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Abstract
OBJECTIVE In this review the authors discuss evidence from the literature concerning vitamin D and temporal bone diseases (benign paroxysmal positional vertigo [BPPV], Menière's disease [MD], vestibular neuritis, idiopathic facial paralysis, idiopathic acute hearing loss). Common features shared by Menière's disease, glaucoma, and the possible influence by vitamin D are briefly discussed. DATA SOURCES, STUDY SELECTION Publications from 1970 until recent times have been reviewed according to a keyword search (see above) in PubMed. CONCLUSIONS MD, BPPV, vestibular neuritis, idiopathic facial paralysis, idiopathic acute hearing loss may all have several etiological factors, but a common feature of the current theories is that an initial viral infection and a subsequent autoimmune/autoinflammatory reaction might be involved. Additionally, in some of these entities varying degrees of demyelination have been documented. Given the immunomodulatory effect of vitamin D, we postulate that it may play a role in suppressing an eventual postviral autoimmune reaction. This beneficial effect may be enhanced by the antioxidative activity of vitamin D and its potential in stabilizing endothelial cells. The association of vitamin D deficiency with demyelination has already been established in other entities such as multiple sclerosis and experimental autoimmune encephalitis. Mice without vitamin D receptor show degenerative features in inner ear ganglia, hair cells, as well as otoconia. The authors suggest further studies concerning the role of vitamin D deficiency in diseases of the temporal bone. Additionally, the possible presence and degree of demyelination in these entities will have to be elucidated more systematically in the future.
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Shang P, Zhu M, Wang Y, Zheng X, Wu X, Zhu J, Feng J, Zhang HL. Axonal variants of Guillain-Barré syndrome: an update. J Neurol 2020; 268:2402-2419. [PMID: 32140865 DOI: 10.1007/s00415-020-09742-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 12/11/2022]
Abstract
Axonal variants of Guillain-Barré syndrome (GBS) mainly include acute motor axonal neuropathy, acute motor and sensory axonal neuropathy, and pharyngeal-cervical-brachial weakness. Molecular mimicry of human gangliosides by a pathogen's lipooligosaccharides is a well-established mechanism for Campylobacter jejuni-associated GBS. New triggers of the axonal variants of GBS (axonal GBS), such as Zika virus, hepatitis viruses, intravenous administration of ganglioside, vaccination, and surgery, are being identified. However, the pathogenetic mechanisms of axonal GBS related to antecedent bacterial or viral infections other than Campylobacter jejuni remain unknown. Currently, autoantibody classification and serial electrophysiology are cardinal approaches to differentiate axonal GBS from the prototype of GBS, acute inflammatory demyelinating polyneuropathy. Newly developed technologies, including metabolite analysis, peripheral nerve ultrasound, and feature selection via artificial intelligence are facilitating more accurate diagnosis of axonal GBS. Nevertheless, some key issues, such as genetic susceptibilities, remain unanswered and moreover, current therapies bear limitations. Although several therapies have shown considerable benefits to experimental animals, randomized controlled trials are still needed to validate their efficacy.
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Affiliation(s)
- Pei Shang
- Department of Neurology, First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China
| | - Mingqin Zhu
- Department of Neurology, First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China
| | - Ying Wang
- Department of Neurology, First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China
| | - Xiangyu Zheng
- Department of Neurology, First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China
| | - Xiujuan Wu
- Department of Neurology, First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China
| | - Jie Zhu
- Department of Neurology, First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Jiachun Feng
- Department of Neurology, First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China.
| | - Hong-Liang Zhang
- Department of Life Sciences, National Natural Science Foundation of China, Shuangqing Road 83#, Beijing, 100085, China.
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Lee SY, Lim JS, Oh DJ, Park B, Park IS, Choi HG. The association between Bell's palsy and rheumatoid arthritis: A longitudinal study. Medicine (Baltimore) 2020; 99:e19568. [PMID: 32195966 PMCID: PMC7220118 DOI: 10.1097/md.0000000000019568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
This study aimed to evaluate the relationship between Bell's palsy and rheumatoid arthritis in a national sample cohort from Korea.Data were collected for individuals ≥20 years old from 2002 to 2013 in the Korean National Health Insurance Service-National Sample Cohort. We extracted data for patients with rheumatoid arthritis (n = 7628) and 1:4-matched controls (n = 30,512) and analyzed the occurrence of Bell's palsy in both groups. Matching was performed based on age, sex, income, and region of residence. Rheumatoid arthritis was diagnosed according to International Classification of Disease-10 (ICD-10) codes (M05-M06) and the prescription of biological agents and/or disease-modifying antirheumatic drugs. Bell's palsy patients were diagnosed according to ICD-10 code H912 and treatment ≥2 times with steroids. Adjusted hazard ratios (HRs) were calculated using stratified Cox proportional hazard models for the Charlson comorbidity index and 95% confidence intervals (CIs). Subgroup analyses based on age and sex were also performed.The rates of Bell's palsy were similar between the rheumatoid arthritis group (0.5% [38/7628]) and the control group, with no significant difference (0.4% [124/30,512], P = .270). The adjusted HR for Bell's palsy was 1.12 (95% CI, 0.78-1.62) in the rheumatoid arthritis group (P = .540). In the subgroup analyses according to age and sex, the relationship between Bell's palsy and rheumatoid arthritis did not reach statistical significance.The risk of Bell's palsy was not increased in patients with rheumatoid arthritis.
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Affiliation(s)
- Sang-Yeon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Jae-Sung Lim
- Department of Neurology, Hallym University College of Medicine, Anyang
| | - Dong Jun Oh
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Bumjung Park
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang
| | - Il-Seok Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Dongtan, South Korea
| | - Hyo Geun Choi
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang
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Ordoñez G, Rivas V, Santos M, Mondragon M, Pineda B, Rodríguez K, Corona T, Flores J, Sotelo J. Herpes viruses in optic neuritis: Similar to Bell’s palsy. Clin Neurol Neurosurg 2020; 188:105588. [DOI: 10.1016/j.clineuro.2019.105588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 11/03/2019] [Indexed: 11/27/2022]
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Measurement of the depth of facial nerve at the level of stylomastoid foramen using MR imaging in Bell's palsy. Clin Imaging 2019; 58:34-38. [DOI: 10.1016/j.clinimag.2019.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 05/25/2019] [Accepted: 06/13/2019] [Indexed: 11/22/2022]
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Is C-reactive protein to albumin ratio an indicator of poor prognosis in Bell's palsy? Eur Arch Otorhinolaryngol 2019; 277:115-119. [PMID: 31620889 DOI: 10.1007/s00405-019-05691-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 10/08/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this study was to determine whether the C-reactive protein to albumin ratio was associated with the prognosis in patients with Bell's palsy. METHODS Reviewing records of 79 patients diagnosed with Bell's palsy, 3 groups were constituted: recovered group (with a House Brackman grade of 1 or 2 after treatment, 56 patients), unrecovered group (23 patients) and control group (60 healthy individuals). Age, hemoglobin, C-reactive protein to albumin ratio, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, white blood cell and hemoglobin values were compared among the groups. RESULTS Age, hemoglobin and platelet to lymphocyte ratio were not significantly different between the groups (p = 0.12, p = 0.31, p = 0.86 and p = 0.87, respectively). Median C-reactive protein to albumin ratio, neutrophil to lymphocyte ratio and white blood cell were significantly greater both in non-recovery group (p < 0.001) and recovery group (p = 0.001 and p < 0.001, respectively) compared to the control group. Additionally, median C-reactive protein to albumin ratio and neutrophil to lymphocyte ratio were significantly greater in the non-recovery group, compared to the recovery group (p = 0.002, and p < 0.001, respectively). However, median white blood cell did not significantly differ between the non-recovery and the recovery groups (p = 0.89). CONCLUSION Higher C-reactive protein to albumin ratio and neutrophil to lymphocyte ratio were associated with poor prognosis in patients with Bell's palsy. C-reactive protein to albumin ratio might be the most significant indicator of poor prognosis in patients with Bell's palsy.
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Association of Patients' Characteristics with Acupuncture Treatment Outcomes in Treating Bell's Palsy: Results from a Randomised Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:6073484. [PMID: 31511780 PMCID: PMC6714330 DOI: 10.1155/2019/6073484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/22/2019] [Accepted: 07/29/2019] [Indexed: 11/17/2022]
Abstract
Background Acupuncture has been found to be effective for treating Bell's palsy (BP). However, which class of BP patients will have a better response to acupuncture remains uncertain and requires investigation. Methods We performed a secondary analysis of a multicenter, randomized, controlled trial. BP patients were randomly divided into five acupuncture treatment groups. The degree of facial nerve recovery was assessed according to the House–Brackmann grading system (HB grade). Grade I was defined as complete recovery (CR), and grades II–VI were defined as incomplete recovery (IR). The relevant patient characteristics were collected and compared between CR and IR groups by univariate and logistic regression analyses. Results Eight-hundred twenty-six subjects were analyzed. Among these, 698 (85%) subjects had a good prognosis. No significant difference in the effectiveness of the five treatments was observed (all P > 0.05). The likelihood of IR increased by 2.2% with each one-year increase in age (odds ratio (OR) 1.022, 95% confidence interval (CI) 1.005–1.038; P=0.009). The likelihood of IR increased by 9% with each kg/m2 increase in BMI (OR 1.090, 95% CI 1.019–1.165; P=0.012). The likelihood of IR at the recovery stage was higher than that at the acute stage (OR 7.996, 95% CI 4.570–13.991; P < 0.001), and the likelihood of IR of patients with lesions at or above the chorda tympani was higher than that of patients with lesions below the chorda tympani (OR 1.989, 95% CI 1.256–3.150; P=0.003). The likelihood of IR increased by 281.7% with each unit increase in the HB grade (OR 2.817, 95% CI 2.113–3.756; P < 0.001). Conclusions Younger patients at the acute stage of the disease with low BMIs, low initial HB grades, and lesions below the chorda tympani were more likely to respond to acupuncture.
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Lee SY, Seong J, Kim YH. Clinical Implication of Facial Nerve Decompression in Complete Bell's Palsy: A Systematic Review and Meta-Analysis. Clin Exp Otorhinolaryngol 2019; 12:348-359. [PMID: 31487771 PMCID: PMC6787481 DOI: 10.21053/ceo.2019.00535] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/15/2019] [Indexed: 11/22/2022] Open
Abstract
We compared the therapeutic efficacy of facial nerve decompression (FND) and conservative treatment in patients with Bell’s palsy through a systematic review and meta-analysis. Primary database search was performed in PubMed, Medline, and Embase. After screening, 13 studies were assessed for their eligibility. Among them, seven studies employing either the House-Brackmann grading system (HBGS) or May’s classification (modified HBGS) were selected for quantitative and qualitative analysis. Based on May’s classification, the degree of recovery was classified into complete (HBGS I), fair (HBGS II–III), or failed (HBGS IV–VI) recovery. The outcomes were assessed between 6 and 12 months after surgery. The estimated pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using random effects model. Cohorts were comprised of patients who underwent FND (n=202, 53.0%) and conservative treatments (n=179, 47.0%). In pooled analysis, the rate of complete recovery was significantly higher in the FND group than in the control group (OR, 2.06; 95% CI, 1.22 to 3.48; P=0.007) showing neither heterogeneity nor publication bias. Meanwhile, the rates of fair recovery (OR, 0.71; 95% CI, 0.42 to 1.21; P=0.208) and failed recovery (OR, 0.60; 95% CI, 0.22 to 1.67; P=0.327) in the FND group were similar to that in the control group. In subgroup analyses, there was no significant difference in the OR according to the operation timing and surgical approach. FND can be a possible treatment option for patients with complete Bell’s palsy, especially for complete recovery, which provide insights on decision-making and outcome prediction. However, FND should be determined carefully given the risk of small study effects and possible complications.
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Affiliation(s)
- Sang-Yeon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeon Seong
- Department of Otorhinolaryngology-Head and Neck Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Young Ho Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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Evaluation of serum ischaemia-modified albumin levels in patients with Bell's palsy. The Journal of Laryngology & Otology 2019; 133:810-813. [PMID: 31434591 DOI: 10.1017/s0022215119001683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This prospective study aimed to evaluate the relationship between serum ischaemia-modified albumin levels and Bell's palsy severity. METHODS The study included 30 patients diagnosed with Bell's palsy and 30 healthy individuals. The patients were separated into three disease severity groups (grades 2, 3 and 4) according to House-Brackmann classification. Blood samples were collected from all participants and the results compared between groups. RESULTS Significant differences in serum ischaemia-modified albumin were found between the study and control groups (p < 0.001); values were significantly higher in the study group than in the control group. CONCLUSION The significantly higher levels of serum ischaemia-modified albumin in the study group suggest that Bell's palsy pathogenesis is associated with oxidative stress.
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Infectious causes of peripheral facial nerve palsy in children-a retrospective cohort study with long-term follow-up. Eur J Clin Microbiol Infect Dis 2019; 38:2177-2184. [PMID: 31372902 DOI: 10.1007/s10096-019-03660-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 07/23/2019] [Indexed: 12/24/2022]
Abstract
The aim of this study was to analyze the clinical and laboratory characteristics of children with peripheral facial nerve palsy (pFP) with a focus on identifying infectious etiology and long-term outcome. We conducted an ICD-10-based retrospective chart review on children hospitalized with pFP between January 1, 2006, and December 31, 2016. Furthermore, a telephone-based follow-up survey was performed. A total of 158 patients were identified, with a median age of 10.9 years (interquartile range 6.4-13.7). An infectious disease was associated with pFP in 82 patients (51.9%); 73 cases were classified as idiopathic pFP (46.2%). Three cases occurred postoperatively or due to a peripheral tumor. Among the infectious diseases, we identified 33 cases of neuroborreliosis and 12 viral infections of the central nervous system (CNS), caused by the varicella-zoster virus, human herpesvirus 6, herpes simplex virus, enterovirus, and Epstein-Barr virus. Other infections were mainly respiratory tract infections (RTIs; 37 cases). Children with an associated CNS infection had more often headache and nuchal rigidity, a higher cerebrospinal fluid cell count, and a longer length of hospital stay. Long-term follow-up revealed an associated lower risk of relapse in CNS infection-associated pFP. Among all groups, permanent sequelae were associated with female sex, a shorter length of hospitalization, and a lower white blood cell count at presentation. pFP is frequently caused by an CNS infection or is associated with concurrent RTIs, with a potential impact on the short- and long-term clinical course.
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Zimmermann J, Jesse S, Kassubek J, Pinkhardt E, Ludolph AC. Differential diagnosis of peripheral facial nerve palsy: a retrospective clinical, MRI and CSF-based study. J Neurol 2019; 266:2488-2494. [DOI: 10.1007/s00415-019-09387-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/13/2019] [Accepted: 05/16/2019] [Indexed: 10/26/2022]
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Zhang W, Xu L, Luo T, Zhao B, Wu F, Li X. Immune-related gene expression profiles of hypothermia adipocytes: Implications for Bell's palsy. Oral Dis 2019; 25:1652-1663. [PMID: 31127963 DOI: 10.1111/odi.13126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 05/03/2019] [Accepted: 05/14/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To identify immune-related gene expression profiles of adipocytes under low temperatures with RNA sequencing as a model for Bell's palsy implications. METHODS Adipocytes were harvested from the white adipose tissue of male Sprague-Dawley rats and cultured under different acute-grade cold exposure conditions of 30, 20, and 10°C, and their genomes were sequenced for RNA sequencing analysis. The differentially expressed genes (DEGs) were validated with reverse transcription polymerase chain reaction. RESULTS In total, 55 (35 upregulated and 20 downregulated), 121 (76 upregulated and 45 downregulated), and 92 (64 upregulated and 28 downregulated) DEGs were identified under 30, 20, and 10°C compared with the control, respectively. KEGG and GO analysis revealed that the DEGs were considerably enriched in immune-related pathways (leukocyte transendothelial migration and platelet activation) and infection (bacterial invasion of epithelial cells and Salmonella infection). The levels of key inflammatory chemokines (CSF1, CXCL1, CCL2, and CCL7) were enhanced after cold exposure. CONCLUSION These findings broaden our understanding of the immune responses to cold exposure in adipocytes. The molecular profiles of adipocyte immune function will help clarify the potential mechanism impacting myelin, which might contribute to the development of strategies to control Bell's palsy.
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Affiliation(s)
- Wenjuan Zhang
- School and Hospital of Stomatology, Shanxi Medical University, Taiyuan, China
| | - Lei Xu
- School and Hospital of Stomatology, Shanxi Medical University, Taiyuan, China
| | - Tingting Luo
- School and Hospital of Stomatology, Shanxi Medical University, Taiyuan, China.,The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory for Oral Biomedical Engineering of Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Bin Zhao
- School and Hospital of Stomatology, Shanxi Medical University, Taiyuan, China
| | - Feng Wu
- School and Hospital of Stomatology, Shanxi Medical University, Taiyuan, China
| | - Xianqi Li
- School and Hospital of Stomatology, Shanxi Medical University, Taiyuan, China.,Department of Oral and Maxillofacial Surgery, Matsumoto Dental University, Shiojiri, Japan
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Abstract
Bell’s palsy is the most common condition involving a rapid and unilateral onset of peripheral paresis/paralysis of the seventh cranial nerve. It affects 11.5–53.3 per 100,000 individuals a year across different populations. Bell’s palsy is a health issue causing concern and has an extremely negative effect on both patients and their families. Therefore, diagnosis and prompt cause determination are key for early treatment. However, the etiology of Bell’s palsy is unclear, and this affects its treatment. Thus, it is critical to determine the causes of Bell’s palsy so that targeted treatment approaches can be developed and employed. This article reviews the literature on the diagnosis of Bell’s palsy and examines possible etiologies of the disorder. It also suggests that the diagnosis of idiopathic facial palsy is based on exclusion and is most often made based on five factors including anatomical structure, viral infection, ischemia, inflammation, and cold stimulation responsivity.
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Zhang H, Du H, Qian M, Wang Y, Zhou S, Chen J, Wan H, Yang J. A study of affecting the recovery of Chinese patients with Bell palsy. Medicine (Baltimore) 2019; 98:e14244. [PMID: 30681613 PMCID: PMC6358322 DOI: 10.1097/md.0000000000014244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/30/2022] Open
Abstract
We explored the risk factors for preventing recovery of Bell palsy (BP) in Chinese inpatients. Five hundred thirteen patients were included. The two end-points of assessment were the discharge and final follow-up results. Relationship between discharge and baseline: long patients delay (unhealed 4.03 ± 1.16 d vs improved 2.24 ± 1.0 d, P < .001), combined diseases (yes 77.06% vs no 86.71%, P = .01), and early use of acupuncture (yes 47.46% vs no 97.62%, P < .001) were bad factors. Therapeutic factors and discharge: only use of steroids was a positive factor (yes 92.54% vs no 57.30%, P < .001). Binary logistic regression found that early use of steroids was a favorable factor (P = .001), while early use of acupuncture (P < .001) and long patient delay (P < .001) were adverse factors. Subgroups analysis showed early use of steroids plus antivirals (steroids + antivirals vs antivirals + mecobalamin, P < .001) and early use of steroids plus mecobalamin were good choices (steroids + antivirals vs steroids + mecobalamin, P = .745), while early use of antivirals plus mecobalamin was a bad choice (vs other 2 groups, P < .001). Effect of drug dose and treatment course on discharge: long time use of steroids didn't mean good efficacy (unhealed 10.80 ± 1.53 d vs improved 10.38 ± 1.21 d, P = .026). Final follow-up results: improved patients were better than that of unhealed at discharge (P < .001). Risk factors of discharge included long patient delay, combined diseases, and early use of acupuncture. Steroids plus antivirals or steroids plus mecobalamin were good choices for treatment. Long time use of steroids didn't mean good effect. Improved patients at discharge had better results finally.
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Affiliation(s)
- Hongbo Zhang
- Institute of Cardio-Cerebrovascular Diseases, Zhejiang Chinese Medical University, Hangzhou
| | - Haixia Du
- Institute of Cardio-Cerebrovascular Diseases, Zhejiang Chinese Medical University, Hangzhou
| | - Mingjing Qian
- Department of Neurology, the First People's Hospital of Huzhou
| | - Yu Wang
- Institute of Cardio-Cerebrovascular Diseases, Zhejiang Chinese Medical University, Hangzhou
| | - Shenghua Zhou
- Department of Neurology, the Third People's Hospital of Huzhou, Zhejiang Province, Huzhou
| | - Jing Chen
- Department of Neurology, the Third People's Hospital of Huzhou, Zhejiang Province, Huzhou
| | - Haitong Wan
- Institute of Cardio-Cerebrovascular Diseases, Zhejiang Chinese Medical University, Hangzhou
| | - Jiehong Yang
- College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, China
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65
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Kim S, Lee HY, Kim NK, Yook TH, Seo ES, Kim JU. The association between paralytic side and health-related quality of life in facial palsy: a cross-sectional study of the Korea National Health and Nutrition Examination Survey (2008-2012). Health Qual Life Outcomes 2018; 16:213. [PMID: 30453961 PMCID: PMC6245704 DOI: 10.1186/s12955-018-1038-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 10/29/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Facial palsy is known to have correlations with low level of quality of life. However, little is known about the association between preference based health-related quality of life (HRQoL) and paralytic side of facial palsy. METHODS This study used Korea National Health and Nutrition Examination Survey (KNHANES, 2008-2012) data, only when the facial palsy examination had been included in the survey contents. Hierarchical regression analyses were used to obtain optimal regression coefficients in the association between paralytic side of the facial palsy and HRQoL measured by EuroQoL-5 Dimension (EQ-5D). We also analyzed the association between the deteriorated domains of EQ-5D and facial palsy in both subgroups by using multiple logistic regression models. RESULTS We included the data of 28,106 participants aged ≥19 years who were examined as facial palsy according to House-Brackmann score and completed EQ-5D questionnaire in KNHANES 2008-2012. The mean EQ-5D score was significantly low and percentages of deteriorated numbers in its domains were significantly high in facial palsy group. CONCLUSIONS These results show that, after adjusting for confounding variables, left facial palsy is associated with impaired HRQoL compared with right-sided palsy. Among the domains of EQ-5D, only 'self-care' domain was directly affected by the disease in left facial palsy patients. These findings could be used in developing model and conducting analyses of economic evaluation about facial palsy interventions.
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Affiliation(s)
- Sina Kim
- Center for Comparative Effectiveness Research & Economic Evaluation in Korean Medicine, Pusan National University, Yangsan, Gyeongnam South Korea
| | - Hye-Yoon Lee
- National Clinical Research Center for Korean Medicine, Pusan National University Korean Medicine Hospital, Yangsan, South Korea
| | - Nam-Kwen Kim
- Center for Comparative Effectiveness Research & Economic Evaluation in Korean Medicine, Pusan National University, Yangsan, Gyeongnam South Korea
- Department of Korean Medicine, Pusan National University, Yangsan, Gyeongnam South Korea
| | - Tae Han Yook
- Department of Acupuncture & Moxibustion Medicine, Korean Medicine Hospital of Woosuk University, Jeonju, South Korea
| | - Eun-Sung Seo
- Department of Food and Nutrition, Seoul National University, Seoul, South Korea
| | - Jong Uk Kim
- Department of Acupuncture & Moxibustion Medicine, Korean Medicine Hospital of Woosuk University, Jeonju, South Korea
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Amin MR, Achlatis S, Gherson S, Fang Y, Wang B, Born H, Branski RC, Johnson AM. The Role of Oral Steroids in the Treatment of Phonotraumatic Vocal Fold Lesions in Women. Otolaryngol Head Neck Surg 2018; 160:512-518. [PMID: 30322353 DOI: 10.1177/0194599818804776] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES (1) To determine the short-term effectiveness of oral steroids in women with benign vocal fold lesions and (2) to determine the effectiveness of adjuvant oral steroids in women undergoing voice therapy for benign vocal fold lesions. STUDY DESIGN Randomized, double-blind, placebo-controlled clinical trial. SETTING Tertiary voice care center. SUBJECTS AND METHODS Thirty-six patients undergoing voice therapy for the treatment of phonotraumatic vocal fold lesions randomly received either a 4-day course of oral steroids or a placebo prior to initiating voice therapy. Voice Handicap Index-10 (VHI-10) scores, video and audioperceptual analyses, acoustic and aerodynamic analyses at baseline, and patient perception of improvement after a short course of steroids or a placebo and at the conclusion of voice therapy were collected. RESULTS Thirty patients completed the study, of whom 27 (only female) were analyzed. The primary outcome measure, VHI-10, did not improve after the 4-day course of steroids or placebo. Secondary measures similarly showed no improvement with steroids relative to placebo. Voice therapy demonstrated a positive effect on both VHI-10 and patient-perceived improvement of voice in all subjects. CONCLUSION A short course of oral steroids did not benefit women with phonotraumatic vocal fold lesions. In addition, steroids had little beneficial effect when used adjunctively with voice therapy in this patient cohort.
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Affiliation(s)
- Milan R Amin
- 1 NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
| | - Stratos Achlatis
- 1 NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
| | - Shirley Gherson
- 1 NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, USA.,2 Rusk Institute of Rehabilitation, New York University School of Medicine, New York, New York, USA
| | - Yixin Fang
- 3 Department of Mathematical Sciences, New Jersey Institute of Technology, Newark, New Jersey, USA.,4 Department of Population Heath, Division of Biostatistics, New York University School of Medicine, New York, New York, USA
| | - Binhuan Wang
- 4 Department of Population Heath, Division of Biostatistics, New York University School of Medicine, New York, New York, USA
| | - Hayley Born
- 5 Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Ryan C Branski
- 1 NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
| | - Aaron M Johnson
- 1 NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
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Dizdar D, Avınçsal MÖ, Kurt Dizdar S. Investigation Of The Prognostic Value Of The Neutrophil/Lymphocyte Ratio In Bell Palsy. ENT UPDATES 2018. [DOI: 10.32448/entupdates.459024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Calik M, Ethemoglu O. "Childhood peripheral facial palsy". Childs Nerv Syst 2018; 34:1441-1442. [PMID: 29948133 DOI: 10.1007/s00381-018-3849-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 05/21/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Mustafa Calik
- Department of Pediatric Neurology, Harran University School of Medicine, 63200, Sanliurfa, Turkey.
| | - Ozlem Ethemoglu
- Department of Neurology, Harran University School of Medicine, Sanliurfa, Turkey
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Thielker J, Geißler K, Granitzka T, Klingner CM, Volk GF, Guntinas-Lichius O. Acute Management of Bell’s Palsy. CURRENT OTORHINOLARYNGOLOGY REPORTS 2018. [DOI: 10.1007/s40136-018-0198-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Greco A, De Virgilio A, Ralli M, Ciofalo A, Mancini P, Attanasio G, de Vincentiis M, Lambiase A. Behçet's disease: New insights into pathophysiology, clinical features and treatment options. Autoimmun Rev 2018; 17:567-575. [PMID: 29631062 DOI: 10.1016/j.autrev.2017.12.006] [Citation(s) in RCA: 168] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 12/21/2017] [Indexed: 12/12/2022]
Abstract
Behçet's disease (BD) is a rare systemic vasculitis characterized by oral aphthous ulcers, genital ulcers, ocular lesions and other systemic manifestations. BD occurs most frequently in Eurasian populations along the ancient trading route known as the "Silk Road" which extends from eastern Asia to the Mediterranean basin. The causes of BD are unknown: it is believed to be due to an autoimmune process triggered by an infectious or environmental agent in genetically predisposed individuals. HLA-B51 allele located in the MHC locus, on chromosome 6p, has been the most strongly associated risk factor for BD in areas along the Old Silk Route. Herpes simplex virus-1 and Streptococcus have been postulated as possible environmental triggers of BD. T cell homeostasis perturbation, especially Th1 and Th17 expansion and decreased regulation by Tregs are now supposed to be the cornerstone of BD pathogenesis. The histology shows vasculitis that involves both arteries and veins, and vessels of any size. BD is a systemic vasculitis with significant neutrophil infiltration, endothelial cell swelling, and fibrinoid necrosis. The diagnosis of BD is only supported by clinical criteria and requires the exclusion of other diagnoses based on clinical presentation. There are no pathognomonic laboratorial findings of BD. This rare disease often leads to blindness and fatal systemic involvement. Main causes of death include major vessel disease and central nervous system involvement. Corticosteroids are commonly used to treat clinical manifestations of BD in combination with immunosuppressant drugs. Tumor necrosis factor (TNF)-blocking agents such as Infliximab, Etanercept, and Adalimumab have been reported to have success in patients with BD.
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Affiliation(s)
- Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00100 Rome, Italy.
| | - Armando De Virgilio
- Department of Otolaryngology-Head and Neck Surgery, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano, MI, Italy
| | - Massimo Ralli
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00100 Rome, Italy.
| | - Andrea Ciofalo
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00100 Rome, Italy.
| | - Patrizia Mancini
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00100 Rome, Italy.
| | - Giuseppe Attanasio
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00100 Rome, Italy.
| | - Marco de Vincentiis
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00100 Rome, Italy.
| | - Alessandro Lambiase
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00100 Rome, Italy.
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Wormser GP, McKenna D, Scavarda C, Karmen C. Outcome of facial palsy from Lyme disease in prospectively followed patients who had received corticosteroids. Diagn Microbiol Infect Dis 2018; 91:336-338. [PMID: 29720355 DOI: 10.1016/j.diagmicrobio.2018.03.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/19/2018] [Accepted: 03/26/2018] [Indexed: 12/01/2022]
Abstract
Although a short course of corticosteroid therapy has been shown to improve the outcome of idiopathic facial nerve palsy (Bell's palsy), it is unclear whether corticosteroids, in addition to antibiotic therapy, are beneficial, are harmful, or have no impact on the outcome of facial palsy from Lyme disease (LDFP). From 2011 through 2016, 14 patients with LDFP were enrolled into a prospective study to determine the outcome of Lyme disease over the ensuing 12 months. Eleven (78.6%) had received corticosteroids in addition to oral antibiotics and entered the study within 24 days after onset of the LDFP (median 14 days, range 2-24 days). Overall, 6 of the corticosteroid-treated patients (54.5%, 95% C.I.: 28.0% to 78.7%) had evidence of residual dysfunction of the facial nerve at the last evaluation, which occurred at a mean of 13.1 months after the baseline visit (range 9.6-19.6 months). In conclusion, although corticosteroids are frequently prescribed for LDFP, the efficacy of this therapy has not been established. Like another recent report, our study raises concern about the safety of adjunctive corticosteroid treatment for LDFP. A well-designed, prospective clinical trial is needed to determine the risk-to-benefit ratio of corticosteroid therapy for LDFP.
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Affiliation(s)
- Gary P Wormser
- Division of Infectious Diseases, New York Medical College, Valhalla, NY 10595.
| | - Donna McKenna
- Division of Infectious Diseases, New York Medical College, Valhalla, NY 10595
| | - Carol Scavarda
- Division of Infectious Diseases, New York Medical College, Valhalla, NY 10595
| | - Carol Karmen
- Division of General Internal Medicine, New York Medical College, Valhalla, NY 10595
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Liou LS, Chang CY, Chen HJ, Tseng CH, Chen CY, Sung FC. Increased risk of peripheral arterial occlusive disease in patients with Bell's palsy using population data. PLoS One 2017; 12:e0188982. [PMID: 29216223 PMCID: PMC5720702 DOI: 10.1371/journal.pone.0188982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/16/2017] [Indexed: 11/19/2022] Open
Abstract
Objective This population-based cohort study investigated the risk of developing peripheral arterial occlusive disease (PAOD) in patients with Bell’s palsy. Methods We used longitudinal claims data of health insurance of Taiwan to identify 5,152 patients with Bell’s palsy newly diagnosed in 2000–2010 and a control cohort of 20,608 patients without Bell’s palsy matched by propensity score. Incidence and hazard ratio (HR) of PAOD were assessed by the end of 2013. Results The incidence of PAOD was approximately 1.5 times greater in the Bell’s palsy group than in the non-Bell’s palsy controls (7.75 vs. 4.99 per 1000 person-years). The Cox proportional hazards regression analysis measured adjusted HR was 1.54 (95% confidence interval (CI) = 1.35–1.76) for the Bell’s palsy group compared to the non-Bell’s palsy group, after adjusting for sex, age, occupation, income and comorbidities. Men were at higher risk of PAOD than women in the Bell’s palsy group, but not in the controls. The incidence of PAOD increased with age in both groups, but the Bell’s palsy group to control group HR of PAOD decreased as age increased. The systemic steroid treatment reduced 13% of PAOD hazard for Bell’s palsy patients, compared to those without the treatment, but not significant. Conclusions Bell’s palsy appears to be associated with an increased risk of developing PAOD. Further pathophysiologic, histopathology and immunologic research is required to explore the underlying biologic mechanism.
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Affiliation(s)
- Li-Syue Liou
- Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien City, Hualien County, Taiwan, ROC
- Department of Family Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Xindian Dist., New Taipei City, Taiwan(R.O.C)
- Department of Family and Community Medicine, Tri-Service General Hospital, Neihu District, Taipei City, Taiwan(R.O.C.)
- School of Medicine, National Defense Medical Center, Neihu Dist., Taipei City, aiwan (R.O.C.)
| | - Chih-Ya Chang
- School of Medicine, National Defense Medical Center, Neihu Dist., Taipei City, aiwan (R.O.C.)
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, Neihu District, Taipei City, Taiwan(R.O.C.)
| | - Hsuan-Ju Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan, Taichung, Taichung, Taiwan (R.O.C.)
| | - Chun-Hung Tseng
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan, North District, Taichung, Taiwan (R.O.C.)
- School of Medicine, China Medical University, Taichung, Taiwan, Taichung, Taichung, Taiwan (R.O.C.)
| | - Cheng-Yu Chen
- Department of Family Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Xindian Dist., New Taipei City, Taiwan(R.O.C)
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan, Taichung, Taichung, Taiwan (R.O.C.)
- Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Taichung, Taiwan; Taichung, Taichung, Taiwan (R.O.C.)
- Department of Health Services Administration, China Medical University, Taichung, Taiwan; Taichung, Taichung, Taiwan (R.O.C.)
- * E-mail:
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Tseng CC, Hu LY, Liu ME, Yang AC, Shen CC, Tsai SJ. Bidirectional association between Bell's palsy and anxiety disorders: A nationwide population-based retrospective cohort study. J Affect Disord 2017; 215:269-273. [PMID: 28359982 DOI: 10.1016/j.jad.2017.03.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 03/01/2017] [Accepted: 03/24/2017] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Bell's palsy and anxiety disorders share numerous risk factors (e.g., immune response, ischemia, and psychological stress). However, there have been no studies on the bidirectional temporal association between the two illnesses. In this study, we used the Taiwan National Health Insurance Research Database (NHIRD) to test the bidirectional association between Bell's palsy and anxiety disorders. We hypothesized that patients with Bell's palsy would have an increased risk of subsequent anxiety disorders later in life and that, conversely, those with anxiety disorders would have an increased likelihood of developing Bell's palsy later in life. METHODS We conducted two retrospective cohort studies using Taiwan's National Health Insurance Research Database (NHIRD). Study 1 included 8070 patients diagnosed with anxiety disorders and 32,280 controls without anxiety disorders who were matched with sex, age, and enrollment date to analyze the following risk of Bell's palsy among both groups. Study 2 included 4980 patients with Bell's palsy and 19,920 controls without Bell's palsy who were matched with sex, age, and enrollment date to analyze the following risk of anxiety disorders among both groups. The patient records selected for the studies were dated between January 1, 2000, and December 31, 2004. All subjects were observed until their outcomes of interest, death or December 31, 2009. RESULTS After adjustment for age, sex, comorbidities, urbanization, and income, the hazard ratio (HR) for patients with anxiety disorders to contract Bell's palsy was 1.53 (95% CI, 1.21-1.94, P<.001), and the HR for patients with Bell's palsy to develop an anxiety disorder was 1.59 (95% CI, 1.23-2.06, P<.001). CONCLUSION This study found a bidirectional temporal association between Bell's palsy and anxiety disorders. After one of these conditions develops, the morbidity rate for the other significantly increases. Additional studies are required to determine whether these two conditions share the same pathogenic mechanisms, and whether successfully treating one will reduce the morbidity rate for the other.
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Affiliation(s)
- Chih-Chieh Tseng
- Department of Psychiatry, Beitou branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Li-Yu Hu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Mu-En Liu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Albert C Yang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Che Shen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan.
| | - Shih-Jen Tsai
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.
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CHEN S, XUAN LH, LIU S. Warm needling moxibustion at Xià guān ( ST 7) plus shallow Puncture for Bell's palsy in pregnancy. WORLD JOURNAL OF ACUPUNCTURE-MOXIBUSTION 2017. [DOI: 10.1016/s1003-5257(17)30121-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bell's palsy and influenza(H1N1)pdm09 containing vaccines: A self-controlled case series. PLoS One 2017; 12:e0175539. [PMID: 28467420 PMCID: PMC5414992 DOI: 10.1371/journal.pone.0175539] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 03/27/2017] [Indexed: 11/28/2022] Open
Abstract
Background An association between AS03 adjuvanted pandemic influenza vaccine and the occurrence of Bell’s palsy was found in a population based cohort study in Stockholm, Sweden. To evaluate this association in a different population, we conducted a self-controlled case series in a primary health care database, THIN, in the United Kingdom. The aim of this study was to determine whether there was an increased risk of Bell’s palsy following vaccination with any influenza vaccine containing A/California/7/2009 (H1N1)-like viral strains. Secondly, we investigated whether risks were different following pandemic influenza A(H1N1)pdm09 vaccines and seasonal influenza vaccines containing the influenza A(H1N1)pdm09 strain. Methods The study population comprised all incident Bell’s palsy cases between 1 June 2009 and 30 June 2013 identified in THIN. We determined the relative incidence (RI) of Bell’s palsy during the 6 weeks following vaccination with either pandemic or seasonal influenza vaccine. All analyses were adjusted for seasonality and confounding variables. Results We found an incidence rate of Bell’s palsy of 38.7 per 100,000 person years. Both acute respiratory infection (ARI) consultations and pregnancy were found to be confounders. When adjusted for seasonality, ARI consultations and pregnancies, the RI during the 42 days after vaccination with an influenza vaccine was 0.85 (95% CI: 0.72–1.01). The RI was similar during the 42 days following seasonal vaccine (0.96, 95%CI: 0.82–1.13) or pandemic vaccine (0.73, 95%CI: 0.47–1.12). Conclusion We found no evidence for an increased incidence of Bell’s palsy following seasonal influenza vaccination overall, nor for monovalent pandemic influenza vaccine in 2009.
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Phillips KM, Heiser A, Gaudin R, Hadlock TA, Jowett N. Onset of bell's palsy in late pregnancy and early puerperium is associated with worse long-term outcomes. Laryngoscope 2017; 127:2854-2859. [DOI: 10.1002/lary.26569] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 12/06/2016] [Accepted: 02/14/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Katie M. Phillips
- Department of Otolaryngology; Massachusetts Eye and Ear and Harvard Medical School; Boston Massachusetts U.S.A
| | - Alyssa Heiser
- Department of Otolaryngology; Massachusetts Eye and Ear and Harvard Medical School; Boston Massachusetts U.S.A
| | - Robert Gaudin
- Department of Otolaryngology; Massachusetts Eye and Ear and Harvard Medical School; Boston Massachusetts U.S.A
| | - Tessa A. Hadlock
- Department of Otolaryngology; Massachusetts Eye and Ear and Harvard Medical School; Boston Massachusetts U.S.A
| | - Nate Jowett
- Department of Otolaryngology; Massachusetts Eye and Ear and Harvard Medical School; Boston Massachusetts U.S.A
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Babl FE, Mackay MT, Borland ML, Herd DW, Kochar A, Hort J, Rao A, Cheek JA, Furyk J, Barrow L, George S, Zhang M, Gardiner K, Lee KJ, Davidson A, Berkowitz R, Sullivan F, Porrello E, Dalziel KM, Anderson V, Oakley E, Hopper S, Williams F, Wilson C, Williams A, Dalziel SR. Bell's Palsy in Children (BellPIC): protocol for a multicentre, placebo-controlled randomized trial. BMC Pediatr 2017; 17:53. [PMID: 28193257 PMCID: PMC5307816 DOI: 10.1186/s12887-016-0702-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 09/27/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Bell's palsy or acute idiopathic lower motor neurone facial paralysis is characterized by sudden onset paralysis or weakness of the muscles to one side of the face controlled by the facial nerve. While there is high level evidence in adults demonstrating an improvement in the rate of complete recovery of facial nerve function when treated with steroids compared with placebo, similar high level studies on the use of steroids in Bell's palsy in children are not available. The aim of this study is to assess the utility of steroids in Bell's palsy in children in a randomised placebo-controlled trial. METHODS/DESIGN We are conducting a randomised, triple-blinded, placebo controlled trial of the use of prednisolone to improve recovery from Bell's palsy at 1 month. Study sites are 10 hospitals within the Australian and New Zealand PREDICT (Paediatric Research in Emergency Departments International Collaborative) research network. 540 participants will be enrolled. To be eligible patients need to be aged 6 months to < 18 years and present within 72 hours of onset of clinician diagnosed Bell's palsy to one of the participating hospital emergency departments. Patients will be excluded in case of current use of or contraindications to steroids or if there is an alternative diagnosis. Participants will receive either prednisolone 1 mg/kg/day to a maximum of 50 mg/day or taste matched placebo for 10 days. The primary outcome is complete recovery by House-Brackmann scale at 1 month. Secondary outcomes include assessment of recovery using the Sunnybrook scale, the emotional and functional wellbeing of the participants using the Pediatric Quality of Life Inventory and Child Health Utility 9D Scale, pain using Faces Pain Scale Revised or visual analogue scales, synkinesis using a synkinesis assessment questionnaire and health utilisation costs at 1, 3 and 6 months. Participants will be tracked to 12 months if not recovered earlier. Data analysis will be by intention to treat with primary outcome presented as differences in proportions and an odds ratio adjusted for site and age. DISCUSSION This large multicenter randomised trial will allow the definitive assessment of the efficacy of prednisolone compared with placebo in the treatment of Bell's palsy in children. TRIAL REGISTRATION The study is registered with the Australian New Zealand Clinical Trials Registry ACTRN12615000563561 (1 June 2015).
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Affiliation(s)
- Franz E. Babl
- Department of Emergency Medicine, Royal Children’s Hospital, Flemington Rd, Parkville, VIC 3052 Australia
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
| | - Mark T. Mackay
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
- Department of Neurology, Royal Children’s Hospital, Parkville, VIC Australia
| | - Meredith L. Borland
- Princess Margaret Hospital for Children, Perth, Australia
- Schools of Paediatric and Child Health and Primary, Aboriginal and Rural Health Care, University of Western Australia, Perth, Western Australia Australia
| | - David W. Herd
- Lady Cilento Children’s Hospital, Brisbane, Australia
- University of Queensland, Brisbane, Australia
- Mater Research Institute, Brisbane, Australia
| | - Amit Kochar
- Women’s & Children’s Hospital, Adelaide, Australia
| | - Jason Hort
- The Children’s Hospital at Westmead, Sydney, Australia
| | - Arjun Rao
- Sydney Children’s Hospital, Randwick, New South Wales, Australia
| | - John A. Cheek
- Department of Emergency Medicine, Royal Children’s Hospital, Flemington Rd, Parkville, VIC 3052 Australia
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
- Monash Medical Centre, Clayton, Victoria, Australia
| | - Jeremy Furyk
- Townsville Hospital and James Cook University College of Medicine and Dentistry, Townsville, Australia
| | - Lisa Barrow
- Sunshine Hospital, St Albans, Victoria Australia
| | - Shane George
- Gold Coast University Hospital, Southport, Queensland Australia
| | - Michael Zhang
- John Hunter Hospital, Newcastle, New South Wales Australia
| | - Kaya Gardiner
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
| | - Katherine J. Lee
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
| | - Andrew Davidson
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
- Department of Anaesthesia, Royal Children’s Hospital, Parkville, Victoria Australia
| | - Robert Berkowitz
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
- Department of Otolaryngology, Royal Children’s Hospital, Parkville, Victoria Australia
| | - Frank Sullivan
- Department of Family & Community Medicine, North York General Hospital, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Emily Porrello
- Pharmacy Department, Royal Children’s Hospital, Parkville, Victoria Australia
| | - Kim Marie Dalziel
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
- Centre for Health Policy Melbourne School of Global and Population Health, The University of Melbourne, Carlton, Victoria Australia
| | - Vicki Anderson
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
- Psychological Sciences & Paediatrics, University of Melbourne, The Royal Children’s Hospital, Melbourne, VIC Australia
| | - Ed Oakley
- Department of Emergency Medicine, Royal Children’s Hospital, Flemington Rd, Parkville, VIC 3052 Australia
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
| | - Sandy Hopper
- Department of Emergency Medicine, Royal Children’s Hospital, Flemington Rd, Parkville, VIC 3052 Australia
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
| | - Fiona Williams
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
| | - Catherine Wilson
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
| | - Amanda Williams
- Department of Emergency Medicine, Royal Children’s Hospital, Flemington Rd, Parkville, VIC 3052 Australia
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
| | - Stuart R Dalziel
- Starship Hospital, Auckland, New Zealand
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - for the PREDICT (Paediatric Research In Emergency Departments International Collaborative) research network
- Department of Emergency Medicine, Royal Children’s Hospital, Flemington Rd, Parkville, VIC 3052 Australia
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
- Department of Neurology, Royal Children’s Hospital, Parkville, VIC Australia
- Princess Margaret Hospital for Children, Perth, Australia
- Schools of Paediatric and Child Health and Primary, Aboriginal and Rural Health Care, University of Western Australia, Perth, Western Australia Australia
- Lady Cilento Children’s Hospital, Brisbane, Australia
- University of Queensland, Brisbane, Australia
- Mater Research Institute, Brisbane, Australia
- Women’s & Children’s Hospital, Adelaide, Australia
- The Children’s Hospital at Westmead, Sydney, Australia
- Sydney Children’s Hospital, Randwick, New South Wales, Australia
- Monash Medical Centre, Clayton, Victoria, Australia
- Townsville Hospital and James Cook University College of Medicine and Dentistry, Townsville, Australia
- Sunshine Hospital, St Albans, Victoria Australia
- Gold Coast University Hospital, Southport, Queensland Australia
- John Hunter Hospital, Newcastle, New South Wales Australia
- Department of Anaesthesia, Royal Children’s Hospital, Parkville, Victoria Australia
- Department of Otolaryngology, Royal Children’s Hospital, Parkville, Victoria Australia
- Department of Family & Community Medicine, North York General Hospital, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
- Pharmacy Department, Royal Children’s Hospital, Parkville, Victoria Australia
- Centre for Health Policy Melbourne School of Global and Population Health, The University of Melbourne, Carlton, Victoria Australia
- Psychological Sciences & Paediatrics, University of Melbourne, The Royal Children’s Hospital, Melbourne, VIC Australia
- Starship Hospital, Auckland, New Zealand
- Liggins Institute, University of Auckland, Auckland, New Zealand
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Cárdenas Palacio CA, Múnera Galarza FA. Cutaneous Sensibility Changes in Bell's Palsy Patients. Otolaryngol Head Neck Surg 2017; 156:828-833. [PMID: 28168888 DOI: 10.1177/0194599817690107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Bell's palsy is a cranial nerve VII dysfunction that renders the patient unable to control facial muscles from the affected side. Nevertheless, some patients have reported cutaneous changes in the paretic area. Therefore, cutaneous sensibility changes might be possible additional symptoms within the clinical presentation of this disorder. Accordingly, the aim of this research was to investigate the relationship between cutaneous sensibility and facial paralysis severity in these patients. Study Design Prospective longitudinal cohort study. Settings Tertiary care medical center. Subjects and Methods Twelve acute-onset Bell's palsy patients were enrolled from March to September 2009. In addition, 12 sex- and age-matched healthy volunteers were tested. Cutaneous sensibility was evaluated with pressure threshold and 2-point discrimination at 6 areas of the face. Facial paralysis severity was evaluated with the House-Brackmann scale. Results Statistically significant correlations based on the Spearman's test were found between facial paralysis severity and cutaneous sensitivity on forehead, eyelid, cheek, nose, and lip ( P < .05). Additionally, significant differences based on the Student's t test were observed between both sides of the face in 2-point discrimination on eyelid, cheek, and lip ( P < .05) in Bell's palsy patients but not in healthy subjects. Conclusion Such results suggest a possible relationship between the loss of motor control of the face and changes in facial sensory information processing. Such findings are worth further research about the neurophysiologic changes associated with the cutaneous sensibility disturbances of these patients.
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Terzi S, Dursun E, Yılmaz A, Özergin Coşkun Z, Özgür A, Çeliker M, Demirci M. Oxidative Stress and Antioxidant Status in Patients with Bell's Palsy. J Med Biochem 2017; 36:18-22. [PMID: 28680345 PMCID: PMC5471655 DOI: 10.1515/jomb-2016-0033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 11/05/2016] [Indexed: 11/15/2022] Open
Abstract
Background Bell's palsy (BP) is the most common acute mononeuropathy of unilateral facial paralysis. Immune, infective and ischaemic mechanisms are potential contributors to the development of BP, but the precise cause remains unclear. Recently, oxidative stress has been proposed as a risk factor of various idiopathic diseases. The aim of this study was to investigate the possible role of oxidative stress in patients with BP. Methods Thirty-two patients with BP and 30 healthy controls were included in this study. Serum total oxidant status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI) were measured by the Erel method. Results Serum TOS activities and OSI values were significantly higher in patients with BP compared with the control group (P <0.003 for all comparisons), whereas there was no significant difference between the groups in terms of TAS levels (P >0.05). Conclusions The data suggest that oxidative stress is increased in BP. These results of high oxidative stress in patients with BP may be helpful to clarify the etiopathogenesis of BP and contribute to improvement in the management or prevention of the disease.
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Affiliation(s)
- Suat Terzi
- Recep Tayyip Erdogan University, Medical Faculty, Department of Otorhinolaryngology, Rize, Turkey
| | - Engin Dursun
- Recep Tayyip Erdogan University, Medical Faculty, Department of Otorhinolaryngology, Rize, Turkey
| | - Adnan Yılmaz
- Recep Tayyip Erdogan University, Medical Faculty, Department of Biochemistry, Rize, Turkey
| | - Zerrin Özergin Coşkun
- Recep Tayyip Erdogan University, Medical Faculty, Department of Otorhinolaryngology, Rize, Turkey
| | - Abdulkadir Özgür
- Recep Tayyip Erdogan University, Medical Faculty, Department of Otorhinolaryngology, Rize, Turkey
| | - Metin Çeliker
- Recep Tayyip Erdogan University Research and Training Hospital, Department of Otorhinolaryngology, Rize, Turkey
| | - Münir Demirci
- Recep Tayyip Erdogan University, Medical Faculty, Department of Otorhinolaryngology, Rize, Turkey
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Eviston TJ, Krishnan AV. Assessment of axonal excitability properties in two branches of the human facial nerve. J Neurosci Methods 2016; 274:53-60. [DOI: 10.1016/j.jneumeth.2016.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/22/2016] [Accepted: 09/27/2016] [Indexed: 01/27/2023]
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Abstract
OBJECTIVE To determine the plasma fibrinogen level in patients with Bell palsy and explore the significances of it in Bell palsy. METHODS One hundred five consecutive patients with facial paralysis were divided into 3 groups: group I (Bell palsy), group II (temporal bone fractures), and group III (facial nerve schwannoma). In addition, 22 volunteers were defined as control group. Two milliliters fasting venous blood from elbow was collected, and was evaluated by CA-7000 Full-Automatic Coagulation Analyzer. RESULTS The plasma fibrinogen concentration was significantly higher in the group of patients with Bell palsy (HB IV-VI) than that in the control group (P <0.05). There was no significant difference between group II and control group (P >0.05); similarly, there was also no marked difference between group III and control group (P >0.05). In group I, the plasma fibrinogen levels became higher with the HB grading increase. The plasma fibrinogen level of HB-VI was highest. CONCLUSIONS Plasma fibrinogen has an important clinical meaning in Bell palsy, which should be used as routine examination items. Defibrinogen in treatment for patients with high plasma fibrinogen content also should be suggested.
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Abstract
Bell's palsy is unilateral, acute onset facial paralysis that is a common condition. One in every 65 people experiences Bell's palsy in the course of their lifetime. The majority of patients afflicted with this idiopathic disorder recover facial function. Initial treatment involves oral corticosteroids, possible antiviral drugs, and protection of the eye from desiccation. A small subset of patients may be left with incomplete recovery, synkinesis, facial contracture, or hemifacial spasm. A combination of medical and surgical treatment options exist to treat the long-term sequelae of Bell's palsy.
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Vivera MJ, Gomersall JS. The effectiveness of ayurvedic oil-based nasal instillation (Nasya) medicines in the treatment of facial paralysis (Ardita): a systematic review. ACTA ACUST UNITED AC 2016; 14:198-228. [PMID: 27532316 DOI: 10.11124/jbisrir-2016-2402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Ardita (facial paralysis) is a medical condition that disfigures or distorts the facial appearance of the sufferer causing facial asymmetry and malfunction. Ardita patients may benefit from considering alternative treatments such as Ayurveda, including Taila Nasya (nasal instillation of medicated oil). OBJECTIVES To synthesize the best available evidence on the effectiveness of different Nasya oils in the treatment of Ardita. INCLUSION CRITERIA TYPES OF PARTICIPANTS Studies conducted on adult sufferers (18-70 years) of Ardita (chronic or acute) in any setting were considered. Studies including participants who were pregnant or suffered allergic rhinitis, fever, intracranial tumor/hemorrhage and bilateral facial palsy were excluded. INTERVENTION(S)/COMPARATOR(S) Standalone treatment of Nasya (at all dosages and frequencies) compared to Nasya in combination with other Ayurvedic treatments was considered. Comparisons between different interventions including Taila Nasya alone, Taila Nasya in combination with other Ayurvedic interventions and Ayurvedic interventions that did not include Taila Nasya were also considered. OUTCOMES AND MEASURES Changes in Ardita symptoms, including facial distortion, speech disorders and facial pain, were measured. TYPES OF STUDIES All quantitative study designs (experimental, quasi-experimental and observational) were considered. SEARCH STRATEGY Relevant studies were identified following a comprehensive literature search. References provided within these key studies identified additional resources. Indian universities were also contacted for results of Ardita studies undertaken in their institutions.A three-step search strategy aimed to find studies of published and unpublished studies was undertaken. Studies published in the English language were considered for inclusion, irrespective of publication date/year. Following an initial limited search of MEDLINE and CINAHL, the text words contained in the title and abstract, and of the index terms used to describe each articles were analyzed. From the identified keywords and index terms, searches were undertaken across all relevant databases such as PubMed, CINHAL, Cochrane (CENTRAL), Scopus, Centre for Review and Dissemination databases, Turning Research into Practice (TRIP), EMBASE, EBM Reviews, DHARA, Google Scholar, MedNar and ProQuest Dissertations. Finally, reference lists of identified theses and articles were searched for additional studies. Universities and website operators related to Ayurvedic research in India were contacted, including the National Institute of Ayurveda for relevant studies. Besides this, the University of Adelaide librarian was contacted to retrieve those studies identified in the reference lists of theses and articles. METHODOLOGICAL QUALITY Studies were critically assessed by the review author and a secondary reviewer prior to inclusion in the review using the standardized critical appraisal instrument from the Joanna Briggs Institute. DATA EXTRACTION Data was extracted by the primary reviewer using the standardized data extraction tool from the Joanna Briggs Institute. DATA SYNTHESIS Different interventions and comparators across studies precluded meta-analysis. Narrative synthesis was performed. RESULTS Only two pseudo randomized studies with a small number of participants met inclusion criteria and were included in the review. One study with 20 participants, divided equally into two groups compared the effectiveness of two nasal instillations in alleviating four Ardita symptoms. The second study of 15 participants each in two groups compared the effectiveness of nasal instillation with placement of medicated oil on the head on seven Ardita symptoms. Observational measurements of Ardita symptoms were graded as Mild, Moderate or Marked at baseline and after one month. The study conducted on 30 participants using Nasya intervention showed participants had better relief from the symptoms of facial pain, speech disorder and earache within the range of 78.2% to 90.9%, graded as Marked. Along with statistical data available in the studies, this review found low levels of evidence favoring Taila Nasya intervention. The review did not include any studies examining effectiveness of Nasya compared to conventional treatment for Ardita. CONCLUSIONS This review presents extremely limited evidence from only two small experimental studies that administration of Nasya oil alone may provide some relief from Ardita symptoms of facial distortion, speech disorder, inability to shut eyelids/upward eye rolling and dribbling of saliva in adult patients. No strong conclusions may be drawn from the evidence included in the review due to the limited number of studies, limited number of participants and poor quality of studies. IMPLICATIONS FOR PRACTICE Practitioners should advice Ardita patients that there is extremely limited evidence suggesting the potential effectiveness of Nasya oils alone or Nasya in conjunction with other Ayurvedic treatments in managing symptoms. However, given the absence of a strong evidence base, practitioners should be guided by clinical wisdom and patient preference. IMPLICATIONS FOR RESEARCH Well controlled clinical trials comparing standalone Nasya therapy to other Ayurvedic treatments and/or conventional medicine for Ardita symptoms need to be conducted to examine the relative effectiveness of different Nasya oils in treating Ardita.
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Affiliation(s)
- Manuel Joseph Vivera
- Joanna Briggs Institute, Faculty of Health Sciences, University of Adelaide, Australia
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Alzhrani F, Lenarz T, Teschner M. Facial palsy following cochlear implantation. Eur Arch Otorhinolaryngol 2016; 273:4199-4207. [DOI: 10.1007/s00405-016-4124-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 05/30/2016] [Indexed: 11/24/2022]
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Alstadhaug KB, Kvarenes HW, Prytz J, Vedeler C. A case of relapsing-remitting facial palsy and ipsilateral brachial plexopathy caused by HSV-1. J Clin Virol 2016; 78:62-5. [PMID: 26991053 DOI: 10.1016/j.jcv.2016.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 03/03/2016] [Accepted: 03/05/2016] [Indexed: 11/16/2022]
Abstract
The etiologies of Bell's palsy and brachial neuritis remain uncertain, and the conditions rarely co-occur or reoccur. Here we present a woman in her twenties who had several relapsing-remitting episodes with left-sided facial palsy and brachial neuropathy. The episodes always started with painful left-sided oral blisters. Repeat PCRs HSV-1 DNA from oral vesicular lesions were positive. Extensive screening did not reveal any other underlying cause. Findings on MRI T2-weighted brachial plexus STIR images, using a 3.0-Tesla scanner during an episode, were compatible with brachial plexus neuritis. Except a mannose-binding lectin deficiency, a congenital complement deficiency that is frequently found in the general Caucasian population, no other immunodeficiency was demonstrated in our patient. In vitro resistance to acyclovir was tested negative, but despite prophylactic treatment with the drug in high doses, relapses recurred. To our knowledge, this is the first ever reported documentation of relapsing-remitting facial and brachial plexus neuritis caused by HSV-1.
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Affiliation(s)
- Karl B Alstadhaug
- Department of Neurology, Nordland Hospital Trust, Bodø, Norway; Institue Clinical Medicine, UiT The Arctic University of Tromsø, Tromsø, Norway.
| | - Hanne W Kvarenes
- Institue Clinical Medicine, UiT The Arctic University of Tromsø, Tromsø, Norway; Department of Infectious Diseases, Nordland Hospital Trust, Bodø, Norway
| | - Jan Prytz
- Institue Clinical Medicine, UiT The Arctic University of Tromsø, Tromsø, Norway; Department of Radiology, Nordland Hospital Trust, Bodø, Norway
| | - Christian Vedeler
- Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical medicine, University of Bergen, Norway
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Longo L, Greco A, Rea A, Lo Vasco VR, De Virgilio A, De Vincentiis M. Relapsing polychondritis: A clinical update. Autoimmun Rev 2016; 15:539-43. [PMID: 26876384 DOI: 10.1016/j.autrev.2016.02.013] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 02/08/2016] [Indexed: 02/07/2023]
Abstract
Relapsing polychondritis (RP) is a rare connective tissue disease in which recurrent bouts of inflammation, involve the cartilage of the ears, nose, larynx, tracheobronchial tree and cardiovascular system. RP is generally observed in the fourth and fifth decades of life and occurs with equal frequency in both sexes. The cause of RP is still unknown. It is considered an immune-mediated disease, as there is an overlap between well documented RP with other rheumatic and autoimmune diseases. There is a significant association of RP with the antigen HLA-DR4. RP includes loss of basophilic staining of cartilage matrix perichondral accompanied by inflammation of the cartilage. Cells are present perivascular mononuclear and polymorphonuclear cells infiltrated. The chondrocytes become vacuolated and necrotic and are replaced by fibrous tissue. Common symptoms are often absent in the early stages of the disease in almost half the cases, resulting in delay in diagnosis. The development of chondrite allows the diagnosis of RP in patients initially evaluated for joint abnormalities, ocular, cutaneous, or audio-vestibular. Diagnostic criteria for RP are based on characteristic clinical manifestations. According to Damiani and Levine, the diagnosis can be considered final when one or more of the clinical features are present in conjunction with biopsy confirmation. The course of symptoms for patients with relapsing polychondritis is often unpredictable. Patients with mild signs of acute inflammation are usually treated with non-steroidal anti-inflammatory drugs and small doses of prednisone. Patients with severe manifestations, such as airway compromise may require high doses of prednisone or even intravenous pulse methyl-prednisone.
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Affiliation(s)
- Lucia Longo
- Department Organs of Sense, Phoniatrics Section, 'Sapienza' University of Rome, Viale del Policlinico 155, 00100 Roma, Italy
| | - Antonio Greco
- Department Organs of Sense, ENT Section, 'Sapienza' University of Rome, Viale del Policlinico 155, 00100 Roma, Italy
| | - Andrea Rea
- Department Organs of Sense, Phoniatrics Section, 'Sapienza' University of Rome, Viale del Policlinico 155, 00100 Roma, Italy
| | - Vincenza Rita Lo Vasco
- Department Organs of Sense, 'Sapienza' University of Rome, Viale del Policlinico 155, 00100 Roma, Italy
| | - Armando De Virgilio
- Department Organs of Sense, ENT Section, 'Sapienza' University of Rome, Viale del Policlinico 155, 00100 Roma, Italy.
| | - Marco De Vincentiis
- Department Organs of Sense, ENT Section, 'Sapienza' University of Rome, Viale del Policlinico 155, 00100 Roma, Italy
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Iannella G, Greco A, Granata G, Manno A, Pasquariello B, Angeletti D, Didona D, Magliulo G. Granulomatosis with polyangiitis and facial palsy: Literature review and insight in the autoimmune pathogenesis. Autoimmun Rev 2016; 15:621-31. [PMID: 26851550 DOI: 10.1016/j.autrev.2016.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 02/01/2016] [Indexed: 01/28/2023]
Abstract
Granulomatosis with polyangiitis (GPA) is an autoimmune systemic necrotizing small-vessel vasculitis associated with the presence of anti-neutrophil cytoplasmic antibodies (ANCA). Oto-neurological manifestations of ANCA-associated vasculitis according to PR3-ANCA positivity and MPO-ANCA positivity are usually reported. Facial nerve palsy is usually reported during the clinical course of the disease but it might appear as the presenting sign of GPA. Necrotizing vasculitis of the facial nerve 'vasa nervorum' is nowadays the most widely accepted etiopathogenetic theory to explain facial damage in GPA patients. A central role for PR3-ANCA in the pathophysiology of vasculitis in GPA patients with oto-neurological manifestation is reported. GPA requires prompt, effective management of the acute and chronic manifestations. Once the diagnosis of GPA has been established, clinicians should devise an appropriate treatment strategy for each individual patient, based on current clinical evidence, treatment guidelines and recommendations.
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Affiliation(s)
- Giannicola Iannella
- Organi di Senso Department University, Sapienza University of Rome, Viale del Policlinico,151-00161, Rome, Italy.
| | - Antonio Greco
- Organi di Senso Department University, Sapienza University of Rome, Viale del Policlinico,151-00161, Rome, Italy.
| | - Guido Granata
- Department of Clinical Immunology, Sapienza University of Rome, Viale dell'Università, 37-00161 Rome, Italy.
| | - Alessandra Manno
- Organi di Senso Department University, Sapienza University of Rome, Viale del Policlinico,151-00161, Rome, Italy.
| | - Benedetta Pasquariello
- Organi di Senso Department University, Sapienza University of Rome, Viale del Policlinico,151-00161, Rome, Italy.
| | - Diletta Angeletti
- Organi di Senso Department University, Sapienza University of Rome, Viale del Policlinico,151-00161, Rome, Italy.
| | - Dario Didona
- First Dermatology Division, Institute Dermopatico dell'Immacolata-IRCCS, Via Monti di Creta, 104-00167 Rome, Italy.
| | - Giuseppe Magliulo
- Organi di Senso Department University, Sapienza University of Rome, Viale del Policlinico,151-00161, Rome, Italy.
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The Importance of the Neutrophil-Lymphocyte Ratio in Patients with Idiopathic Peripheral Facial Palsy. Int J Otolaryngol 2015; 2015:981950. [PMID: 26713095 PMCID: PMC4680058 DOI: 10.1155/2015/981950] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 11/19/2015] [Indexed: 12/11/2022] Open
Abstract
Objective. The purpose of this study was to investigate whether or not there was a correlation between the neutrophil-to-lymphocyte ratio (NLR) value and the severity of idiopathic peripheral facial palsy (IPFP) and to determine whether or not NLR could be used as an early predictive parameter in the prognosis of IPFP patients. Material and Method. This retrospective study was conducted on 146 patients who were diagnosed with IPFP. The control group comprised 140 patients. Patients with IPFP were categorized according to the House-Brackmann grading system (HBS). The NLR value was obtained by dividing the neutrophil value by the lymphocyte value. Results. In the IPFP group, the mean NLR value was 3.63 ± 2.74 and, in the control group, 1.84 ± 0.78. The mean NLR value was significantly higher in IPFP patients than in the control subjects (p < 0.0001). The mean NLR value in group A (Grades I-II ) was 2.61 ± 2.28, in group B (Grades III-IV) 3.22 ± 2.65, and in group C (Grades V-VI) 10.69 ± 6.30. Conclusion. We determined that as the severity of IPFP increased, the NLR value increased. The NLR value can be used as a prognostic factor in the early prediction of IPFP prognosis.
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Ibrahim W, Elzouki AN, Husain A, Osman L. Varicella Zoster Aseptic Meningitis: Report of an Atypical Case and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:594-7. [PMID: 26342350 PMCID: PMC4565033 DOI: 10.12659/ajcr.894045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Patient: Female, 15 Final Diagnosis: Varicella Zoster aseptic meningitis Symptoms: — Medication: — Clinical Procedure: Lumber punctur Specialty: Infectious Diseases
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Affiliation(s)
- Walid Ibrahim
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Abdel-Naser Elzouki
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Husain
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Lubna Osman
- Department of Psychiatry, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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Atan D, İkincioğulları A, Köseoğlu S, Özcan KM, Çetin MA, Ensari S, Dere H. New Predictive Parameters of Bell's Palsy: Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio. Balkan Med J 2015; 32:167-70. [PMID: 26167340 DOI: 10.5152/balkanmedj.2015.15456] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 12/03/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Bell's palsy is the most frequent cause of unilateral facial paralysis. Inflammation is thought to play an important role in the pathogenesis of Bell's palsy. AIMS Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are simple and inexpensive tests which are indicative of inflammation and can be calculated by all physicians. The aim of this study was to reveal correlations of Bell's palsy and degree of paralysis with NLR and PLR. STUDY DESIGN Case-control study. METHODS The retrospective study was performed January 2010 and December 2013. Ninety-nine patients diagnosed as Bell's palsy were included in the Bell's palsy group and ninety-nine healthy individuals with the same demographic characteristics as the Bell's palsy group were included in the control group. As a result of analyses, NLR and PLR were calculated. RESULTS The mean NLR was 4.37 in the Bell's palsy group and 1.89 in the control group with a statistically significant difference (p<0.001). The mean PLR was 137.5 in the Bell's palsy group and 113.75 in the control group with a statistically significant difference (p=0.008). No statistically significant relation was detected between the degree of facial paralysis and NLR and PLR. CONCLUSION The NLR and the PLR were significantly higher in patients with Bell's palsy. This is the first study to reveal a relation between Bell's palsy and PLR. NLR and PLR can be used as auxiliary parameters in the diagnosis of Bell's palsy.
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Affiliation(s)
- Doğan Atan
- Department of Otorhinolaryngology, Head and Neck Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Aykut İkincioğulları
- Department of Otorhinolaryngology, Head and Neck Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | | | - Kürşat Murat Özcan
- Department of Otorhinolaryngology, Head and Neck Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Mehmet Ali Çetin
- Department of Otorhinolaryngology, Head and Neck Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Serdar Ensari
- Department of Otorhinolaryngology, Head and Neck Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Hüseyin Dere
- Department of Otorhinolaryngology, Head and Neck Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
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SU YIPENG, DONG XIAOMENG, LIU JUAN, HU YAOZHI, CHEN JINBO. Nerve growth factor for Bell’s palsy: A meta-analysis. Exp Ther Med 2015; 9:501-506. [PMID: 25574223 PMCID: PMC4280984 DOI: 10.3892/etm.2014.2100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 07/08/2014] [Indexed: 11/06/2022] Open
Abstract
A meta-analysis was performed to evaluate the efficacy and safety of nerve growth factor (NGF) in the treatment of Bell’s palsy. PubMed, the Cochrane Central Register of Controlled Trials, Embase and a number of Chinese databases, including the China National Knowledge Infrastructure, China Biology Medicine disc, VIP Database for Chinese Technical Periodicals and Wan Fang Data, were used to collect randomised controlled trials (RCTs) of NGF for Bell’s palsy. The span of the search covered data from the date of database establishment until December 2013. The included trials were screened comprehensively and rigorously. The efficacies of NGF were pooled via meta-analysis performed using Review Manager 5.2 software. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using the fixed-effects model. The meta-analysis of eight RCTs showed favorable effects of NGF on the disease response rate (n=642; OR, 3.87; 95% CI, 2.13–7.03; P<0.01; I2=0%). However, evidence supporting the effectiveness of NGF for the treatment of Bell’s palsy is limited. The number and quality of trials are too low to form solid conclusions. Further meticulous RCTs are required to overcome the limitations identified in the present study.
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Lyme disease: A rigorous review of diagnostic criteria and treatment. J Autoimmun 2015; 57:82-115. [DOI: 10.1016/j.jaut.2014.09.004] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 09/15/2014] [Accepted: 09/16/2014] [Indexed: 01/07/2023]
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Abstract
Churg-Strauss syndrome (CSS), alternatively known as eosinophilic granulomatosis with polyangiitis (EGPA), was first described in 1951 by Churg and Strauss as a rare disease characterized by disseminated necrotizing vasculitis with extravascular granulomas occurring exclusively among patients with asthma and tissue eosinophilia. EGPA is classified as a small-vessel vasculitis associated with antineutrophil cytoplasmic antibodies (ANCAs) and the hypereosinophilic syndromes (HESs) in which vessel inflammation and eosinophilic proliferation are thought to contribute to organ damage. Although still considered an idiopathic condition, EGPA is classically considered a Th2-mediated disease. Emerging clinical observations provide compelling evidence that ANCAs are primarily and directly involved in the pathogenesis of AASVs, although recent evidence implicates B cells and the humoral response as further contributors to EGPA pathogenesis. EGPA has traditionally been described as evolving through a prodromic phase characterized by asthma and rhino-sinusitis, an eosinophilic phase marked by peripheral eosinophilia and organ involvement, and a vasculitic phase with clinical manifestations due to small-vessel vasculitis. The American College of Rheumatology defined the classification criteria to distinguish the different types of vasculitides and identified six criteria for EGPA. When four or more of these criteria are met, vasculitis can be classified as EGPA. The French Vasculitis Study Group has identified five prognostic factors that make up the so-called five-factor score (FFS). Patients without poor prognosis factors (FFS=0) have better survival rates than patients with poor prognosis factors (FFS≥1). The treatment of patients with CSS must be tailored to individual patients according to the presence of poor prognostic factors. A combination of high-dose corticosteroids and cyclophosphamide is still the gold standard for the treatment of severe cases, but the use of biological agents such as rituximab or mepolizumab seems to be a promising therapeutic alternative.
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Li Y, Li J, Mao Y, Li X, Liu W, Xu L, Han Y, Wang H. The alteration of SHARPIN expression in the mouse brainstem during herpes simplex virus 1-induced facial palsy. Neurosci Lett 2014; 586:50-4. [PMID: 25484257 DOI: 10.1016/j.neulet.2014.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 12/01/2014] [Indexed: 10/24/2022]
Abstract
Bell's palsy presents a unilateral weakness or paralysis of the face due to acute dysfunction of the peripheral facial nerve with no readily identifiable cause. Although data show that herpes simplex virus type 1 (HSV-1) may be the possible causative agent of Bell's palsy, the precise mechanism of the paralysis is still unknown. SHANK-associated RH domain-interacting protein (SHARPIN) is thought to play a role in the control of inflammatory responses. In order to clarify the molecular pathway of SHARPIN involved in the facial palsy caused by HSV-1 in mice and the inhibitory effect of corticosteroids, we used 4-week-old Balb/c mice inoculated with HSV-1 for experiments. The expression and location of SHARPIN in the facial nucleus of brainstem were detected respectively by quantitative real-time polymerase chain reaction, western blot and immunofluorescence. Expression level of SHARPIN increased and peaked at 2 days and then decreased in the facial nucleus of brainstem after the manifestation of the facial paralysis. After the administration of MPSS, the protein expression of SHARPIN at the peak point was down-regulated. Our results suggest that SHRPIN were activated during the inflammatory reaction in the HSV-1-induced facial paralysis. MPSS can effectively inhibit the expression of SHARPIN that may contribute to attenuate HSV-1-mediated nervous system damage.
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Affiliation(s)
- Yue Li
- Otolaryngology-Head and Neck Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, China; Shandong Provincial Key Laboratory of Otology, Jinan, China
| | - Jianfeng Li
- Shandong Provincial Key Laboratory of Otology, Jinan, China; Institute of Eye and ENT, Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Yanyan Mao
- Otolaryngology-Head and Neck Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, China; Shandong Provincial Key Laboratory of Otology, Jinan, China
| | - Xiaofei Li
- Otolaryngology-Head and Neck Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, China; Shandong Provincial Key Laboratory of Otology, Jinan, China
| | - Wenwen Liu
- Shandong Provincial Key Laboratory of Otology, Jinan, China
| | - Lei Xu
- Otolaryngology-Head and Neck Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Yuechen Han
- Otolaryngology-Head and Neck Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Haibo Wang
- Otolaryngology-Head and Neck Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, China; Shandong Provincial Key Laboratory of Otology, Jinan, China; Institute of Eye and ENT, Provincial Hospital Affiliated to Shandong University, Jinan, China.
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95
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Effects of Electroacupuncture on Facial Nerve Function and HSV-1 DNA Quantity in HSV-1 Induced Facial Nerve Palsy Mice. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 2014:693783. [PMID: 24991226 PMCID: PMC4065775 DOI: 10.1155/2014/693783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 05/20/2014] [Indexed: 01/28/2023]
Abstract
Acupuncture is a common and effective therapeutic method to treat facial nerve palsy (FNP). However, its underlying mechanism remains unclear. This study was aimed to investigate the effects of electroacupuncture on symptoms and content of HSV-1 DNA in FNP mice. Mice were randomized into four groups, an electroacupuncture treatment group, saline group, model animal group, and blank control group. Electroacupuncture was applied at Jiache (ST6) and Hegu (LI4) in electroacupuncture group once daily for 14 days, while electroacupuncture was not applied in model animal group. In electroacupuncture group, mice recovered more rapidly and HSV-1 DNA content also decreased more rapidly, compared with model animal group. We conclude that electroacupuncture is effective to alleviate symptoms and promote the reduction of HSV-1 in FNP.
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96
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Singh AK, Bathla G, Altmeyer W, Tiwari R, Valencia MP, Bazan C, Tantiwongkosi B. Imaging spectrum of facial nerve lesions. Curr Probl Diagn Radiol 2014; 44:60-75. [PMID: 24975082 DOI: 10.1067/j.cpradiol.2014.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 05/22/2014] [Accepted: 05/23/2014] [Indexed: 11/22/2022]
Abstract
The facial nerve is affected by a wide variety of pathologies, including congenital, traumatic, inflammatory, and neoplastic conditions. Imaging plays a vital role in the diagnosis of these pathologies. The facial nerve has a complex anatomy and course. A strong grasp of normal facial nerve anatomy is essential for the radiologist to maintain a high level of diagnostic sensitivity. This article details the normal imaging anatomy of the facial nerve and the imaging features of common facial nerve pathologies.
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Affiliation(s)
- Achint K Singh
- University of Texas Health Science Center, San Antonio, TX.
| | - Girish Bathla
- University of Iowa Hospitals and Clinics, Iowa city, IA
| | | | - Ruchi Tiwari
- University of Texas Health Science Center, San Antonio, TX
| | | | - Carlos Bazan
- University of Texas Health Science Center, San Antonio, TX
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97
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Ahmed SS, Schur PH, MacDonald NE, Steinman L. Narcolepsy, 2009 A(H1N1) pandemic influenza, and pandemic influenza vaccinations: What is known and unknown about the neurological disorder, the role for autoimmunity, and vaccine adjuvants. J Autoimmun 2014; 50:1-11. [DOI: 10.1016/j.jaut.2014.01.033] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 01/13/2014] [Accepted: 01/22/2014] [Indexed: 11/17/2022]
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98
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Abstract
The initiation and perpetuation of autoimmunity recognize numerous checkpoints, from the genomic susceptibility to the breakdown of tolerance. This latter phenomenon includes the loss of B cell anergy and T regulatory cell failure, as well as the production of autoantibodies and autoreactive T cells. These mechanisms ultimately lead to tissue injury via different mechanisms that span from the production of proinflammatory cytokines to the chemotaxis of immune cells to the target sites. The pathways to autoimmunity have been widely investigated over the past year and resulted in a number of articles in peer-reviewed journals that has increased by nearly 10 % compared to 2011. We herein follow on the attempt to provide a brief discussion of the majority of articles on autoimmune diseases that were published in the major immunology journals in the previous solar year. The selection is necessarily arbitrary and may thus not be seen as comprehensive but reflects current research trends. Indeed, 2012 articles were mostly dedicated to define new and old mechanisms with potential therapeutic implications in autoimmunity in general, though based on specific clinical conditions or animal models. As paradigmatic examples, the environmental influence on autoimmunity, Th17 changes modulating the autoimmune response, serum autoantibodies and B cell changes as biomarkers and therapeutic targets were major issues addressed by experimental articles in 2012. Further, a growing number of studies investigated the sex bias of autoimmunity and supported different working hypotheses to explain the female predominance, including sex chromosome changes and reproductive life factors. In conclusion, the resulting scenario illustrates that common factors may underlie different autoimmune diseases and this is well represented by the observed alterations in interferon-α and TGFβ or by the shared signaling pathways.
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Affiliation(s)
- Carlo Selmi
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy,
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99
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Turriziani O, Falasca F, Maida P, Gaeta A, De Vito C, Mancini P, De Seta D, Covelli E, Attanasio G, Antonelli G. Early collection of saliva specimens from Bell's palsy patients: Quantitative analysis of HHV-6, HSV-1, and VZV. J Med Virol 2014; 86:1752-8. [DOI: 10.1002/jmv.23917] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2014] [Indexed: 11/10/2022]
Affiliation(s)
| | - Francesca Falasca
- Department of Molecular Medicine; Sapienza University of Rome; Rome Italy
| | - Paola Maida
- Department of Molecular Medicine; Sapienza University of Rome; Rome Italy
| | - Aurelia Gaeta
- Department of Public Health and Infectious Diseases; Sapienza University of Rome; Rome Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases; Sapienza University of Rome; Rome Italy
| | - Patrizia Mancini
- Department of Sense Organs; Sapienza University of Rome; Rome Italy
| | - Daniele De Seta
- Department of Sense Organs; Sapienza University of Rome; Rome Italy
| | - Edoardo Covelli
- Department of Sense Organs; Sapienza University of Rome; Rome Italy
| | | | - Guido Antonelli
- Department of Molecular Medicine; Sapienza University of Rome; Rome Italy
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100
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Zandian A, Osiro S, Hudson R, Ali IM, Matusz P, Tubbs SR, Loukas M. The neurologist's dilemma: a comprehensive clinical review of Bell's palsy, with emphasis on current management trends. Med Sci Monit 2014; 20:83-90. [PMID: 24441932 PMCID: PMC3907546 DOI: 10.12659/msm.889876] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Recent advances in Bell’s palsy (BP) were reviewed to assess the current trends in its management and prognosis. Material/Methods We retrieved the literature on BP using the Cochrane Database of Systematic Reviews, PubMed, and Google Scholar. Key words and phrases used during the search included ‘Bell’s palsy’, ‘Bell’s phenomenon’, ‘facial palsy’, and ‘idiopathic facial paralysis’. Emphasis was placed on articles and randomized controlled trails (RCTs) published within the last 5 years. Results BP is currently considered the leading disorder affecting the facial nerve. The literature is replete with theories of its etiology, but the reactivation of herpes simplex virus isoform 1 (HSV-1) and/or herpes zoster virus (HZV) from the geniculate ganglia is now the most strongly suspected cause. Despite the advancements in neuroimaging techniques, the diagnosis of BP remains one of exclusion. In addition, most patients with BP recover spontaneously within 3 weeks. Conclusions Corticosteroids are currently the drug of choice when medical therapy is needed. Antivirals, in contrast, are not superior to placebo according to most reliable studies. At the time of publication, there is no consensus as to the benefit of acupuncture or surgical decompression of the facial nerve. Long-term therapeutic agents and adjuvant medications for BP are necessary due to recurrence and intractable cases. In the future, large RCTs will be required to determine whether BP is associated with an increased risk of stroke.
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Affiliation(s)
- Anthony Zandian
- Department of Anatomical Sciences, School of Medicine, St. George's University, St. George's, Grenada
| | - Stephen Osiro
- Department of Anatomical Sciences, School of Medicine, St. George's University, St. George's, Grenada
| | - Ryan Hudson
- Department of Anatomical Sciences, School of Medicine, St. George's University, St. George's, Grenada
| | - Irfan M Ali
- Department of Anatomical Sciences, School of Medicine, St. George's University, St. George's, Grenada
| | - Petru Matusz
- Department of Anatomy, Victor Babes University of Medicine and Dentistry, Timisoara, Romania
| | - Shane R Tubbs
- Pediatric Neurosurgery, Children's Hospital, Birmingham, USA
| | - Marios Loukas
- Department of Anatomical Sciences, School of Medicine, St. George's University, St. George, Grenada
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