Successful treatment of intractable neuralgia in patients with typical and atypical Ramsay-Hunt syndrome by transcutaneous facial nerve stimulation: A case series study

Yan-Bo Deng Ying Zhong Yu-Xian Lin Chen Lin Pin-Pin Ji Shen-Yin Wang Wei-Yi Gong ^*

• Affiliated Hospital of Guilin Medical University, Guilin, China

Objectives: Typical Ramsay-Hunt syndrome (RHS) is a rare peripheral facial neuropathy associated with reactivation of latent varicella-zoster virus in the geniculate ganglion. Atypical RHS involves lesions of multiple cranial nerves and/or cervical roots with more complex manifestations. The main goals of treatment are to reduce the occurrence of late complications, especially in devastating postherpetic neuralgia (PHN). To date, there is no definitive effective treatment. We present a case series of patients with typical and atypical RHS with severe PHN, who were successfully treated with transcutaneous facial nerve stimulation (FNS). Materials and Methods: This is a retrospective case series including two atypical RHS cases and one typical RHS case. The first patient with atypical RHS suffered from persistent otalgia with severe paroxysmal radiation to the dermatome of CN V and Ⅸ lesion. The second atypical RHS patient with CN V and Ⅶ lesion had persistent fronto-temporal neuralgia and otalgia with severe paroxysmal radiation to the CN V and Ⅸ dermatome. The third typical patient had persistent otalgia with severe paroxysmal exacerbations. A FNS in the stylomastoid foramen was successfully performed under ultrasound- and DSA-guidance. Pain assessment was performed during treatment and follow-up. Pain intensity was assessed by Number Rate Scale (NRS) and Verbal Rating Scale (VRS). The therapeutic effect was assessed using Pain Relief Scale (PRS). In addition, Pain Relief Ratio (PRR) was calculated and treatment was considered effective if the PRR was greater than 50%. Results: The t-FNS showed excellent pain relief, especially for breakthrough pain. The breakthrough pain ceased completely before the FNS was turned off, and the persistent pain decreased from moderate intensity to mild intensity before the patients were discharged. The mild persistent pain of the first patient on the three months follow-up and the third patient on the two months follow-up had completely disappeared, but the mild persistent pain of the second patient was still felt in the temporal region for one year. Conclusions: For the first time, transcutaneous FNS was successfully used to treat intractable PHN in typical and atypical RHS. However, further research is needed to determine the optimal procedure and specific stimulation parameters.