1
|
Liu J, Li G, Wu R, Qin X, Pan S, Liang P, Sun J. The Systemic Inflammatory Response Index as a Novel Diagnostic Indicator for Bell's Palsy. Br J Hosp Med (Lond) 2024; 85:1-14. [PMID: 39347675 DOI: 10.12968/hmed.2024.0386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2024]
Abstract
Aims/Background The systemic inflammatory response index (SIRI), an emerging hematological marker of inflammation, has shown promise as a promising biomarker for a variety of inflammatory conditions. This study aims to explore the diagnostic role of SIRI in Bell's palsy (BP). Methods For this retrospective study, 73 people diagnosed with BP between January 2021 and December 2023 were recruited, along with 73 healthy controls who were age- and sex-matched. The SIRI and other blood inflammatory markers, including the systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), were determined for all participants, by enumerating their peripheral blood cell counts. Facial nerve function was assessed upon admission and after one month of treatment using the House-Brackmann Facial Nerve Grading System (H-B). According to this system, patients with an H-B grade of 1-2 are considered recovered, while those with an H-B grade of 3-6 are regarded as not recovered. Results The SIRI (0.94 vs 0.48, p < 0.001), SII (480.3 vs 329.12, p < 0.001), NLR (2.42 vs 1.41, p < 0.001), and PLR (141.05 vs 117.28, p = 0.001) showed a significant increase in the BP group compared to the control group. The receiver operating characteristic (ROC) curve analysis revealed that the area under the curve (AUC) for SIRI was higher than those for SII, NLR, and PLR, respectively. Upon one-month follow-up, significant differences in the values of SIRI, SII, and NLR were observed between the favorable prognosis group and the poor prognosis group (SIRI: 1.07 vs 0.87, p = 0.011; SII: 647.85 vs 422.11, p = 0.005; NLR: 3.31 vs 2.11, p = 0.013). The AUC of ROC curve for SIRI was found to be lower than that of SII but higher than that of NLR. Conclusion The SIRI has the potential to be an important BP diagnostic and prognostic marker.
Collapse
Affiliation(s)
- Jianhui Liu
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Department of Neurology, The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou, China
| | - Guangyu Li
- Department of Neurology, The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou, China
| | - Rui Wu
- Department of Neurology, The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou, China
| | - Xuan Qin
- The Second Clinical College, Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou, China
| | - Shuixiang Pan
- The Second Clinical College, Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou, China
| | - Ping Liang
- The Second Clinical College, Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou, China
| | - Jingbo Sun
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| |
Collapse
|
2
|
Rim HS, Byun JY, Kim SH, Yeo SG. Optimal Bell's Palsy Treatment: Steroids, Antivirals, and a Timely and Personalized Approach. J Clin Med 2023; 13:51. [PMID: 38202059 PMCID: PMC10779900 DOI: 10.3390/jcm13010051] [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: 11/29/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
IMPORTANCE The optimal treatment approach for patients with Bell's palsy, a condition characterized by acute facial nerve palsy, remains unclear. The present study was designed to provide insights into the most effective treatment strategies, whether steroids alone or steroids plus antiviral agents, as well as the optimal timing of treatment initiation. OBJECTIVE To investigate the impact of treatment modalities and timing on the recovery rates of Bell's palsy patients and to assess the roles of individual factors. DESIGN, SETTING, AND PARTICIPANTS This retrospective analysis included 1504 patients with Bell's palsy who visited Kyung Hee University Hospital. Patients were divided based on the treatment modality (steroid monotherapy vs. combined steroid and antiviral therapy) and the timing of treatment initiation (≤72 vs. >72 h). MAIN OUTCOMES AND MEASURES The primary outcome was the recovery rate, as assessed by the House-Brackmann (HB) grade. Secondary outcomes included factors such as age, electroneurography (ENoG) and electromyography (EMG) results, and comorbid conditions. RESULTS A combined comparison of patients treated with steroids plus antivirals and steroids alone, stratified by treatment start time, showed that recovery rates were highest in patients who received steroid monotherapy initiated within 72 h (OR 2.36; p < 0.05). Patients with severe Bell's palsy tended to benefit more from combined therapy when treatment was initiated within 72 h. The recovery rate was higher in patients who received steroid monotherapy than combined therapy (86.32% vs. 79.25%, p < 0.05). Initiating treatment beyond 72 h was associated with a higher recovery rate than starting treatment within 72 h (85.69% vs. 76.92%, p < 0.05). An evaluation of the factors affecting recovery showed that patients aged 20 to 39 years had a higher recovery rate than other age groups (OR 1.47; p < 0.05). Fairly predictive EMG results were associated with significantly higher recovery rates (OR 3.52; p < 0.05). CONCLUSIONS These findings underscore the importance of individualized treatment approaches in Bell's palsy management. Steroid monotherapy remains effective, although combined treatment may have potential advantages, especially in patients with more severe disease. The best treatment results were achieved when steroid treatment was administered within 72 h. Our results suggest that there may be more flexibility in the application of the 72 h treatment period if we consider the time of treatment initiation alone, but this should take into account patient behavior patterns and the limitations of retrospective analysis. Further research is warranted to validate these findings and refine treatment recommendations for patients with Bell's palsy.
Collapse
Affiliation(s)
| | | | | | - Seung Geun Yeo
- Department of Otorhinolaryngology—Head and Neck Surgery, College of Medicine, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea; (H.S.R.); (J.Y.B.); (S.H.K.)
| |
Collapse
|
3
|
Boegle AK, Narayanaswami P. Infectious Neuropathies. Continuum (Minneap Minn) 2023; 29:1418-1443. [PMID: 37851037 DOI: 10.1212/con.0000000000001334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVE This article discusses the clinical manifestations and management of infectious peripheral neuropathies. LATEST DEVELOPMENTS Several infectious etiologies of peripheral neuropathy are well-recognized and their treatments are firmly established. The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is associated with several central and peripheral nervous system manifestations, including peripheral neuropathies. Additionally, some COVID-19 vaccines have been associated with Guillain-Barré syndrome. These disorders are an active area of surveillance and research. Recent evidence-based guidelines have provided updated recommendations for the diagnosis and treatment of Lyme disease. ESSENTIAL POINTS Infectious agents of many types (primarily bacteria and viruses) can affect the peripheral nerves, resulting in various clinical syndromes such as mononeuropathy or mononeuropathy multiplex, distal symmetric polyneuropathy, radiculopathy, inflammatory demyelinating polyradiculoneuropathy, and motor neuronopathy. Knowledge of these infections and the spectrum of peripheral nervous system disorders associated with them is essential because many have curative treatments. Furthermore, understanding the neuropathic presentations of these disorders may assist in diagnosing the underlying infection.
Collapse
|
4
|
Zhang C, Dong F, Wu Q, Jin J, Li M, Xu X, Peng Z, Chen Y, Ye M, Liu X, Wang L, Zhong Y. Sunshine duration and solar radiation contributed to severe Bell's palsy: An 11-year time series analysis based on a distributed lag non-linear model model. Medicine (Baltimore) 2023; 102:e34400. [PMID: 37478212 PMCID: PMC10662859 DOI: 10.1097/md.0000000000034400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/28/2023] [Indexed: 07/23/2023] Open
Abstract
Although previous studies have suggested that meteorological factors are associated with Bell's palsy, articles on this topic are rare and the results are inconsistent. We aim to reveal the relationship between exposure to different meteorological factors and the onset of severe Bell's palsy (SBP) with daily data. A case-crossover study based on time-series data was applied, and the minimum risk value of each climatic factor was set as the reference value. We fitted a distributed lag non-linear model (DLNM) which applied quasi-Poisson regression to evaluate the exposure-response association and the lag-response association of meteorological factors on the occurrence of SBP. The mode value and per-decile interval value of each meteorological factor were all included in the analysis. Sensitivity analyses were conducted to test the robustness of results. A total of 863 SBP patients (474 males and 389 females) from 7 hospitals in the Shenzhen Futian District were selected from January 2009 to February 2020. The highest relations effect was tested in the cumulative exposure-response result shown as follows; mean temperature at the minimum value 15.3°C with RR of 10.370 (1.557-69.077) over lag 0 to 13; relative humidity at the 30th value 71% with RR of 8.041 (1.016-63.616) over lag 0 to 14; wind speed at the 90th value 31 (0.1 m/s) with RR of 1.286 (1.038-1.593) over lag 0; mean air pressure at the 30th value 1001.4 (pa) with RR of 9.052 (1.039-78.858) over lag 0 to 5; visibility at the 80th value 26.5 (km) with RR of 1.961 (1.005-1.423) over lag 0 to 2; average total cloud cover at the max value 100 (%) with RR 1.787 (1.014-3.148) over lag 0 to 2; sunshine duration at the 10th value 0.1 (h) with RR of 4.772 (1.018-22.361); daily evaporation shows no relationship in the cumulative result; daily average solar radiation at the minimum value 0 (W/m2) with RR of 5.588 (1.184-26.382). There is a relationship between wind speed and the onset of SBP, while mean air pressure, visibility, and average total cloud cover, especially sunshine duration and solar radiation which showed a strong effect, may be associated with severe clinical symptoms of SBP. Mean temperature and relative humidity may affect the course of SBP.
Collapse
Affiliation(s)
- Cuiyi Zhang
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Fang Dong
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Qi Wu
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Jinlan Jin
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Mengtao Li
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Xiaojuan Xu
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Zhihua Peng
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Yuanting Chen
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Meixia Ye
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Xingli Liu
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Lijun Wang
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Yinqin Zhong
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| |
Collapse
|
5
|
Kwon KJ, Bang JH, Kim SH, Yeo SG, Byun JY. Prognosis prediction changes based on the timing of electroneurography after facial paralysis. Acta Otolaryngol 2022; 142:213-219. [PMID: 35073495 DOI: 10.1080/00016489.2021.1976417] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The process of determining the prognosis and subsequent facial nerve decompression has become an important factor in determining the patient's quality of life. AIM In this study, the prognosis of facial paralysis was verified in detail based on the timing of electroneurography (ENOG) and nerve conduction study (NCS). MATERIALS AND METHODS The ENOG and NCS of 368 facial palsy patients were analyzed. House-Brackmann (HB) scale after 6 months was used as an outcome. For the ENOG, nasalis muscle/levator labii superioris alaeque nasi (NL), and orbicularis oculi (OO) muscle were used and NCS performed using temporal, zygomatic, and buccal branches. RESULTS ENOG at the OO performed 4-6 d after onset was ≤10% (p = .002, 10.0-fold) and showed unfavorable results (when the standard was ≥30%). In addition, the ENOG at the NL performed 13-15 d after onset was ≤10% (p = .001, 10.5-fold) and showed unfavorable results (when the standard was ≥30%). CONCLUSIONS The results indicated that ENOG at the OO performed 4-6 d after onset and ENOG at the NL performed 13-15 d after onset had more prognostic value for the outcomes of acute peripheral facial palsy.
Collapse
Affiliation(s)
- Ki Jin Kwon
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Je Ho Bang
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Sang Hoon Kim
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Seung Geun Yeo
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jae Yong Byun
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| |
Collapse
|
6
|
Zamzam SM, Hanafy RG. Impact of COVID-19 on vocal cord mobility: a case series study. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2021. [PMCID: PMC8446466 DOI: 10.1186/s43163-021-00157-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background The World Health Organization (WHO) has declared the pandemic of COVID-19 infection in March 2020, most of cases presented with mild symptoms, and a significant number of cases showed variable neurological pictures. Vocal cord paralysis with no clear cause is termed as idiopathic vocal cord paralysis and supposed to be caused by viral infection. This is a case series study; data were collected prospectively from patients presented to the ENT clinic of Kasr Alainy (Cairo university) and Railway hospitals. Patients presented with defective vocal cord movement with concurrently or recently passed COVID-19 infection were reported from March 2020 to April 2021. Results Authors have reported 6 cases of vocal cord paralysis mainly unilateral due to COVID-19 infection as an only clear cause within 14 months. Age ranges from 39 to 69 years, 2 males and 4 females. Patients presented with different clinical scenarios. Follow-up of the cases showed spontaneous recovery in 5 cases and one case underwent cord medialization. Conclusion Viral infection could be an underlying cause of idiopathic laryngeal cord paralysis; in the new era of the COVID-19 pandemic, physicians all over the world noticed variable neurological pictures; in this study, we presented 6 cases of vocal cord paralysis mainly unilateral supposed to be due to COVID-19 infection; all cases showed spontaneous recovery apart from one case that needed medialization of the cord.
Collapse
|
7
|
Kim Y, Doo JG, Chon J, Lee JH, Jung J, Lee JM, Kim SH, Yeo SG. Steroids plus antiviral agents are more effective than steroids alone in the treatment of severe Bell's palsy patients over 40 years of age. Int J Immunopathol Pharmacol 2021; 35:20587384211042124. [PMID: 34633253 PMCID: PMC8511921 DOI: 10.1177/20587384211042124] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective The effectiveness of the combination of steroids and antiviral agents in the
treatment of Bell’s palsy remains unclear. This study evaluated the
therapeutic effect of combination therapy in severe Bell’s palsy patients
and assesses specific conditions under which combination therapy is more
effective than steroids alone. Methods From January 2005 to December 2019, the records of 1710 Bell’s palsy patients
who visited Kyung Hee University Hospital were reviewed retrospectively. Of
these, 335 (19.6%) patients were diagnosed with severe Bell’s palsy, with
162 patients treated with steroids alone and 173 patients treated with
combinations of steroids and antiviral agents. The outcomes of treatment
were assessed using the House–Brackmann (H-B) grade according to age, sex,
hypertension, diabetes, and obesity. Results The favorable recovery rate was significantly higher in severe Bell’s palsy
patients who were treated with combinations of steroids and antiviral agents
than with steroids alone (78.0% vs. 66.7%, p = 0.020).
Subgroup analysis showed that combination therapy resulted in significantly
higher recovery rates than steroids alone in patients aged ≥40 years (77.5%
vs. 64.1%, p = 0.023) and in those without hypertension
(75.8% vs. 63.3%, p = 0.044) and diabetes (79.7% vs. 65.5%,
p = 0.007). Conclusion Combination therapy with steroids and antiviral agents resulted in
significantly higher favorable recovery rates than steroids alone in severe
Bell’s palsy patients. Combination therapy was particularly more effective
than steroids alone in patients aged ≥40 years and in patients without
hypertension and diabetes.
Collapse
Affiliation(s)
- Yong Kim
- Department of Rehabilitation Medicine, School of Medicine, 26723Kyung Hee University, Seoul, Republic of Korea
| | - Jeon Gang Doo
- Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, 26723Kyung Hee University, Seoul, Republic of Korea
| | - Jinmann Chon
- Department of Rehabilitation Medicine, School of Medicine, 26723Kyung Hee University, Seoul, Republic of Korea
| | - Jong Ha Lee
- Department of Rehabilitation Medicine, School of Medicine, 26723Kyung Hee University, Seoul, Republic of Korea
| | - Junyang Jung
- Department of Anatomy and Neurobiology, School of Medicine, 26723Kyung Hee University, Seoul, Republic of Korea
| | - Jae Min Lee
- Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, 26723Kyung Hee University, Seoul, Republic of Korea
| | - Sang Hoon Kim
- Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, 26723Kyung Hee University, Seoul, Republic of Korea
| | - Seung Geun Yeo
- Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, 26723Kyung Hee University, Seoul, Republic of Korea
| |
Collapse
|
8
|
Zain S, Petropoulou K, Mirchia K, Hussien A, Mirchia K. COVID-19 as a rare cause of facial nerve neuritis in a pediatric patient. Radiol Case Rep 2021; 16:1400-1404. [PMID: 33824691 PMCID: PMC8015400 DOI: 10.1016/j.radcr.2021.03.063] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 11/23/2022] Open
Abstract
COVID-19 has been noted to present with neurological symptoms in nearly 30% of patients. While children are more likely to be asymptomatic, neurological involvement has been observed. We present the case of a 23-month-old previously healthy female who was brought to the emergency room for a new-onset facial droop. The patient tested positive for COVID-19 but was otherwise asymptomatic. Magnetic resonance imaging of the brain with and without contrast revealed abnormal enhancement along the canalicular segment of the right cranial VII extending to the first genu suggestive of cranial nerve neuritis. Given that our case involves a pediatric patient with no significant comorbidities presenting with facial drop, COVID-19 should be considered on the differential when evaluating causes of new onset peripheral nerve palsies.
Collapse
Affiliation(s)
- Sultan Zain
- College of Medicine, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210, USA
| | - Kalliopi Petropoulou
- Department of Radiology, Upstate University Hospital, 750 E Adams St, Syracuse, NY 13210, USA
| | - Kanish Mirchia
- Department of Pathology, Upstate University Hospital, 750 E Adams St, Syracuse, NY 13210, USA
| | - Abdelmohsen Hussien
- Department of Radiology, Upstate University Hospital, 750 E Adams St, Syracuse, NY 13210, USA
| | - Kavya Mirchia
- Department of Radiology, Upstate University Hospital, 750 E Adams St, Syracuse, NY 13210, USA
| |
Collapse
|
9
|
A meta-analysis uncovers the first sequence variant conferring risk of Bell's palsy. Sci Rep 2021; 11:4188. [PMID: 33602968 PMCID: PMC7893061 DOI: 10.1038/s41598-021-82736-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 01/22/2021] [Indexed: 01/31/2023] Open
Abstract
Bell's palsy is the most common cause of unilateral facial paralysis and is defined as an idiopathic and acute inability to control movements of the facial muscles on the affected side. While the pathogenesis remains unknown, previous studies have implicated post-viral inflammation and resulting compression of the facial nerve. Reported heritability estimates of 4-14% suggest a genetic component in the etiology and an autosomal dominant inheritance has been proposed. Here, we report findings from a meta-analysis of genome-wide association studies uncovering the first unequivocal association with Bell's palsy (rs9357446-A; P = 6.79 × 10-23, OR = 1.23; Ncases = 4714, Ncontrols = 1,011,520). The variant also confers risk of intervertebral disc disorders (P = 2.99 × 10-11, OR = 1.04) suggesting a common pathogenesis in part or a true pleiotropy.
Collapse
|
10
|
Yoo MC, Soh Y, Chon J, Lee JH, Jung J, Kim SS, You MW, Byun JY, Kim SH, Yeo SG. Evaluation of Factors Associated With Favorable Outcomes in Adults With Bell Palsy. JAMA Otolaryngol Head Neck Surg 2021; 146:256-263. [PMID: 31971554 DOI: 10.1001/jamaoto.2019.4312] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Identification of the factors associated with improved facial nerve function after treatment of Bell palsy is important to provide patients with early and effective treatment. Objective To identify factors that are associated with improved treatment outcomes in patients with Bell palsy. Design, Setting, and Participants This retrospective cohort study included 1364 patients with Bell palsy treated at the outpatient clinic of the Department of Otolaryngology at the Kyung Hee University Hospital, Seoul, Republic of Korea, between January 1, 2005, and December 31, 2017. The medical records of patients admitted to this hospital for management of acute facial palsy were reviewed by 3 otolaryngologists with more than 20 years' experience in treating facial palsy. Main Outcomes and Measures Facial function at the initial and final visits were measured using the House-Brackmann (H-B) grading system, which is one of several analysis tools developed to quantify facial function and provide reproducible information. It is a widely accepted system for grading facial function in 6 steps, from normal (H-B grade I) to total paralysis (H-B grade VI). Results In total, 1364 patients with primary Bell palsy (718 [52.6%] women) and a mean (SD) age of 47.7 (16.7) years were enrolled. The overall rate of favorable outcome, which was defined as an H-B grade of I or II at the 6-month follow-up visit, was 80.6% (1099 of 1364 patients). Of 1099 patients who had a favorable outcome at 6 months, 343 (31.2%) were younger than 40 years. Of 1364 patients, 1053 (77.2%) had moderate facial dysfunction (H-B grade III or IV). No pathological spontaneous fibrillation activity (ie, good electromyography [EMG] results) was detected on EMG in 937 of 1364 patients (68.7%), 492 (36.1%) had controlled hypertension, and 673 (49.3%) were treated with oral corticosteroids alone. Multivariable analysis revealed that the following factors were associated with favorable outcome: age younger than 40 years (odds ratio [OR], 1.56; 95% CI, 1.09-2.22), an initial H-B grade of III or IV (OR, 2.62; 95% CI, 1.93-3.57), good EMG results after 2 weeks of treatment (OR, 3.38; 95% CI, 2.48-4.61), absence of diabetes (OR, 1.43; 95% CI, 1.04-2.36), and control of hypertension (OR, 1.64; 95% CI, 1.16-2.33). Conclusions and Relevance Multiple logistic regression analysis in this study suggests that multiple clinical factors are associated with favorable outcomes in patients with Bell palsy.
Collapse
Affiliation(s)
- Myung Chul Yoo
- Department of Physical Medicine & Rehabilitation, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Yunsoo Soh
- Department of Physical Medicine & Rehabilitation, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jinmann Chon
- Department of Physical Medicine & Rehabilitation, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jong Ha Lee
- Department of Physical Medicine & Rehabilitation, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Junyang Jung
- School of Medicine, Department of Anatomy and Neurobiology, Kyung Hee University, Seoul, Republic of Korea
| | - Sung Su Kim
- Medical Research Center for Bioreaction to Reactive Oxygen Species and Biomedical Science Institute, School of Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Myung-Won You
- School of Medicine, Department of Radiology, Kyung Hee University, Seoul, Republic of Korea
| | - Jae Yong Byun
- School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University, Seoul, Republic of Korea
| | - Sang Hoon Kim
- School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University, Seoul, Republic of Korea
| | - Seung Geun Yeo
- School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University, Seoul, Republic of Korea
| |
Collapse
|
11
|
Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Prognostic Hematologic Markers of Bell's Palsy: A Meta-analysis. Otol Neurotol 2020; 40:681-687. [PMID: 31083100 DOI: 10.1097/mao.0000000000002166] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Bell's palsy (BP) is the most common cause of unilateral peripheral facial paralysis, and inflammation has been proposed as the main pathological cause. The study aim was to investigate the relationship between hematologic inflammatory markers, including the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), and BP. DATA SOURCES The following key words were used to search PubMed and Scopus for English language articles: Bell's palsy, facial palsy, facial paresis or facial paralysis, neutrophil, lymphocyte, and platelet. STUDY SELECTION Articles related to BP with NLR or PLR data. DATA EXTRACTION The data included patient profiles, House-Brackmann score, treatment modality, NLR, and PLR. DATA SYNTHESIS Seven articles were selected. A random effect model was used to analyze the aggregated data. Six of these articles that included the NLR and two that included the PLR of BP and control patients were analyzed for the difference between BP and control patients. Three articles that included the NLR of the recovery and nonrecovery groups were analyzed for the relationship between NLR and recovery. CONCLUSIONS The NLR was significantly higher for the BP patients than for the controls. Furthermore, the NLR was significantly lower for the recovery group than for the nonrecovery group. A high NLR was associated with poor prognosis and related to the severity of facial nerve inflammation. There was no significant difference between the PLRs of the BP patients and controls. The NLR, but not the PLR, was found to be a useful prognostic indicator of BP.
Collapse
|
12
|
Kim JY, Kim MS, Kim MH, Kim DK, Yu MS. Bell Palsy and the Risk of Cardio-Cerebrovascular Disease: A Population-Based Follow-Up Study. Laryngoscope 2019; 129:2371-2377. [PMID: 30632167 DOI: 10.1002/lary.27802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/04/2018] [Accepted: 12/19/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To evaluate the risk of cardio-cerebrovascular disease (CCVD), such as ischemic stroke and acute myocardial infarction (AMI), in patients diagnosed with Bell palsy STUDY DESIGN: Population-based follow-up study. METHODS We used the National Sample Cohort 2002 to 2013 data from the Korea National Health Insurance Service. The Bell palsy group comprised all patients diagnosed with Bell palsy (n = 730). The comparison group comprised patients selected randomly using propensity score matching (n = 1,460). The Kaplan-Meier survival analysis, log-rank test, and Cox proportional-hazards regression models were used to calculate the disease-free survival rate and hazard ratio (HR) of CCVD for each group. RESULTS Of the total study population, ischemic stroke developed in 15.7% of patients with Bell palsy and 9% of patients in the comparison group during the 12-year follow-up period. After adjusting for other factors, the HR of ischemic stroke during the 12-year follow-up period was 1.84 times greater in the Bell palsy group than in the comparison group (95% confidence interval [CI], 1.43-2.36). However, the adjusted HR of developing ischemic stroke for patients with Bell palsy treated concurrently with antiviral agents and steroids was 1.12 (95% CI, 0.62.-2.04). There was no significant relationship between Bell palsy and risk of AMI development (HR, 1.13; 95% CI, 0.71-1.82). CONCLUSION Bell palsy is linked with an increased incidence of ischemic stroke. Our data suggest that Bell palsy may be used as an indicator of increased stroke risk, and concurrent treatment with antiviral agents and steroids may be effective in preventing ischemic stroke. LEVEL OF EVIDENCE NA Laryngoscope, 129:2371-2377, 2019.
Collapse
Affiliation(s)
- Jong-Yeup Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Konyang University, Daejeon, Republic of Korea.,Department of Biomedical Informatics, Konyang University, Daejeon, Republic of Korea
| | - Myoung Suk Kim
- Myunggok Medical Research Institute, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Myeong Hee Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Konyang University, Daejeon, Republic of Korea
| | - Dong-Kyu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea.,Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Myeong Sang Yu
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
13
|
|
14
|
Abstract
Bell palsy and traumatic facial nerve injury are two common causes of acute facial palsy. Most patients with Bell palsy recover favorably with medical therapy alone. However, those with complete paralysis (House-Brackmann 6/6), greater than 90% degeneration on electroneurography, and absent electromyography activity may benefit from surgical decompression via a middle cranial fossa (MCF) approach. Patients with acute facial palsy from traumatic temporal bone fracture who meet these same criteria may be candidates for decompression via an MCF or translabyrinthine approach based on hearing status.
Collapse
Affiliation(s)
- Daniel Q Sun
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline St 6th Floor, Baltimore MD, 21287, USA.
| | - Nicholas S Andresen
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline St 6th Floor, Baltimore MD, 21287, USA
| | - Bruce J Gantz
- University of Iowa Hospitals and Clinics, 375 Newton Road, Iowa City, IA 52242, USA
| |
Collapse
|
15
|
Bhatt NK, Pipkorn P, Paniello RC. Association between Upper Respiratory Infection and Idiopathic Unilateral Vocal Fold Paralysis. Ann Otol Rhinol Laryngol 2018; 127:667-671. [PMID: 30124061 DOI: 10.1177/0003489418787542] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Unilateral vocal fold paralysis (UVFP) without an identifiable cause is termed idiopathic unilateral vocal fold paralysis (IUVFP). Some authors have postulated that select cases of IUVFP have a viral etiology, but the causality has not been established. We set out to review institutional cases of IUVFP and determine if there is a correlation between upper respiratory infection symptoms and presentation of IUVFP. METHODS Cases of IUVFP were reviewed over a 10-year period (2002-2012). The history was investigated to review presenting symptoms. We specifically reviewed for symptoms of upper respiratory infection at the onset of UVFP and tallied the frequency. Symptoms included sore throat, laryngitis, cough, influenza, bronchitis, pneumonia, otalgia, and sinusitis. The seasonal onset (if possible) was determined based on the history provided from the initial consultation. STUDY DESIGN Case series. RESULTS Overall, 107 patients presented with IUVFP; 35.5% of patients reported symptoms of upper respiratory infection at the onset of UVFP. Among these individuals, pharyngitis/laryngitis was the most common presenting symptom; 34.2% reported cough. In total, 40.0% of patients with IUVFP reported an onset of symptoms between December and February. CONCLUSIONS This study suggests that symptoms of upper respiratory infection frequently occur with the presentation of IUVFP. The onset of symptoms tended to occur between December and February. The mechanism of viral-mediated UVFP has not been established. Future studies to explore this pathophysiology are needed.
Collapse
Affiliation(s)
- Neel K Bhatt
- 1 Department of Otolaryngology - Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri, USA
| | - Patrik Pipkorn
- 1 Department of Otolaryngology - Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri, USA
| | - Randal C Paniello
- 1 Department of Otolaryngology - Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri, USA
| |
Collapse
|
16
|
Abstract
PURPOSE OF REVIEW Bell's palsy is a common outpatient problem, and while the diagnosis is usually straightforward, a number of diagnostic pitfalls can occur, and a lengthy differential diagnosis exists. Recognition and management of Bell's palsy relies on knowledge of the anatomy and function of the various motor and nonmotor components of the facial nerve. Avoiding diagnostic pitfalls relies on recognizing red flags or features atypical for Bell's palsy, suggesting an alternative cause of peripheral facial palsy. RECENT FINDINGS The first American Academy of Neurology (AAN) evidence-based review on the treatment of Bell's palsy in 2001 concluded that corticosteroids were probably effective and that the antiviral acyclovir was possibly effective in increasing the likelihood of a complete recovery from Bell's palsy. Subsequent studies led to a revision of these recommendations in the 2012 evidence-based review, concluding that corticosteroids, when used shortly after the onset of Bell's palsy, were "highly likely" to increase the probability of recovery of facial weakness and should be offered; the addition of an antiviral to steroids may increase the likelihood of recovery but, if so, only by a very modest effect. SUMMARY Bell's palsy is characterized by the spontaneous acute onset of unilateral peripheral facial paresis or palsy in isolation, meaning that no features from the history, neurologic examination, or head and neck examination suggest a specific or alternative cause. In this setting, no further testing is necessary. Even without treatment, the outcome of Bell's palsy is favorable, but treatment with corticosteroids significantly increases the likelihood of improvement.
Collapse
|
17
|
Acute Facial Nerve Palsy With Ipsilateral Soft Palate Ulcers. J Oral Maxillofac Surg 2017; 75:1906-1914. [DOI: 10.1016/j.joms.2017.02.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 02/19/2017] [Accepted: 02/21/2017] [Indexed: 11/20/2022]
|
18
|
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.
Collapse
|
19
|
Benefits of High-dose Steroid + Hespander + Mannitol Administration in the Treatment of Bell's Palsy. Otol Neurotol 2017; 38:272-277. [DOI: 10.1097/mao.0000000000001307] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
20
|
Oral Biofluid Biomarker Research: Current Status and Emerging Frontiers. Diagnostics (Basel) 2016; 6:diagnostics6040045. [PMID: 27999326 PMCID: PMC5192520 DOI: 10.3390/diagnostics6040045] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/15/2016] [Accepted: 12/07/2016] [Indexed: 12/24/2022] Open
Abstract
Salivary diagnostics is a rapidly advancing field that offers clinicians and patients the potential of rapid, noninvasive diagnostics with excellent accuracy. In order for the complete realization of the potential of saliva, however, extensive profiling of constituents must be conducted and diagnostic biomarkers must be thoroughly validated. This article briefly overviews the process of conducting a study of salivary biomarkers in a patient cohort and highlights the studies that have been conducted on different classes of molecules in the saliva. Emerging frontiers in salivary diagnostics research that may significantly advance the field will also be highlighted.
Collapse
|
21
|
Stjernquist-Desatnik A, Skoog E, Aurelius E. Detection of Herpes Simplex and Varicella-Zoster Viruses in Patients with Bell's Palsy by the Polymerase Chain Reaction Technique. Ann Otol Rhinol Laryngol 2016; 115:306-11. [PMID: 16676828 DOI: 10.1177/000348940611500410] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Infectious causes of peripheral facial paralysis are well known. Bell's palsy, however, is an idiopathic facial paralysis, and the genesis is still unknown. Herpes simplex virus type 1 (HSV-1) and varicella-zoster virus (VZV) have been suggested as etiologic agents. Methods: Twenty consecutive adult patients with Bell's palsy were included in the study. Ten adult patients operated on for chronic otitis served as controls. A biopsy specimen from the posterior auricular muscle was resected within 72 hours after the onset of Bell's palsy and was analyzed together with cerebrospinal fluid (CSF) by nested polymerase chain reaction for HSV-1 and VZV DNA. Serum samples were analyzed for antibodies to HSV-1 and VZV. Results: HSV-1 DNA was found in the muscle biopsy specimen from 1 of the 20 patients, but was not found in any of the CSF samples. VZV DNA was detected in the muscle biopsy as well as the CSF from 1 other patient. All controls were negative. Seventeen of 19 patients had stationary serum antibody concentrations to HSV-1, and none displayed an antibody titer rise. A significant antibody titer rise to VZV was found in 1 of 19 patients, whereas 17 of 19 had stationary antibody levels. Conclusions: HSV-1 or VZV DNA was detected in 10% of patients with Bell's palsy in the present study. Viral replication might already have declined in many cases at the onset of the palsy. Use of an HSV-1/VZV polymerase chain reaction on a muscle biopsy specimen or CSF does not seem to be the method of choice for rapid etiologic diagnosis in the acute phase of Bell's palsy.
Collapse
|
22
|
Facial nerve palsy including Bell's palsy: Case definitions and guidelines for collection, analysis, and presentation of immunisation safety data. Vaccine 2016; 35:1972-1983. [PMID: 27235092 DOI: 10.1016/j.vaccine.2016.05.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 05/09/2016] [Indexed: 12/17/2022]
|
23
|
Comparison of acyclovir and famciclovir for the treatment of Bell's palsy. Eur Arch Otorhinolaryngol 2016; 273:3083-90. [PMID: 26873601 DOI: 10.1007/s00405-016-3927-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 02/04/2016] [Indexed: 10/22/2022]
Abstract
The relative effectiveness of acyclovir and famciclovir in the treatment of Bell's palsy is unclear. This study therefore compared recovery outcomes in patients with Bell's palsy treated with acyclovir and famciclovir. The study cohort consisted of patients with facial palsy who visited the outpatient clinic between January 2006 and January 2014. Patients were treated with prednisolone plus either acyclovir (n = 457) or famciclovir (n = 245). Patient outcomes were measured using the House-Brackmann scale according to initial severity of disease and underlying disease. The overall recovery rate tended to be higher in the famciclovir than in the acyclovir group. The rate of recovery in patients with initially severe facial palsy (grades V and VI) was significantly higher in the famciclovir than in the acyclovir group (p = 0.01), whereas the rates of recovery in patients with initially moderate palsy (grade III-IV) were similar in the two groups. The overall recovery rates in patients without hypertension or diabetes mellitus were higher in the famciclovir than in the acyclovir group, but the difference was not statistically significant. Treatment with steroid plus famciclovir was more effective than treatment with steroid plus acyclovir in patients with severe facial palsy. Famciclovir may be the antiviral agent of choice in the treatment of patients with severe facial palsy.
Collapse
|
24
|
Jeandel A, Thibaud JL, Blot S. Facial and vestibular neuropathy of unknown origin in 16 dogs. J Small Anim Pract 2016; 57:74-8. [DOI: 10.1111/jsap.12428] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 09/14/2015] [Accepted: 10/27/2015] [Indexed: 11/28/2022]
Affiliation(s)
- A. Jeandel
- Neurology Unit & UPR de Neurobiologie, Ecole nationale vétérinaire d'Alfort; Université Paris-Est Créteil; 94700 Maisons Alfort France
| | | | - S. Blot
- Neurology Unit & UPR de Neurobiologie, Ecole nationale vétérinaire d'Alfort; Université Paris-Est Créteil; 94700 Maisons Alfort France
| |
Collapse
|
25
|
Kim SH, Ryu EW, Yang CW, Yeo SG, Park MS, Byun JY. The prognostic value of electroneurography of Bell's palsy at the orbicularis oculi versus nasolabial fold. Laryngoscope 2015; 126:1644-8. [PMID: 26466560 DOI: 10.1002/lary.25709] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 08/06/2015] [Accepted: 09/09/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS We compared the prognostic value of different placements measured by electroneurography (ENoG) in Bell's palsy, especially among patients with poor results on ENoG. STUDY DESIGN Retrospective study using electrodiagnostic data and medical chart review from August 2006 to June 2013 was performed of patients who were diagnosed with Bell's palsy. METHODS We included 81 patients treated from August 2006 to June 2013. Initial and final facial function was established clinically by the House-Brackmann scale. Final state of facial palsy was estimated after 6 months from onset of facial palsy. Patients with less than 10% of ENoG response (more than 90% degeneration) were divided into three groups according to ENoG response by electrode placement as follows: group A, ENoG for orbicularis oculi (oculi) ≥ 10% and ENoG for nasolabial fold (NLF) < 10%; group B, ENoG (oculi) < 10% and ENoG (NLF) ≥ 10%; and group C, ENoG (oculi) < 10% and ENoG (NLF) < 10%. RESULTS There were no differences in demographic data among the three groups in terms of age, gender, initial paralysis, and days from the onset to ENoG. The complete/nearly complete recovery rates were the following: group A, 49.9%; group B, 75%; group C, 32%. The overall incomplete recovery rate in groups A and C was significantly worse than group B, and group C was the worst (P < 0.05). CONCLUSION The results suggest that ENoG of the NLF has more prognostic value in the outcomes of Bell's palsy than ENoG of the oculi, with poorest results in patients with the NLF < 10%. LEVEL OF EVIDENCE 4. Laryngoscope, 126:1644-1648, 2016.
Collapse
Affiliation(s)
- Sang Hoon Kim
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Eun Woong Ryu
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Chul Won Yang
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Seung Geun Yeo
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Moon Suh Park
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jae Yong Byun
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| |
Collapse
|
26
|
Ng SY, Chu MHE. Treatment of Bell's Palsy Using Monochromatic Infrared Energy: A Report of 2 Cases. J Chiropr Med 2015; 13:96-103. [PMID: 25685117 DOI: 10.1016/j.jcm.2014.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 03/19/2014] [Accepted: 04/14/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE The purpose of the study is to describe the use of monochromatic infrared energy (MIRE) therapy in the management of 2 patients with Bell's palsy. CLINICAL FEATURES Two patients presented to a chiropractic clinic with Bell's palsy that was diagnosed by a medical physician. Both patients were treated using MIRE. The acute patient was a 32-year-old male. He presented with left facial palsy 1 day before the consultation. He was unable to puff the left cheek and close the left eyelid. He had difficulty raising the left eyebrow. The chronic case was a 46-year-old lady. Prior to the first consultation, she was treated with corticosteroid and electro-acupuncture for one and a half years, with incomplete recovery. When first seen, the left corner of mouth drooped and she had difficulty raising her left eyebrow. INTERVENTION AND OUTCOME Monochromatic infrared energy therapy, emitting 890 nm infrared light, was placed on the post-auricular area, pre-auricular area, the temple and mandibular area of the affected side. Each treatment lasted 30 minutes. Photographs were taken every week to document changes. The acute case received 19 treatments in 6 weeks. He reported an improvement of 95%. The chronic case received a total of 45 treatments in 9 months. She rated an improvement of 50%. At the conclusion of treatment, she was able to close her left eyelid and puff her left cheek but still could not raise her left eyebrow. CONCLUSION These 2 patients seemed to respond to a different degree to the MIRE therapy. As 71% of patients with Bell's palsy recover uneventfully without any treatment, the present study describes the course of care but cannot confirm the effectiveness of MIRE therapy in the management of Bell's palsy.
Collapse
Affiliation(s)
- Shu Yan Ng
- Private practice, Wanchai Chiropractic Clinic, Hong Kong, China
| | - Ming Him E Chu
- Private practice, Wanchai Chiropractic Clinic, Hong Kong, China
| |
Collapse
|
27
|
Esaki S, Yamano K, Katsumi S, Minakata T, Murakami S. Facial nerve palsy after reactivation of herpes simplex virus type 1 in diabetic mice. Laryngoscope 2014; 125:E143-8. [PMID: 25359410 DOI: 10.1002/lary.24994] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Bell's palsy is highly associated with diabetes mellitus (DM). Either the reactivation of herpes simplex virus type 1 (HSV-1) or diabetic mononeuropathy has been proposed to cause the facial paralysis observed in DM patients. However, distinguishing whether the facial palsy is caused by herpetic neuritis or diabetic mononeuropathy is difficult. We previously reported that facial paralysis was aggravated in DM mice after HSV-1 inoculation of the murine auricle. In the current study, we induced HSV-1 reactivation by an auricular scratch following DM induction with streptozotocin (STZ). STUDY DESIGN Controlled animal study. METHODS Diabetes mellitus was induced with streptozotocin injection in only mice that developed transient facial nerve paralysis with HSV-1. Recurrent facial palsy was induced after HSV-1 reactivation by auricular scratch. RESULTS After DM induction, the number of cluster of differentiation 3 (CD3)(+) T cells decreased by 70% in the DM mice, and facial nerve palsy recurred in 13% of the DM mice. Herpes simplex virus type 1 deoxyribonucleic acid (DNA) was detected in the facial nerve of all of the DM mice with palsy, and HSV-1 capsids were found in the geniculate ganglion using electron microscopy. Herpes simplex virus type 1 DNA was also found in some of the DM mice without palsy, which suggested the subclinical reactivation of HSV-1. CONCLUSIONS These results suggested that HSV-1 reactivation in the geniculate ganglion may be the main causative factor of the increased incidence of facial paralysis in DM patients.
Collapse
Affiliation(s)
- Shinichi Esaki
- Department of Otolaryngology, Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences and Medical School, Nagoya, Japan; Department of Virology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | | | | | | | | |
Collapse
|
28
|
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.
Collapse
|
29
|
Salivary biomarkers: toward future clinical and diagnostic utilities. Clin Microbiol Rev 2014; 26:781-91. [PMID: 24092855 DOI: 10.1128/cmr.00021-13] [Citation(s) in RCA: 349] [Impact Index Per Article: 34.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The pursuit of timely, cost-effective, accurate, and noninvasive diagnostic methodologies is an endeavor of urgency among clinicians and scientists alike. Detecting pathologies at their earliest stages can significantly affect patient discomfort, prognosis, therapeutic intervention, survival rates, and recurrence. Diagnosis and monitoring often require painful invasive procedures such as biopsies and repeated blood draws, adding undue stress to an already unpleasant experience. The discovery of saliva-based microbial, immunologic, and molecular biomarkers offers unique opportunities to bypass these measures by utilizing oral fluids to evaluate the condition of both healthy and diseased individuals. Here we discuss saliva and its significance as a source of indicators for local, systemic, and infectious disorders. We highlight contemporary innovations and explore recent discoveries that deem saliva a mediator of the body's physiological condition. Additionally, we examine the current state of salivary diagnostics and its associated technologies, future aspirations, and potential as the preferred route of disease detection, monitoring, and prognosis.
Collapse
|
30
|
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
| |
Collapse
|
31
|
Youshani AS, Mehta B, Davies K, Beer H, De S. Management of Bell's palsy in children: an audit of current practice, review of the literature and a proposed management algorithm. Emerg Med J 2013; 32:274-80. [PMID: 24317290 DOI: 10.1136/emermed-2013-202385] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE We carried out a complete audit cycle, reviewing our management of paediatric patients with Bell's palsy within 72 h of symptom onset. Our protocol was published after the initial audit in 2009, and a re-audit was carried out in 2011. We aimed to improve our current practice in accordance with up-to-date evidence-based research on the use of steroids and antivirals. PATIENTS AND METHODS A total of 17 patients were included in the first cycle, but only eight patients met our inclusion and exclusion criteria for the re-audit. We assessed documentation of House-Brackmann (HB) grade on presentation, initial treatment, follow-up and recovery. RESULTS The first cycle revealed inconsistent management with steroids (41%), antivirals (6%), steroids and antivirals (6%) or nothing at all (47%). In addition, only 65% of patients were followed-up in the ear, nose and throat (ENT) clinic. Our management protocol was published in 2010, and a re-audit was completed. Our results showed 100% compliance with steroid treatment and 100% follow-up with the ENT team. A thorough literature review revealed some additional benefit from the use of antivirals. CONCLUSIONS At present there is insufficient evidence to discount the use of steroids and antivirals. Therefore, with our new management protocol, we recommend the use of steroids in patients presenting within 72 h of symptom onset, and antivirals for patients with a HB grade of IV or higher.
Collapse
Affiliation(s)
- Amir Saam Youshani
- Department of Otolaryngology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Bimal Mehta
- Department of Accident & Emergency, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Katharine Davies
- Department of Otolaryngology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Helen Beer
- Department of Otolaryngology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Sujata De
- Department of Otolaryngology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| |
Collapse
|
32
|
Pons Y, Ukkola-Pons E, Ballivet de Régloix S, Champagne C, Raynal M, Lepage P, Kossowski M. La paralysie faciale périphérique. J Fr Ophtalmol 2013; 36:548-53. [DOI: 10.1016/j.jfo.2013.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 02/03/2013] [Accepted: 02/07/2013] [Indexed: 10/26/2022]
|
33
|
Pavlou E, Gkampeta A, Arampatzi M. Facial nerve palsy in childhood. Brain Dev 2012; 34:405; author reply 406-7. [PMID: 22230787 DOI: 10.1016/j.braindev.2011.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 12/03/2011] [Indexed: 12/01/2022]
|
34
|
A cell culture model of facial palsy resulting from reactivation of latent herpes simplex type 1. Otol Neurotol 2012; 33:87-92. [PMID: 22158020 DOI: 10.1097/mao.0b013e31823dbb20] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HYPOTHESIS Reactivation of herpes simplex virus type 1 (HSV-1) in geniculate ganglion neurons (GGNs) is an etiologic mechanism of Bell's palsy (BP) and delayed facial palsy (DFP) after otologic surgery. BACKGROUND Several clinical studies, including temporal bone studies, antibody, titers, and intraoperative studies, suggest that reactivation of HSV-1 from latently infected GGNs may lead to both BP and DFP. However, it is difficult to study these processes in humans or live animals. METHODS Primary cultures of GGNs were latently infected with Patton strain HSV-1 expressing a green fluorescent protein-late lytic gene chimera. Four days later, these cultures were treated with trichostatin A (TSA), a known chemical reactivator of HSV-1 in other neurons. Cultures were monitored daily by fluorescent microscopy. Titers of media from lytic, latent, and latent/TSA treated GGN cultures were obtained using plaque assays on Vero cells. RNA was harvested from latently infected GGN cultures and examined for the presence of viral transcripts using reverse transcription-polymerase chain reaction. RESULTS Latently infected GGN cultures displayed latency-associated transcripts only, whereas lytically infected and reactivated latent cultures produced other viral transcripts, as well. The GGN cultures displayed a reactivation rate of 65% after treatment with TSA. Media from latently infected cultures contained no detectable infectious HSV-1, whereas infectious virus was observed in both lytically and latently infected/TSA-treated culture media. CONCLUSION We have shown that cultured GGNs can be latently infected with HSV-1, and HSV-1 in these latently infected neurons can be reactivated using TSA, yielding infectious virus. These results have implications for the cause of both BP and DFP.
Collapse
|
35
|
Harishankar A, Jambulingam M, Gowrishankar R, Venkatachalam A, Vetrivel U, Ravichandran S, Yesupadam SM, Madhavan HNR. Phylogenetic comparison of exonic US4, US7 and UL44 regions of clinical herpes simplex virus type 1 isolates showed lack of association between their anatomic sites of infection and genotypic/sub genotypic classification. Virol J 2012; 9:65. [PMID: 22416856 PMCID: PMC3359161 DOI: 10.1186/1743-422x-9-65] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 03/14/2012] [Indexed: 11/21/2022] Open
Abstract
Background HSV-1 genome is a mosaic of recombinants. Clinical Herpes simplex virus -1 (HSV1) isolates were already genotyped as A, B and C types based on nucleotide variations at Unique Short (US) 4 (gG) and US 7 (gI) regions through phylogeny. Analysis of Glycoprotein C (gC) exon present on the Unique Long (UL) region had also revealed the existence of different genotypes. Glycoprotein C is mainly involved in initial viral attachment to heparan sulphate on host cell surface facilitating the virus's binding and penetration into cell. As the amount of heparan sulphate on the host cell surface varies according to the cell type, it is plausible that different genotypes bind differentially to cell types. Hence, this study was framed to determine the existence of novel genotypes/sub genotypes in the US or UL regions which could associate with clinical entities. Results All the twenty five isolates analyzed in this study were of genotype A as per their gG gene sequences. In case of gI gene, 16 out of 25 were found to be type A and the remaining nine were type B putative intergenic recombinants. Intragenic recombinations were also encountered in both the US genes, with gG possessing novel subgenotypes, arbitrarily designated A1 and A2. The 9 type B isolates of gI genes also branched out into 2 clades due to genetic variations. Glycoprotein C of UL region had two distinct genotypic clades α and β, whose topological distribution was significantly different from that of the US region. Neither the US nor UL regions, however, showed any preference among the genotypes to a specific anatomic site of infection. Even the non synonymous variations identified in the functional domain of gC, were not confined to a particular genotype/clinical entity. Conclusion The analyses of the US and UL regions of the HSV-1 genome showed the existence of variegated genotypes in these two regions. In contrary to the documented literature, in which Asian strains were concluded as more conserved than European ones, our study showed the existence of a higher degree of variability among Indian strains. However, the identified novel genotypes and subgenotypes were not found associated with clinical entities.
Collapse
Affiliation(s)
- Anusha Harishankar
- Larsen & Toubro Microbiology Research Centre, Sankara Nethralaya, No,18, College Road, Chennai 600006, India
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Tsai J, Cohrs RJ, Nagel MA, Mahalingam R, Schmid DS, Choe A, Gilden D. Reactivation of type 1 herpes simplex virus and varicella zoster virus in an immunosuppressed patient with acute peripheral facial weakness. J Neurol Sci 2011; 313:193-5. [PMID: 21924743 DOI: 10.1016/j.jns.2011.08.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 08/23/2011] [Accepted: 08/29/2011] [Indexed: 12/29/2022]
Abstract
We describe a 26-year-old man treated with azathioprine for myasthenia gravis who developed acute left-sided peripheral facial weakness. Brain magnetic resonance imaging (MRI) revealed enhancement in the left geniculate ganglion and in the intracanalicular and tympanic segments of the facial nerve. Analysis of cerebrospinal fluid (CSF) and serum revealed intrathecal synthesis of anti-varicella zoster virus (VZV) IgG antibody. Although previous analyses of saliva, blood mononuclear cells, serum antibodies, middle ear fluid, and auricular and geniculate zone skin scrapings have shown that a small but definite proportion of patients with idiopathic peripheral facial palsy ("Bell's palsy") have the Ramsay Hunt syndrome zoster sine herpete (RHS ZSH), this is the first confirmation of RHS ZSH by intrathecal synthesis of anti-VZV IgG antibody. In addition, herpes simplex virus (HSV)-1 DNA was found in saliva of the patient on 3 consecutive days. Simultaneous reactivation of two alphaherpesviruses (HSV-1 and VZV) in our immunosuppressed patient underscores the need to consider opportunistic infection as a cause of facial weakness.
Collapse
Affiliation(s)
- Jean Tsai
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | | | | | | | | | | | | |
Collapse
|
37
|
Parálisis facial asociada a eritema multiforme por virus del herpes simple. An Pediatr (Barc) 2011; 75:210-2. [DOI: 10.1016/j.anpedi.2011.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 03/14/2011] [Accepted: 03/28/2011] [Indexed: 11/19/2022] Open
|
38
|
Pavlou E, Gkampeta A, Arampatzi M. Facial nerve palsy in childhood. Brain Dev 2011; 33:644-50. [PMID: 21144684 DOI: 10.1016/j.braindev.2010.11.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 11/09/2010] [Accepted: 11/10/2010] [Indexed: 01/08/2023]
Abstract
Facial nerve palsy in children is usually idiopathic but can also result from many conditions such as neoplasias, systemic diseases, or congenital anomalies with poor prognosis. Children with idiopathic facial palsy (Bell's palsy) have a very good prognosis, while treatment with prednisone does not certainly improve the outcome. The causes of facial nerve palsy in childhood differ from those in adults. A detailed investigation and differential diagnosis are recommended for facial palsy in children.
Collapse
Affiliation(s)
- Evangelos Pavlou
- 2nd Department of Pediatrics, Aristotle University of Thessaloniki, AHEPA General Hospital, Thessaloniki, Greece.
| | | | | |
Collapse
|
39
|
Lackner A, Kessler HH, Walch C, Quasthoff S, Raggam RB. Early and reliable detection of herpes simplex virus type 1 and varicella zoster virus DNAs in oral fluid of patients with idiopathic peripheral facial nerve palsy: Decision support regarding antiviral treatment? J Med Virol 2010; 82:1582-5. [PMID: 20648613 DOI: 10.1002/jmv.21849] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Idiopathic peripheral facial nerve palsy has been associated with the reactivation of herpes simplex virus type 1 (HSV-1) or varicella zoster virus (VZV). In recent studies, detection rates were found to vary strongly which may be caused by the use of different oral fluid collection devices in combination with molecular assays lacking standardization. In this single-center pilot study, liquid phase-based and absorption-based oral fluid collection was compared. Samples were collected with both systems from 10 patients with acute idiopathic peripheral facial nerve palsy, 10 with herpes labialis or with Ramsay Hunt syndrome, and 10 healthy controls. Commercially available IVD/CE-labeled molecular assays based on fully automated DNA extraction and real-time PCR were employed. With the liquid phase-based oral fluid collection system, three patients with idiopathic peripheral facial nerve palsy tested positive for HSV-1 DNA and another two tested positive for VZV DNA. All patients with herpes labialis tested positive for HSV-1 DNA and all patients with Ramsay Hunt syndrome tested positive for VZV DNA. With the absorption-based oral fluid collection system, detections rates and viral loads were found to be significantly lower when compared to those obtained with the liquid phase-based collection system. Collection of oral fluid with a liquid phase-based system and the use of automated and standardized molecular methods allow early and reliable detection of HSV-1 and VZV DNAs in patients with acute idiopathic peripheral facial nerve palsy and may provide a valuable decision support regarding start of antiviral treatment at the first clinical visit.
Collapse
Affiliation(s)
- Andreas Lackner
- Department of Neurotology, Medical University of Graz, 8036 Graz, Austria
| | | | | | | | | |
Collapse
|
40
|
Norberg P. Divergence and genotyping of human alpha-herpesviruses: an overview. INFECTION GENETICS AND EVOLUTION 2009; 10:14-25. [PMID: 19772930 DOI: 10.1016/j.meegid.2009.09.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2009] [Revised: 09/08/2009] [Accepted: 09/14/2009] [Indexed: 11/30/2022]
Abstract
Herpesviruses are large DNA viruses that are highly disseminated among animals. Of the eight herpesviruses identified in humans, three are classified into the alpha-herpesvirus subfamily: herpes simplex virus types 1 (HSV-1) and 2 (HSV-2), which are typically associated with mucocutaneous lesions, and varicella-zoster virus (VZV), which is the cause of chicken pox and herpes zoster. All three viruses establish lifelong infections and may also induce more severe symptoms, such as neurological manifestations and fatal neonatal infections. Despite thorough investigation of the genetic variability among circulating strains of each virus in recent decades, little is known about possible associations between the genetic setups of the viruses and clinical manifestations in human hosts. This review focuses mainly on evolutionary studies of and genotyping strategies for these three human alpha-herpesviruses, emphasizing the ambiguities induced by a high frequency of circulating recombinant strains. It also aims to shed light on the challenges of establishing a uniform genotyping strategy for all three viruses.
Collapse
Affiliation(s)
- Peter Norberg
- Dept. of Cell and Molecular Biology, Microbiology, University of Gothenburg, Box 462, 405 30 Gothenburg, Sweden.
| |
Collapse
|
41
|
Tankéré F, Bernat I. Paralysie faciale a frigore : de l’étiologie virale à la réalité diagnostique. Rev Med Interne 2009; 30:769-75. [DOI: 10.1016/j.revmed.2008.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 11/22/2008] [Accepted: 12/17/2008] [Indexed: 10/21/2022]
|
42
|
Abstract
BACKGROUND The most common disorder of the facial nerve is acute idiopathic facial paralysis or Bell's palsy and there may be significant morbidity or incomplete recovery associated with severe cases. OBJECTIVES To assess the efficacy of aciclovir or similar agents for treating Bell's palsy. SEARCH STRATEGY We searched the Cochrane Neuromuscular Disease Group register (searched April 2003), MEDLINE (from January 1966 to April 2003), EMBASE (from January 1980 to April 2003) and LILACS (from January 1982 to April 2003). We also contacted authors of identified trials. SELECTION CRITERIA Randomised or quasi-randomised trials of aciclovir or valaciclovir therapy, alone or in combination with any other drug, in patients with Bell's palsy. DATA COLLECTION AND ANALYSIS We identified six randomised trials. MAIN RESULTS Three studies met our inclusion criteria, including 246 patients. One study evaluated aciclovir with corticosteroid versus corticosteroid alone, another study evaluated aciclovir alone versus corticosteroid and a further study evaluated valaciclovir with corticosteroid versus corticosteroid alone or versus placebo alone. Incomplete recovery after one year: data were not available. An analysis was performed on data reported at the end of the study period in each trial. The results from one study four months after the start of treatment significantly favoured the treatment group, whilst the results of the study three months after the start of treatment significantly favoured the control group. The results from the second study at four months showed no statistically significant difference between the three groups.Adverse events: relevant data were not reported in any of the three trials.Complete facial paralysis six months after start of treatment: only one patient had complete paralysis upon entering one of the studies. This patient was assigned to the control group and the level of recovery attained was not reported.Motor synkinesis or crocodile tears one year after start of treatment: data were available up to a maximum of four months after onset of paralysis. One study reported a significant difference between the treatment groups in favour of the aciclovir plus corticosteroid group over corticosteroid alone, another demonstrated an inconclusive result with no difference between the aciclovir and corticosteroid. The third study did not comment upon these sequelae. AUTHORS' CONCLUSIONS More data are needed from a large multicentre randomised controlled and blinded study with at least 12 months' follow up before a definitive recommendation can be made regarding the effect of aciclovir or valaciclovir on Bell's palsy. Two trials, one with 551 participants comparing prednisolone with acyclovir with both and with neither, another with 221 participants comparing prednisolone and valacyclovir with prednisolone and placebo have just been published and will be included in an update of this review.
Collapse
Affiliation(s)
- David Allen
- Department of Clinical Neurophysiology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK, WC1N 3BG
| | | |
Collapse
|
43
|
Tyler KL. Prednisolone--but not antiviral drugs--improves outcome in patients with Bell's palsy. ACTA ACUST UNITED AC 2009; 5:74-5. [PMID: 19139743 DOI: 10.1038/ncpneuro1002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 12/03/2008] [Indexed: 11/09/2022]
Abstract
Randomized, double-blind, placebo-controlled trials have provided compelling evidence that treatment with prednisolone improves outcome in patients with acute idiopathic peripheral facial (Bell's) palsy. The low rate of adverse effects, the small number needed to treat, and the modest cost of therapy indicate that prednisolone should be used in all patients with facial palsy of <72 h duration who do not have contraindications to steroid therapy. By contrast, the best-designed recent clinical trials have failed to suggest any significant beneficial effect on Bell's palsy of treatment with acyclovir or valacyclovir, either as single agents or in combination with prednisolone. Antiviral therapy should not, therefore, be routinely used in the treatment of Bell's palsy.
Collapse
Affiliation(s)
- Kenneth L Tyler
- University of Colorado Denver Health Sciences Center, Aurora, CO 80045, USA.
| |
Collapse
|
44
|
Abstract
PURPOSE Facial nerve injury can occur in the regions ranging from the cerebral cortex to the motor end plate in the face, and from many causes including trauma, viral infection, and idiopathic factors. Facial nerve paralysis in children, however, may differ from that in adults. We, therefore, evaluated its etiology and recovery rate in children and adults. MATERIALS AND METHODS We retrospectively evaluated the records of 975 patients, ranging in age from 0 to 88 years, who displayed facial palsy at Kyung Hee Medical Center between January 1986 and July 2005. RESULTS The most frequent causes of facial palsy in adults were Bell's palsy (54.9%), infection (26.8%), trauma (5.9%), iatrogenic (2.0%), and tumors (1.8%), whereas the most frequent causes of facial palsy in children were Bell's palsy (66.2%), infection (14.6%), trauma (13.4%), birth trauma (3.2%), and leukemia (1.3%). Recovery rates in adults were 91.4% for Bell's palsy, 89.0% for infection, and 64.3% for trauma, whereas recovery rates in children were 93.1% for Bell's palsy, 90.9% for infection, and 42.9% for trauma. CONCLUSION These results show that causes of facial palsy are similar in adults and children, and recovery rates in adults and children are not significantly different.
Collapse
Affiliation(s)
- Chang Il Cha
- Department of Otolaryngology, The College of Medicine, Kyung Hee University, Seoul, Korea
| | - Chang Kee Hong
- Department of Otolaryngology, The College of Medicine, Kyung Hee University, Seoul, Korea
| | - Moon Suh Park
- Department of Otolaryngology, The College of Medicine, Kyung Hee University, Seoul, Korea
| | - Seung Geun Yeo
- Department of Otolaryngology, The College of Medicine, Kyung Hee University, Seoul, Korea
| |
Collapse
|
45
|
Hato N, Sawai N, Teraoka M, Wakisaka H, Takahashi H, Hinohira Y, Gyo K. Valacyclovir for the treatment of Bell's palsy. Expert Opin Pharmacother 2008; 9:2531-6. [DOI: 10.1517/14656566.9.14.2531] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
46
|
Takeda T, Takeda S, Takumida M, Okada T, Kakigi A, Nakatani H, Hamada M, Yamakawa K. Protective effects of edaravone against ischemia-induced facial palsy. Auris Nasus Larynx 2008; 35:321-7. [DOI: 10.1016/j.anl.2007.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2007] [Revised: 07/09/2007] [Accepted: 08/01/2007] [Indexed: 11/28/2022]
|
47
|
Liu J, Li Y, Yuan X, Yang Z, Lin Z. Sodium beta-aescin may be an effective therapeutic agent for Bell's palsy. Med Hypotheses 2008; 71:762-4. [PMID: 18762387 DOI: 10.1016/j.mehy.2008.07.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2008] [Revised: 06/29/2008] [Accepted: 07/02/2008] [Indexed: 11/17/2022]
Abstract
Although Bell's palsy is the most common acute facial paralysis, the cause of it is still unknown. This made the treatment for it remain very limited. Many methods are simply symptomatic treatment. Up to now we have known that Bell's palsy is related to viral infection and the pathomechanism of Bell's palsy involves inflammatory oedema and entrapment neuropathy in the narrow bony facial canal. So treatment plans for Bell's palsy mainly focus on antiviral therapy, relieving inflammatory oedema and accelerating facial nerve recovery. Sodium beta-aescin is derived from horse chestnut and its major constituent is aescigenin which has been approved by China national drug standard. The pharmacologic action of sodium beta-aescin is to relieve tissue oedema, recover vasopermeability and eliminate pressure caused by oedema. Nowadays sodium beta-aescin has been widely used clinically for encephaledema or tumefaction caused by trauma or operation. It also can be used for treating disease of digestive system and increasing intravenous tension and improving microcirculation. Although many papers had been published on the anti-edema effects of sodium beta-aescin, little was known about the effects in treating oedema complicated by Bell's palsy.
Collapse
Affiliation(s)
- Jiaqiang Liu
- Department of Orthodontics, The Fourth Military Medical University, No. 145, Changle xi Road, Xi'an, Shaanxi Province 710032, People's Republic of China
| | | | | | | | | |
Collapse
|
48
|
Affiliation(s)
- Naohito Hato
- Department of Otolaryngology, Ehime University School of Medicine, Ehime 7910295, Japan.
| | | | | |
Collapse
|
49
|
Acyclovir plus steroid vs steroid alone in the treatment of Bell's palsy. Am J Otolaryngol 2008; 29:163-6. [PMID: 18439948 DOI: 10.1016/j.amjoto.2007.05.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Revised: 04/19/2007] [Accepted: 05/01/2007] [Indexed: 11/20/2022]
Abstract
PURPOSE The pathogenetic mechanism of Bell's palsy is thought to involve herpes simplex virus reactivation within the geniculate ganglion, followed by inflammation and entrapment of the nerve at the meatal foramen. We therefore compared the therapeutic effect of acyclovir plus steroid vs steroid alone, in combination with physical therapy, in patients with Bell's palsy. MATERIALS AND METHODS In a double-blind, randomized, prospective trial, 91 patients were randomized to treatment with acyclovir and prednisone (44 patients) or prednisone alone (47 patients). All patients underwent physical therapy. The follow-up period was greater than 6 months or encompassed the period of complete recovery from paralysis. House-Brackmann grade was evaluated 2 and 6 months after onset, with complete and satisfactory recovery defined as House-Brackmann grades I and II, respectively. RESULTS The overall recovery rate of patients treated with steroid and acyclovir (93.1%) was greater than that of patients treated with steroid alone (85.1%), but the difference was not statistically significant. CONCLUSION The benefit of acyclovir in Bell's palsy has not been definitively established.
Collapse
|
50
|
Association between herpes simplex virus-1 infection and idiopathic unilateral facial paralysis in children and adolescents. Pediatr Infect Dis J 2008; 27:468-9. [PMID: 18360300 DOI: 10.1097/inf.0b013e31816507c3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We studied the association between herpes simplex virus-1 (HSV-1) infection and Bell palsy in children. Thirty-three of 42 affected patients had a positive HSV-1 enzyme-linked immunosorbent assay compared with 16 of 41 controls (P = 0.0003). Ten of 47 affected patients had a positive HSV-1 polymerase chain reaction compared with 4 of 45 of controls (P = 0.08). Our findings support an association between HSV-1 infection and Bell palsy in children.
Collapse
|