A patient approached my PTA about needling for facial nerve pain after being diagnosed with Ramsay Hunt syndome. Is DN contraindicated? Risk of facilitated viral propagation? Any insight would be greatly appreciated.
Please disregard. I downloaded an updated manual and found that it is indicated for herpes zoster.
Yeah, the goal is to reduce the nerve inflammation and we discuss this related to Bells Palsy. Ramsay Hunt has the break out phase and you want to of course avoid any open areas. Also, there has never been a study to my knowledge looking at outcomes of treatment- we do know Ramsay has a poorer recovery percent than Bells Palsy so trying all means to assist in facial recovery, under the correct circumstances, is worth a try.
I have a patient who had Ramsay Hunt 12 years ago -- she continues with facial paralysis as well as now has horizontal diploplia and synkinesis of the facial muscles. Would you still try to stimulate the facial nerve at this point? She also has involvment of the vestibulocochlear nerve with chronic vertigo -- would there be any sights we could needle that may impact this region??
I have actually treated a patient with Ramsay Hunt Syndrome.
I focused on addressing her trigeminal nerve distribution initially, staying far away from any lesions. She did get some relief from needling treatment. As her pain diminished, I introduced needling with ENS to her fascial muscles and we were able to improve eye closure and lip puckering. Past, that her recover halted...But she was grateful for what we were able to accomplish.
It took about 4 months of needling to see any motor improvement needing her 1x a week.
I have also worked with patients with Ramsey Hunt Syndrome in the healing phase. They were no longer in the active phase of the infection.
I think there is value to adding dry needling to the plan of care. In this case, I would consider including the trigeminal and facial nerve distributions. I also utilized other manual therapy techniques including pulsed cupping, cupping with gliding as well as soft tissue mobilization to facial structures may be showing restriction.
In regards to using the estim, I think it is important to prevent muscle synkinesis. I would make sure the settings are low to prevent compensatory and abnormal movements. Some educators will suggest that you don't use estim as part of their treatment plan to prevent synkinesis. I have treated both ways.
Below is an article addressing facial reanimation from 2022. A nice takeaway on our rehabilitation goal is "that a number of patients with facial paralysis develop facial muscle weakness and synkinesis, rehabilitation must aim toward control of voluntary movement and decreasing synkinesis [89]"
Thank you SO much Stephanie for this information and the reference - I can't wait to read it. I've started needling with this patient using the facial & trigeminal nerves & she is seeing significant improvements. Was just getting on here to see if there was any guidance on ENS -- you mentioned very low settings -- where would you connect say if you were doing the trigeminal distribution??
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