Effect of Adenosine Triphosphate (ATP) Infusion on Neuropathic Pain in a Patient with Ramsay Hunt Syndrome

Abstract

  We report a patient with Ramsay Hunt syndrome in whom the infusion of adenosine triphosphate (ATP) significantly alleviated neuropathic pain developing as a result of herpes zoster in the trigeminal nerve region.

  The patient was a 74-year-old man who complained of severe pain in the third branch region of the left trigeminal nerve and auricle at the time of his first visit and who exhibited edematous erythema and blisters. Since peripheral facial nerve paralysis appeared 6 days after the initial diagnosis, the administration of a stellate ganglion block (SGB), near-infrared therapy, prednisolone (30 mg/day, gradually decreasing), and mecobalamin (1.5 mg/day) was initiated. Two weeks later, neuropathic pain appeared, so pregabalin (50 mg/day, gradually increasing to 450 mg/day) and amitriptyline (10 mg/day, gradually increasing to 60 mg/day) were additionally administered. After repeated SGB and near-infrared therapy, the facial nerve paralysis nearly disappeared, but the improvement in the neuropathic pain was insufficient.

  Therefore, the intravenous administration of magnesium sulfate hydrate and lidocaine hydrochloride was performed. Since the pain relief was temporary, ATP infusion (100 μg/kg/min) was subsequently performed. The ATP infusion resulted in continuous pain relief ; thereafter, a total of 4 ATP infusions were performed. The pain gradually decreased and ultimately disappeared completely.