Herpes Zoster of a head and limbs: electroneuromyographic and clinical findings in 158 consecutive cases

To quantify electromyographic and neurographic changes and to correlate them with the clinical data of outpatients with herpes zoster. DESIGN: Prospective case series. SETTING: Outpatient department. PATIENTS: A consecutive, unselected series of 158 outpatient cases (88 women, 70 men; mean age, 64y) of herpes zoster of the head and limbs. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Blink reflex and electromyography and motor and sensory nerve conduction velocities of nerves and muscles corresponding to affected dermatomes. RESULTS: Postherpetic neuralgia (PHN), segmental zoster paresis, and polyneuropathy were found in 31%, 19%, and 2.5% of cases, respectively. Absence or reduction of sensory action potential amplitudes, blink reflex areas, and compound muscle action potential amplitudes were found in 60%, 31%, and 18% of cases, respectively. Sensory and motor conduction velocities and motor and blink reflex latencies were nearly always normal or only slightly slowed. Electromyographic signs of abnormal spontaneous activity were found in 36% of the cases. Electrophysiologic alterations were correlated among themselves, with age, with presence of segmental zoster paresis, and with absence of antiviral therapy. The extent of the skin rash (number of dermatomes affected by herpes zoster) was the only variable predictive of disappearance or improvement of PHN. CONCLUSIONS: Sensory axonal neuropathy, often associated with similar motor involvement, can be shown by classical electrophysiologic methods in herpes zoster. The severity of damage to motor fibers was related to damage to sensory fibers, but no relation was found between peripheral axon damage and PHN. The site of motor system damage may be the ventral roots, plexus, or peripheral nerve. The probability of complications and the severity of sensory and motor peripheral axonal damage were increased in older patients. Appropriate antiviral therapy seems to reduce the incidence of segmental zoster paresis and the severity of damage to the peripheral fibers. A reduced extent of herpetic rash was the only factor to correlate with a good outcome of PHN.