Intrathecal Methylprednisolone for Postherpetic Neuralgia

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Abstract
Kotani and colleagues (Nov. 23 issue)1 recommend intrathecal methylprednisolone acetate for treatment of intractable postherpetic neuralgia due to persistent inflammation. But the abnormalities in the cerebrospinal fluid and on magnetic resonance imaging in patients with acute herpes zoster are not persistent. The neuropathological reference that Kotani et al. cite2 does not demonstrate polymorphonuclear leukocytes or “marked inflammation around the spinal cord, with massive infiltration and accumulation of lymphocytes.” The usual association between neutrophil inflammation and interleukin-8 calls into question reliance on the level of interleukin-8 in acellular cerebrospinal fluid.3 The authors' hypothesis that “postherpetic neuralgia provokes an intense inflammatory reaction in the spinal cord” is inverted.