Clinical Study of Motor Paresis in In-patients with Herpes Zoster

Son, Hyun Ho; Sim, Hyun Soo; Lee, Sook Kyung

Abstract

BACKGROUND
Although herpes zoster primarily affects afferent sensory neurons, it may complicated by motor nerve involvement in 0.5% to 5% of cases. However herpes zoster-induced muscle paresis is still under-recognized by dermatologists, and there has been insufficient clinical investigation of these conditions.
OBJECTIVE
This study was conducted to investigate the clinical aspects of motor nerve involvement of herpes zoster.
METHODS
We retrospectively reviewed the data of 711 patients with herpes zoster who had been admitted to our hospital in the departments of dermatology, ophthalmology, otorhinolaryngology, neurology, neurosurgery and rehabilitation medicine between 2005 and 2010.
RESULTS
Among the 711 patients with herpes zoster, 15 patients had motor paresis (2.1%). 11 patients (73.3%) had facial nerve palsy including one patient who had accompanying vagus nerve palsy. Besides, one case of trochlear nerve palsy, one case of hypoglossal nerve palsy, one case of upper limb paresis and one case of lower limb paresis were noted. Associated underlying diseases were observed in nine patients (60.0%). Duration of motor weakness ranged from 1 month to 4 years. Twelve patients (80.0%) achieved complete recovery.
CONCLUSION
In our patient population, the incidence of motor involvement of herpes zoster was higher in cranial nerves, especially the facial nerve, than in spinal nerves. Although motor nerves are usually involved in relation to dermatome, cranial nerve palsy may occur regardless of its dermatome because of complicated anatomical association. The majority of cases recovered completely without any complications. Further prospective investigation with a large group of patients is necessary to better understand the epidemiology of motor nerve involvement of herpes zoster.