Information on Postherpetic Neuralgia Balance Problems

Exposure to chickenpox, a contagious disease caused by the varicella-zoster virus, increases the likelihood of developing painful blisters called shingles later in life. Long-term complications such as a persistent skin rash, encephalitis, lingering pain, vision problems, or loss of balance due to postherpetic neuralgia can occur after an outbreak of shingles. Symptoms of postherpetic neuralgia include neurological problems that interfere with brain functions such as loss of balance.

Causes

• According to "Prevention of Herpes Zoster Recommendations of the Advisory Committee on Immunization Practices" a report by Rafael Harpaz, MD, written at the request of the Centers for Disease Control and Prevention in 2008, the varicella-zoster virus remains in nerve cells for a lifetime. Most people who had chickenpox never know they still carry the virus because they have no symptoms. However, compromised immune systems caused by age, chemotherapy or diseases such as HIV reactivate the virus in one million Americans annually. When the varicella-zoster virus reactivates in adults it spreads along nerve fibers resulting in shingles, which causes pain accompanied by a rash. After the rash clears up the virus continues to damage nerve cells, which send scrambled messages that affect the brain's ability to regulate balance.

Symptoms

• Loss of balance following a rash with pain may indicate signs of postherpetic neuralgia, however, a physician must rule out other medical and psychological causes. To determine the cause of loss of balance a physician such as a dermatologist or internist performs a test on the patient's skin cells. The physician diagnoses postherpetic neuralgia if the test proves positive for shingles.

Treatment

• The likelihood of balance problems caused by postherpetic neuralgia decreases if a patient receives antiviral drugs including acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir), as soon as possible after a shingles outbreak. Over-the-counter pills to lessen pain and creams and ointments to dry blisters do not prevent postherpetic neuralgia. If postherpetic neuralgia still occurs after treatment with antiviral drugs, a physical therapist works with the patient to regain normal balance.

Prevention

• No vaccine prevents postherpetic neuralgia balance problems, however, immunization against shingles and chickenpox eliminate the causes of postherpetic neuralgia. The Centers for Disease Control and Prevention recommend that children and adults who have not contracted chickenpox receive two doses of varicella vaccine. It also recommends that adults over the age of 60 who have had chickenpox as a child receive the herpes zoster vaccine. National Institute of Neurological Disorders and Health cautions that while postherpetic neuralgia is not life threatening it can lead to serious depression and disability.

Pregnant Women

• The Centers for Disease Control and Prevention urges pregnant women and women who intend to become pregnant to consult with their doctor regarding potential birth defects from chickenpox.