was covered by an extensive mass of ulcerated abrasions associated with right facial paralysis.

He came for acupuncture treatment 2 days after the appearance of rash, which was diagnosed by his family doctor as HZ with right facial paralysis.

Acupuncture Management

Acupuncture is proved to be an effective measure in aborting signs and symptoms of HZ although it is a time-consuming procedure, as treatment sessions last for about 30 minutes to one hour.

Daily acupuncture sessions (a combination of manual, electrical and laser acupuncture) were given for 6 days. In each session, disposable and sterilized needles (0.5-1.0 inch long and 30 gauge) were used. Mild manual stimulation with a needle rotation of 60-90 0 and strong manual stimulation with a needle rotation of 90-180 0 were used with either reducing or reinforcing technique for about 10 minutes.

Electrical stimulation was carried out after manual needle stimulation, using low frequency (10Hz: AMBD Acupuncto-scope stimulator, Acumedic) for 10 minutes.

Laser acupuncture was used to radiate each local point for 10-40 seconds. The laser beam intensity used was too low to damage the skin, underlying tissues or the patient’s eyes.

Outcome Results And Discussio

The patient’s skin lesions were cleared after two sessions of this combination treatment. As the treatment progressed, the patient began to show improvement in the right facial paralysis. After completion of 6 acupuncture sessions, the patient was considered clinically cured. The patient, in our opinion, was in a late stage of the acute phase with involvement of geniculate ganglion of the facial nerve.

The patient did not present any signs and symptoms of the 1 st trigeminal branch (ophthalmic) nerve involvement, such as: mucopurulent conjunctivitis, scleritis, episcleritis, visual loss, V nerve palsy, keratitis, iritis, papillary distortion or/and optic atrophy. However, the 3rd branch of trigeminal nerve may be involved as the patient presented the classical signs and symptoms of Herpes Zoster Oticus (Ramsey Hunt Syndrome) characterized by a rash along its distribution in the lower part of the face and severe pain in the ear preceding facial palsy.

The patient responded well to the combination treatment of manual acupuncture, electroacupuncture and laser therapy with an achievement of a remarkable improvement in 7 days of treatment and a significant recovery in only two weeks. Recovery within that period of time would seem to exclude the possibility of natural improvement.

This case with its unique clinical picture and combined acupuncture treatment triggers the need for more scientific studies based on well-constructed single or double blind comparative trials to establish the effectiveness of acupuncture management in Herpes Zoster.