Intravenöse Vitamin-C-Begleittherapie der Herpes-zoster-Neuralgie

Zusammenfassung

Die Wirksamkeit von Vitamin C bei immunogenen Erkrankungen ist evident gesichert, positive Daten liegen für die parenterale Verabreichung vor.

In unserer Fallstudie wurden 3 Patientinnen mit Post-Zoster-Neuralgie beobachtet, 2 erhielten zur Schmerz- und virostatischen Therapie zweitägig 15 g Vitamin C intravenös, die 3. Patientin wurde virostatisch und schmerztherapeutisch gemäß WHO-Stufenschema behandelt. Die mit Vitamin C behandelten Patientinnen wiesen innerhalb von 10 Tagen eine Abheilung der kutanen Effloreszenzen und völlige Remission der PZN (auf der visuellen Analogskala) auf. Die 3. Patientin benötigte intermittierend eine Schmerztherapie WHO III zuzüglich Gabapentin und konnte erst nach 5 Monaten als beschwerdefrei gewertet werden.

Wir schließen daraus, dass Vitamin C einen positiven therapeutischen Einfluss auf den neuropathischen Schmerz aufweist. Randomisierte klinische Studien wären notwendig, um den Einfluss von Vitamin C auf die PZN zu evaluieren.

Abstract

The effectiveness of vitamin C in the influence of immunogenic illnesses has been proven with high evidence for parenteral application.

In our case study, three patients with post herpetic neuralgia (PHN) were observed: two received the basic pain and virostatic therapy and every second day 15 grams of vitamin C intravenously; the third patient merely was treated viro-statically and pain-therapeutically in accordance with WHO-step-scheme. With the patients treated with vitamin C, a total remission of the PHN (it measured on the basis of the visual analogous-scale) could be observed beside the remission of the cutaneous efflorescences within 10 days. The third patient, who required a pain-therapy WHO III intermittently plus Gabapentin, could be assessed as complaint-free status only after 5 months.

We infer that vitamin C shows a positive therapeutic influence on the neuropathic pain. Randomized clinical trials are necessary to evaluate in what way vitamin C has a therapeutic influence of the PHN.

Schlüsselwörter

Post-Zoster-Neuralgie - Immundefizienz - Antioxidanzien - Vitamin C

Keywords

Postherpetic neuralgia - immunodeficiency - antioxidative system - ascorbic acid/vitamin C

Literatur

• 01 Baron R. Post-herpetic neuralgia case study: optimizing pain control.  Eur J Neurol. 2004;  11 (S 1) 3-11
• 02 Dalziel R G, Bingham S, Sutton D. et al. . Allodynia in rats infected with varicella zoster virus – a small animal model for post-herpetic neuralgia.  Brain Res Brain Res Rev. 2004;  46 (2) 234-242
• 03 Sandholzer H. Postherpetische Neuralgie – eine Crux medicorum.  Notfall & Hausarztmedizin (Notfallmedizin). 2005;  3 A 437
• 04 Czernichow S, Dupuy A, Flahault A, Chosidow O. Herpes Zoster. incidence study among „sentinel” general practitioners.  Ann Dermatol Venereol. 2001;  128 (4) 497-501
• 05 Yawn B P, Saddier P, Wollan P C, St Sauver J L, Kurland M J, Sy L S. A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction.  Mayo Clin Proc. 2007;  82 (11) 1341-1139
• 06 Paul E, Thiel T. Zur Epidemiologie der Varizella Zoster Infektion. Ergebnisse einer prospektiven Erhebung im Landkreis Ansbach.  Der Hautarzt. 1996;  47 (8) 604-609
• 07 Wutzler P, Meister W. Herpes Zoster-Symptomatologie, demographische Daten und prognostische Faktoren: Ergebnisse einer prospektiven Studie an ambulanten Zosterpatienten in Deutschland.  Dt Ärztebl. 1997;  94 (17) A-1129/B-963/C-903
• 08 Herr H. Prognostic factors of postherpetic neuralgia.  J Korean Med Sci. 2002;  17 (5) 655-659
• 09 Schmader K E. Epidemiology and impact on quality of life of postherpetic neuralgia and painful diabetic neuropathy.  Clin J Pain. 2002;  18 (6) 350-354
• 10 Hempenstall K, Nurmikko T J, Johnson R W, A`Hern R P, Rice A S. Analgesic therapy in postherpetic neuralgia: a quantitative systematic review.  PLoS Med. 2005;  2 (7) e164
• 11 Saarto T, Wiffen P. Antidepressants for neuropathic pain.  Cochrane Database Syst Rev. 2007;  17 (4) CD 005454
• 12 Zakrzewska J M. Insufficient evidence to recommend topical lidocaine as first-line treatment for postherpetic neuralgia.  Evid Based Dent. 2007;  8 (3) 85-86
• 13 Gross G, Schöfer H, Wassilew S. et al. . Herpes zoster guidelines of the German Dermatology Society (DDG).  J Clin Virol. 2003;  26 (3) 277-289
• 14 Cunningham A L, Dworkin R H. The management of post-herpetic neuralgia.  BMJ. 2000;  321 778-779
• 15 Nishikimi M, Koshizaka T, Ozawa T, Yagi K. Occurrence in humans and guinea pigs of the gene related to their missing enzyme L-gulono-gamma-lactone oxidase.  Arch Biochem Biophys. 1988;  267 (2) 842-846
• 16 Padayatty S J, Sun H, Wang Y. et al. . Vitamin C pharmakokinetics: implications for oral and intravenous use.  Ann Int Med. 2004;  140 533-537
• 17 Davison G, Gleeson M. Influence of acute vitamin C and/or carbohydrate ingestion on hormonal, cytokine and immune responses to prolonged exercises.  Int J Sport Nutr Exerc Metab. 2005;  15 (5) 465-479
• 18 Hemila H. Vitamin C and common cold incidence: a review of studies with subjects under heavy physical stress.  Int J Sports Med. 1996;  17 (5) 379-383
• 19 Kim H K, Park S K, Zhou J L. et al. . Reactive oxygen species (ROS) play an important role in a rat model of neuropathic pain.  Pain. 2004;  111 (1–2) 116-124
• 20 Schäfers M, Sommer C. Anticytokine therapy in neuropathic pain management.  Expert Rev Neurother. 2007;  7 (11) 1613-1627
• 21 Kotani N, Kudo R, Sakurai Y. et al. . Cerebrospinal fluid interleukin 8 concentrations and the subsequent development of postherpetic neuralgia.  Am J Med. 2004;  116 (5) 318-324
• 22 Desloges M, Schubert C, Wolff M H, Rahaus M. Varicella-zoster virus infection induces the secretion of interleukin-8.  Med Microbiol Immunol. 2007; 
• 23 El-Taukhy M A, Salama S M, Abou-Shousha S A, Ismail S S, Saleh M. Effects of chronic ethanol and vitamin C administration on production of tumor necrosis factor-alpha and interleukin-6 in rats.  Egypt J Immunol. 2006;  13 (1) 1-10
• 24 Vlahopoulos S, Boldogh I, Casola A, Brasier A R. Nuclear factor-kappaB-dependent induction of interleukin-8 gene expression by tumor necrosis factor alpha: evidence for an antioxidant sensitive activating pathway distinct from nuclear translocation.  Blood. 1999;  94 (6) 1878-1889
• 25 Eguchi M, Miyazaki T, Masatsuji-Kato E, Tsuzuki T, Oribe T, Miwa N. Cytoprotection against ischemia-induced DNA cleavages and cell injuries in the rat liver by pro-vitamin C via hydrolytic conversion into ascorbate.  Mol Cell Biochem. 2003;  252 (1–2) 17-23
• 26 Rivas C I, Vera J C, Guaiquil V H. et al. . Increased uptake and accumulation of vitamin C in human immunodeficiency virus 1-infected hematopoietic cell lines.  J Biol Chem. 1997;  272 (9) 5814-5820
• 27 Chen Q, Espey M G, Krishna M C. et al. . Pharmacologic ascorbic acid concentrations selectively kill cancer cells: Action as a prodrug to deliver hydrogen peroxide to tissues.  PNAS. 2005;  102 (38) 13604-13609
• 28 Hanck A, Weiser H. Analgesic and anti-inflammatory properties of vitamins.  Int J Vitam Nutr Res Suppl. 1985;  27 189-206
• 29 Yang Z, Copolov D L, Lim A T. Ascorbic acid augments the andenyl cyclase-cAMP system mediated POMC mRNA expression and β-endorphin secretion from hypothalamic neurons in culture.  Brain Res. 1996;  706 243-248
• 30 Wu C M, Lin M W, Cheng J T. et al . Regulated, electroporation-mediated delivery of pro-opiomelanocortin gene suppresses chronic constriction injury-induced neuropathic pain in rats.  Gene Ther. 2004;  11 933-940
• 31 Zureick M. Therapy of herpes and herpes zoster with intravenous vitamin C.  J Prat Rev Gen Clin Ther. 1950;  64 (48) 586
• 32 Chen J Y, Chu C C, So E C, Hsing C H, Hu M L. Treatment of postherpetic neuralgia with intravenous administration of vitamin C.  Anaest Analg. 2006;  103 (6) 1616-1617

Korrespondenzadresse