Application Of Neuroelectrophysiological Technique In Predicting The Efficacy And Prognosis Of Herpetic Neuralgia

Objective Herpes zoster neuralgia is a common disease in pain departments.At present,there are many studies on the efficacy of herpes zoster neuralgia after minimally invasive surgery at home and abroad,but there are few studies on the factors affecting the efficacy.The purpose of this study is to include the clinical data of patients with herpes zoster neuralgia,and to combine the current perception threshold(CPT)examination to analyze the correlation between these factors and efficacy,and to construct a nomogram model to predict efficacy.Methods Herpes zoster neuralgia patients at the First Hospital of Jiaxing between May 2022 to November 2022 were enrolled.Clinical data were collected,and CPT examination was performed on the affected side skin before surgery,obtaining the CPT at different frequencies,namely CPT 2000Hz,CPT 250Hz and CPT 5Hz.Numeric rating scale(NRS)scores were also collected.Efficacy was evaluated by using the NRS score.A 25%decrease in postoperative NRS score from preoperative baseline was effective.One day after surgery was taken as the observation point and divided into effective group and ineffective group.Clinical data and preoperative results of CPT at different frequencies were included,and independent factors influencing the efficacy of minimally invasive surgery for herpes zoster neuralgia were studied by univariate analysis and multivariate logistic regression analysis.R draws the nomogram model for the efficacy of herpes zoster neuralgia after minimally invasive surgery,and use the receiver operating characteristic(ROC)curve and calibration curve to evaluate the predictive ability of the prediction model.Internal validation was evaluated using the bootstrapping validation.Results A total of 88 patients were eventually enrolled.Of the 88 patients,64 were in the effective group and 24 in the ineffective group.The effective and ineffective groups showed statistically significant differences in age,disease course,preoperative CPT 250Hz,and preoperative CPT 5Hz(P<0.05),while in sex,whether or not underlying disease,treatments,affected area,preoperative NRS score,and preoperative CPT 2000Hz was no statistically significant difference(P>0.05).Univariate and multivariate logistic regression analysis results showed that age(OR=3.545,95%CI:0.992-12.664,P=0.046),disease course(OR=6.616,95%CI:1.528-28.638,P=0.004),preoperative CPT 250Hz(OR=5.488,95%CI:1.508-19.966,P=0.005)and the preoperative CPT 5Hz(OR=3.827,95%CI:1.084-13.512,P=0.027)was independent influencing factor for the efficacy.The prediction model constructed with these four factors has good discriminability.The area under the curve(AUC)is 0.828,which has good calibration ability and can still reach a high C-index value of 0.801 in the interval validation.Conclusion Patients with age>70 years,disease course>7 days,preoperative CPT 250Hz>61,preoperative CPT 5Hz>32 may not have good efficacy,and should be treated with caution.Objective Electromyography(EMG)is a widely used electrophysiological detection method in recent years,which plays an important role in the diagnosis and treatment of peripheral neuropathy.Herpes zoster(HZ)is a disease caused by virus invading the peripheral nerve.However,the application of EMG in HZ is rarely reported.The purpose of this study is to analyze the application of EMG in the severity and prognosis of acute upper limb HZ by comparing the EMG-related data in different conditions and prognosis of acute upper limb HZ.Methods Acute upper limb HZ at the First Hospital of Jiaxing between January 2015 and July 2022 were enrolled.The patients were divided into mild,moderate,and severe groups according to their numeric rating scale(NRS)scores.the EMG-related data of the median nerve were measured in each group.Motor nerve indices included distal motor latency(DML),compound muscle action potential(CMAP)amplitude,and motor nerve conduction velocity(MNCV);sensory nerve indices included distal sensory latency(DSL),sensory nerve action potential(SNAP)amplitude,and sensory nerve conduction velocity(SNCV).Spearman’s correlation analysis was used to analyze the relationship between the EMG-related data of the median nerve and the NRS score and muscle strength.The occurrence of postherpetic neuralgia(PHN)was defined as poor prognosis.According to the occurrence of PHN,patients were divided into two groups:good prognosis and poor prognosis.The EMG-related data of median nerve in patients with different prognosis were measured and compared.Univariate and multivariate logistic regression analyses were used to determine the independent influencing factors of PHN in patients with acute upper limb HZ,and the receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of EMG-related data and the NRS score in the acute phase in patients with upper limb HZ.Results A total of 103 patients were finally enrolled.Among 103 patients,there were 31 patients in the mild HZ group,38 in the moderate HZ group,and 34 in the severe HZ group.The amplitudes of CMAP and SNAP of the median nerve in the affected side were lower than those in the healthy’side.However,DML,MNCV,DSL and SNCV were not significantly different between healthy side and affected side(P>0.05).Through Spearman’s correlation analysis,it was found that the CMAP and SNAP amplitudes of the median nerve on the affected limb were negatively correlated with the NRS score(r=-0.267,P=0.006;r=-0.747,P<0.001),and there was no significant correlation between each index and muscle strength(P>0.05).Among 103 patients,54 and 49 were in the non-PHN and PHN groups,respectively.Univariate and multivariate logistic regression analyses showed that the CMAP amplitude of the median nerve on the affected limb(OR=2.958,95%CI:1.215-7.200,P=0.017),SNAP amplitude(OR=2.860,95%CI:1.092-7.485,P=0.032)and the NRS score in the acute phase(OR=0.326,95%CI:0.123-0.870,P=0.025)were independent influencing factors of PHN.Through the analysis of the ROC curve,it was found that the CMAP and SNAP amplitudes,and the NRS score in the acute phase had high predictive value for PHN(AUC=0.684;AUC=0.763;AUC=0.723),with cut values of 5.45mV,10.80uV and 5.5,respectively.Conclusion The CMAP amplitude and SNAP amplitude of the affected median nerve are important indicators to evaluate the pain degree and prognosis of patients with acute upper limb HZ.Patients with lower CMAP amplitude and lower SNAP amplitude,the heavier the pain degree,and the more likely to have a poor prognosis.