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van der Boom MDX, van Eekeren R, van Hunsel FPAM. Observed-over-Expected analysis as additional method for pharmacovigilance signal detection in large-scaled spontaneous adverse event reporting. Pharmacoepidemiol Drug Saf 2023; 32:783-794. [PMID: 36919526 DOI: 10.1002/pds.5610] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/15/2023] [Accepted: 03/08/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND The large-scale COVID-19 vaccination campaigns in 2021 and 2022 led to a rapid increase in numbers of received adverse event reports in spontaneous reporting systems. As background incidences of naturally occurring medical events became increasingly relevant for causality assessment of potential associations with the vaccines, a novel approach for signal detection was warranted. OBJECTIVES This article illustrates the Observed-over-Expected (O/E) analysis as an additional method for signal detection and risk assessment in large-scaled spontaneous reporting systems. METHODS All individual case safety reports (ICSRs) concerning idiopathic peripheral facial paralysis or Bell's palsy following administration of the COVID-19 vaccines (n = 291) manufactured by Pfizer/BioNTech (Comirnaty), Moderna (Spikevax), AstraZeneca (Vaxzevria) and Janssen (JCOVDEN) received by the National Pharmacovigilance Centre Lareb until 24th March 2022 were included in the O/E analysis, within a risk window of 7 and 14 days following immunisation. Dutch background incidence rates from 2019 and exposure of the Dutch population to the vaccines were obtained from the PHARMO institute and RIVM. The data was stratified in age groups, gender and administered dose in order to differentiate between population subgroups. RESULTS Bell's palsy was reported more frequently than expected in several population subgroups following administration of all four COVID-19 vaccines, including children and adolescents. Among children, a high O/E ratio was found for boys aged 5-14 years after receiving the Pfizer/BioNTech vaccine. Regarding adolescents and young adults, women aged 15-24 years receiving Pfizer/BioNTech and Moderna, and men aged 15-24 years receiving Janssen developed Bell's palsy more often than expected. Furthermore, O/E ratios were high for individuals aged 25-64, regarding females receiving Pfizer, Moderna and AstraZeneca and males receiving Janssen. As facial paralysis was not labelled as an adverse event for the Janssen vaccine, this analysis contributed to signalling the association and warranting further regulatory action. CONCLUSIONS The O/E method is a useful approach for signal detection of potential adverse reactions when handling large numbers of ICSRs. Further research is needed to attest to the causality on a clinical basis.
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Affiliation(s)
| | - Rike van Eekeren
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, The Netherlands
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Baude M, Guihard M, Gault-Colas C, Bénichou L, Coste A, Méningaud JP, Schmitz D, Natella PA, Audureau E, Gracies JM. Guided Self-rehabilitation Contract vs conventional therapy in chronic peripheral facial paresis: VISAGE, a multicenter randomized controlled trial. BMC Neurol 2023; 23:148. [PMID: 37038105 PMCID: PMC10084642 DOI: 10.1186/s12883-023-03096-8] [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] [Received: 08/29/2022] [Accepted: 01/27/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND One year after persistent peripheral facial paresis (PFP), prescriptions of conventional rehabilitation are often downgraded into maintenance rehabilitation or discontinued, the patient entering what is seen as a chronic stage. This therapeutic choice is not consistent with current knowledge about behavior-induced plasticity, which is available all life long and may allow intense sensorimotor rehabilitation to remain effective. This prospective, randomized, multicenter single-blind study in subjects with chronic unilateral PFP evaluates changes in facial motor function with a Guided Self-rehabilitation Contract (GSC) vs. conventional therapy alone, carried out for six months. METHODS Eighty-two adult subjects with chronic unilateral PFP (> 1 year since facial nerve injury) will be included in four tertiary, maxillofacial surgery (2), otolaryngology (1) and rehabilitation (1) centers to be randomized into two rehabilitation groups. In the experimental group, the PM&R specialist will implement the GSC method, which for PFP involves intensive series of motor strengthening performed daily on three facial key muscle groups, i.e. Frontalis, Orbicularis oculi and Zygomatici. The GSC strategy involves: i) prescription of a daily self-rehabilitation program, ii) teaching of the techniques involved in the program, iii) encouragement and guidance of the patient over time, in particular by requesting a quantified diary of the work achieved to be returned by the patient at each visit. In the control group, participants will benefit from community-based conventional therapy only, according to their physician's prescription. The primary outcome measure is the composite score of Sunnybrook Facial Grading System. Secondary outcome measures include clinical and biomechanical facial motor function quantifications (Créteil Scale and 3D facial motion analysis through the Cara system), quality of life (Facial Clinimetric Evaluation and Short-Form 12), aesthetic considerations (FACE-Q scale) and mood representations (Hospital Anxiety and Depression scale). Participants will be evaluated every three months by a blinded investigator, in addition to four phone calls (D30/D60/D120/D150) to monitor compliance and tolerance to treatment. DISCUSSION This study will increase the level of knowledge on the effects of intense facial motor streng- Facial paralysisthening prescribed through a GSC in patients with chronic peripheral facial paresis. TRIAL REGISTRATION ClinicalTrials.gov, NCT04074018 . Registered 29 August 2019. PROTOCOL VERSION Version N°4.0-04/02/2021.
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Affiliation(s)
- Marjolaine Baude
- BIOTN Research Unit 7377, Université Paris-Est Créteil (UPEC), 94000, Créteil, France.
- Service de Rééducation Neurolocomotrice, AP-HP, Hôpitaux Universitaires Henri Mondor, 1 Rue Gustave Eiffel, 94000, Créteil, France.
| | - Marina Guihard
- BIOTN Research Unit 7377, Université Paris-Est Créteil (UPEC), 94000, Créteil, France
| | - Caroline Gault-Colas
- Service de Rééducation Neurolocomotrice, AP-HP, Hôpitaux Universitaires Henri Mondor, 1 Rue Gustave Eiffel, 94000, Créteil, France
| | - Ludovic Bénichou
- Hôpital Paris Saint-Joseph, Service de Chirurgie Maxillo-Faciale Stomatologie, 75015, Paris, France
| | - André Coste
- Centre Hospitalier Intercommunal Créteil, Service d'ORL, Stomatologie Et Chirurgie Cervico-Faciale, 94000, Créteil, France
| | - Jean-Paul Méningaud
- AP-HP, Service de Chirurgie Plastique, Reconstructrice, Esthétique Et Maxillo-Faciale, Hôpitaux Universitaires Henri Mondor, 94000, Créteil, France
| | - David Schmitz
- AP-HP, Unité de Recherche Clinique, Hôpitaux Universitaires Henri Mondor, 94000, Créteil, France
| | - Pierre-André Natella
- AP-HP, Unité de Recherche Clinique, Hôpitaux Universitaires Henri Mondor, 94000, Créteil, France
| | - Etienne Audureau
- AP-HP, Unité de Recherche Clinique, Hôpitaux Universitaires Henri Mondor, 94000, Créteil, France
- AP-HP, Service de Santé Publique, Hôpitaux Universitaires Henri Mondor, 94000, Créteil, France
- DHU A-TVB, IRMB- EA 7376 CEpiA (Clinical Epidemiology And Ageing Unit), Université Paris Est-Créteil, 94000, Créteil, France
| | - Jean-Michel Gracies
- BIOTN Research Unit 7377, Université Paris-Est Créteil (UPEC), 94000, Créteil, France
- Service de Rééducation Neurolocomotrice, AP-HP, Hôpitaux Universitaires Henri Mondor, 1 Rue Gustave Eiffel, 94000, Créteil, France
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Peletta A, Lemoine C, Courant T, Collin N, Borchard G. Meeting vaccine formulation challenges in an emergency setting: Towards the development of accessible vaccines. Pharmacol Res 2023; 189:106699. [PMID: 36796463 DOI: 10.1016/j.phrs.2023.106699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/16/2023]
Abstract
Vaccination is considered one of the most successful strategies to prevent infectious diseases. In the event of a pandemic or epidemic, the rapid development and distribution of the vaccine to the population is essential to reduce mortality, morbidity and transmission. As seen during the COVID-19 pandemic, the production and distribution of vaccines has been challenging, in particular for resource-constrained settings, essentially slowing down the process of achieving global coverage. Pricing, storage, transportation and delivery requirements of several vaccines developed in high-income countries resulted in limited access for low-and-middle income countries (LMICs). The capacity to manufacture vaccines locally would greatly improve global vaccine access. In particular, for the development of classical subunit vaccines, the access to vaccine adjuvants is a pre-requisite for more equitable access to vaccines. Vaccine adjuvants are agents required to augment or potentiate, and possibly target the specific immune response to such type of vaccine antigens. Openly accessible or locally produced vaccine adjuvants may allow for faster immunization of the global population. For local research and development of adjuvanted vaccines to expand, knowledge on vaccine formulation is of paramount importance. In this review, we aim to discuss the optimal characteristics of a vaccine developed in an emergency setting by focusing on the importance of vaccine formulation, appropriate use of adjuvants and how this may help overcome barriers for vaccine development and production in LMICs, achieve improved vaccine regimens, delivery and storage requirements.
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Affiliation(s)
- Allegra Peletta
- Section of Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland (ISPSO), University of Geneva, Rue Michel-Servet 1, 1221 Geneva, Switzerland.
| | - Céline Lemoine
- Vaccine Formulation Institute, Rue du Champ-Blanchod 4, 1228 Plan-les-Ouates, Switzerland.
| | - Thomas Courant
- Vaccine Formulation Institute, Rue du Champ-Blanchod 4, 1228 Plan-les-Ouates, Switzerland.
| | - Nicolas Collin
- Vaccine Formulation Institute, Rue du Champ-Blanchod 4, 1228 Plan-les-Ouates, Switzerland.
| | - Gerrit Borchard
- Section of Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland (ISPSO), University of Geneva, Rue Michel-Servet 1, 1221 Geneva, Switzerland.
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Khurshid A, Khurshid M, Sohail A, Raza IM, Ahsan MK, Alam Shah MUF, Taseer AR, Nashwan AJ, Ullah I. Facial palsy as a manifestation of COVID-19: A systematic review of cases. Health Sci Rep 2022; 5:e887. [PMID: 36320650 PMCID: PMC9616168 DOI: 10.1002/hsr2.887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022] Open
Abstract
Background and Aims Facial palsy is a rare complication of the COVID-19 infection. Herein, we conducted a systematic review of all published cases of facial palsy post-COVID-19 infection in an attempt to educate the general population and medical practitioners regarding the likely occurrence of facial palsy in COVID-19 patients, its detection, effective treatment plan, and prognosis of the condition. Methods We searched PubMed, Google Scholar, and Directory of Open Access Journals (DOAJ) from December 1, 2019 to September 21, 2021. Results We included 49 studies bearing accounts of 75 cases who had facial palsy. The mean age of patients was 42.9 ± 19.59 years, with a male-to-female ratio of 8:7. The majority of the cases were reported from Brazil (n = 14), USA (n = 9), Turkey (n = 9), and Spain (n = 9). Noticeably, 30.14% of COVID-19 patients were diagnosed with Guillain-Barré syndrome. In total, 22.97% of patients complained of bilateral facial paralysis (n = 17), whereas ipsilateral paralysis was observed in 77.03% (n = 57). These were common complaints of Lagophthalmos, otalgia, facial drooping, dysarthria, and compromised forehead wrinkling. The treatment regimen mainly included the use of corticosteroids (n = 51) (69.86%), antivirals (n = 23) (31.51%), IVIG (n = 18) (24.66%), antibiotics (n = 13) (17.81%), antiretroviral (n = 9) (12.33%), and antimalarial (n = 8) (10.96%) medications. In all, 35.62% of patients (n = 26) adhered to a combination of antiviral and corticosteroid-based therapy. Positive treatment outcomes were observed in 83.58% (n = 56) of cases. In contrast, 10 patients (14.93%) showed nonsignificant recovery, out of which 3 (4.48%) died from the disease. Conclusion The association of facial palsy with COVID-19 is controversial and therefore requires further investigation and published work to confirm a causal relationship. However, physicians should not overlook the likelihood of facial palsy post-COVID-19 infection and treat it accordingly.
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Affiliation(s)
- Aiman Khurshid
- Department of Forensic Medicine Abbasi Shaheed Hospital Karachi Pakistan
| | - Maman Khurshid
- Department of Internal Medicine Dow University of Health Sciences Karachi Pakistan
| | - Aruba Sohail
- Department of Internal Medicine Dow University of Health Sciences Karachi Pakistan
| | - Imran Mansoor Raza
- Department of Internal Medicine Dow University of Health Sciences Karachi Pakistan
| | | | | | - Anab Rehan Taseer
- Department of Pulmonology, Lady Reading Hospital (LRH) Peshawar Pakistan
| | | | - Irfan Ullah
- Kabir Medical College Gandhara University Peshawar Pakistan
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Mussatto CC, Sokol J, Alapati N. Bell's palsy following COVID-19 vaccine administration in HIV+ patient. Am J Ophthalmol Case Rep 2022; 25:101259. [PMID: 35075436 PMCID: PMC8769876 DOI: 10.1016/j.ajoc.2022.101259] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/13/2022] [Indexed: 11/02/2022] Open
Abstract
Purpose COVID-19 immunizations are novel and there is widespread public concern for the lack of data on their potential adverse effects. Cases of Bell's palsy following COVID-19 vaccination were reported disproportionately in the vaccine group during phase 3 clinical trials and have now been reported multiple times post-licensure. The U.S. Food and Drug Administration has stated the frequency of Bell's palsy in the vaccine group is consistent with the expected background rate of Bell's palsy in the population but recommends "surveillance for cases of Bell's palsy with deployment of the vaccine into larger populations."1 Here we present a case of Bell's palsy following Pfizer/BioNTech BNT162b2 COVID-19 vaccine administration in an HIV+ patient as a potential adverse event following immunization. Observations A 60-year-old male with HIV presented to the emergency department for evaluation of left facial droop. He had received the first dose of Pfizer/BioNTech BNT162b2 vaccination approximately 42 hours prior to symptom onset. Physical examination in the ED revealed left-sided facial weakness with involvement of the forehead, inability to raise left eyebrow, and inability to close left eye with sensation and strength intact in bilateral upper and lower extremities. Physical examination in our outpatient ophthalmology clinic on day 2 following symptom onset was revealing for mild exposure keratopathy, 5 mm lagophthalmos and very poor Bell's reflex in the left eye with otherwise normal exam findings. These findings were judged to be consistent with uncomplicated Bell's palsy. He was provided ophthalmic lubricating ointment to use hourly, artificial tears as needed, moisture goggles and suggested to tape eyelids nightly in addition to standard systemic glucocorticoid and antiviral therapy. The patient's facial weakness and exposure keratopathy were completely resolved at approximately 90 days following symptom onset. Conclusions Though there is insufficient evidence at this time to support any causal association between COVID-19 vaccines and Bell's palsy, the temporal relationship between vaccination and classic clinical features of Bell's palsy in our patient certainly raises suspicion for association with Pfizer/BioNTech BNT162b2 COVID-19 vaccination. It will be important to monitor for cases of Bell's palsy following COVID-19 immunization as an increasing percentage of the global population receives vaccination.
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Affiliation(s)
- Caroline C Mussatto
- University of Kansas School of Medicine, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Jason Sokol
- University of Kansas School of Medicine, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.,Department of Ophthalmology, University of Kansas School of Medicine, 7400 State Line Rd, Prairie Village, KS, 66208, USA
| | - Neeti Alapati
- University of Kansas School of Medicine, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.,Department of Ophthalmology, University of Kansas School of Medicine, 7400 State Line Rd, Prairie Village, KS, 66208, USA
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Barišić N, Turudić D, Marić LS, Tešović G. Vaccination in pediatric acquired inflammatory immune-mediated neuromuscular disorders. Eur J Paediatr Neurol 2022; 36:159-176. [PMID: 34998097 DOI: 10.1016/j.ejpn.2021.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/15/2021] [Accepted: 12/18/2021] [Indexed: 11/26/2022]
Abstract
AIM To analyse literature data on vaccine related induction, worsening of the disease and disease reccurrences as well as vaccine safety and efficacy among pediatric patients with acquired inflammatory immune-mediated neuromuscular disorders (NMD). METHODS Medline, Pub Med and Scopus database search from 1975 to 2020 focused on pediatric age was conducted including peer reviews, meta analyses and epidemiological studies on vaccination and Guillain-Barré syndrome (GBS), Bell's palsy, optic neuritis (ON), myasthenia gravis (MG), chronic inflammatory demyelinating polyneuropathy (CIDP) and immune-mediated inflammatory myopathy (IM). RESULTS AND CONCLUSION s: There are no strong evidence supporting relationship between vaccination with different pediatric vaccines and development of first episodes or reccurrences of GBS, Bell's palsy, optic neuritis (ON), juvenile MG, CIDP, and IM. The vaccination and revaccination with inactivated vaccines is considered safe in children with medical history of GBS, Bell's palsy, ON, MG and IM. Caution when immunization against influenza, quadrivalent conjugated meningococcal vaccine (MCV4) and pneumococcal disease and avoiding tetanus toxoid immunization in CIDP patients is suggested. Patients with immune mediated acquired NMD should be vaccinated with live vaccines before the initiation of immunosupressive treatment. Immunosuppressed patients with low protective antibody titers should be considered for revaccination.
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Affiliation(s)
- Nina Barišić
- Department of Pediatrics, Clinical Medical Centre, Zagreb, Croatia; University of Zagreb, School of Medicine, Zagreb, Croatia.
| | - Daniel Turudić
- Department of Pediatrics, Clinical Medical Centre, Zagreb, Croatia
| | - Lorna Stemberger Marić
- University of Zagreb, School of Medicine, Zagreb, Croatia; University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Zagreb, Croatia
| | - Goran Tešović
- University of Zagreb, School of Medicine, Zagreb, Croatia; University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Zagreb, Croatia
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Talmor G, Nguyen B, Din-Lovinescu C, Paskhover B, Kaye R. Vocal Fold Immobility Following Vaccination. Ann Otol Rhinol Laryngol 2020; 130:609-613. [PMID: 33063519 DOI: 10.1177/0003489420965633] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Vocal fold immobility (VFI) may severely affect quality of life due to dysphonia and respiratory distress. Many etiologies of this disorder have been evaluated, however the relationship between VFI and vaccination has yet to be explored. The objective of this study was to identify the relationship between VFI and vaccine administration. METHODS The Vaccine Adverse Event Reporting System (VAERS) database was queried for patients exhibiting symptoms of VFI following vaccination. Patient demographics and clinical information including presenting symptoms, time of symptom onset, laterality, outcomes, and adverse events were documented. RESULTS Twenty-two patients were found to have VFI following vaccination. Of those reported, 13 patients were female (59.1%) and 8 were male (36.4%) with an average age of 48.4 years. Vaccinations for influenza, shingles, pneumococcus, and hepatitis B were reported. A majority of these cases were unilateral in nature (73.3%). Mean lag time from vaccination to symptom onset was 6.3 days (range 0-45 days). Five adverse events were reported, with 4 patients requiring intubation and tracheostomy. CONCLUSION Vaccine administration may be associated with VFI and physicians should be cognizant of this potential adverse event. This is a rare complication with less reported cases than other post-vaccination cranial neuropathies. The difficulty in establishing an initial diagnosis and need for specialized evaluation by an otolaryngologist may result in under-reporting of such events. Further research is needed to delineate the exact pathophysiology of this complication and determine whether a causal relationship exists.
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Affiliation(s)
- Guy Talmor
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Brandon Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Corina Din-Lovinescu
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Boris Paskhover
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Rachel Kaye
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
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Kim SJ, Lee HY. Acute Peripheral Facial Palsy: Recent Guidelines and a Systematic Review of the Literature. J Korean Med Sci 2020; 35:e245. [PMID: 32743989 PMCID: PMC7402921 DOI: 10.3346/jkms.2020.35.e245] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 06/04/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND This study reviews recent literature on facial palsy guidelines and provides systematic reviews on related topics of interest. METHODS An electronic database search was performed to identify recent guidelines dealing with facial nerve palsy, systematic reviews and recent meta-analysis published between 2011 and 2019 (inclusive). The literature search used the search terms "Bell's palsy," "Ramsay-Hunt syndrome," "Facial palsy," "Facial paralysis," "Facial paresis," "Guideline," "Meta-analysis," "Systematic review," and "Randomized controlled trial." Only studies written in English were used. RESULTS The characteristics of treatment trends for facial palsy have been reviewed over the past decade. The most prominent change noted may be the shift from the conventional House-Brackmann facial nerve grading system to the Sunnybrook and eFACE systems. In addition, the results of serial meta-analyses indicate increasing agreement with the use of surgical decompression of the facial nerve. Beyond steroids or combined steroid-antiviral treatment, various novel drugs and treatments have been tried. For long-standing facial paralysis and postparetic synkinesis sequelae after facial palsy, facial reanimation has been highlighted and the necessity of new paradigms have been raised. CONCLUSION For peripheral facial paralysis, various changes have been made, not only in the facial nerve grading systems, but also in medical treatments, from surgical procedures to rehabilitation, during the last decade.
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Affiliation(s)
- Su Jin Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Ho Yun Lee
- Department of Otolaryngology-Head and Neck Surgery, Ewha Womans University School of Medicine, Seoul, Korea.
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Lee DW, Oh JY, Han MH, Kim DY, Lee JW, Jang DH. Korean language specific dysarthria associated with idiopathic peripheral facial palsy. Medicine (Baltimore) 2020; 99:e19585. [PMID: 32481249 PMCID: PMC7249876 DOI: 10.1097/md.0000000000019585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To investigate the patterns of dysarthria in Korean patients with idiopathic peripheral facial palsy.Seventy-eight patients diagnosed with idiopathic peripheral facial palsy within the onset of symptom to 7 day time frame were prospectively enrolled. The initial symptom of facial palsy was examined by the House-Brackmann scale. All patients were tested by Urimal-Test of Articulation and Phonology-2 (U-TAP-2), which is specialized for the evaluation of dysarthria in Korean language - Hangeul - when the patients first visited and were followed up at 4 weeks after the onset, respectively. The facial electromyography was performed after 7 days, since the presentation of the first symptom. Electric stimulation therapy and simple facial exercise education were performed in all patients as routine treatments for facial palsy with or without dysarthria. The patterns of dysarthria were analyzed by initial and follow-up U-TAP-2 results, respectively.Among 78 patients, 50 patients (64.1%) had dysarthria in the first assessment. The 6 consonants and 3 vowels were errored in U-TAP-2 test. The bilabial consonants "ㅃ"[p] or "ㅍ" [p] were substituted with labiodental consonant [f], and palate-alveolar consonants were replaced by alveolar consonants - "ㅊ"[t(Equation is included in full-text article.)] to "ㅌ"[t]. Bilabial consonant "ㅁ"[m] was replaced by velar nasal consonant "ㅇ"[ŋ]. Liquid consonant was altered to nasal sound. For example, "ㄹ"[r] is replace by "ㄴ"[n]. The velar consonant "ㄲ"[k] was pronounced as "ㅋ" [k]. The diphthong vowels "ㅟ"[[Latin Small Letter Turned H]i], "ㅚ"[ø], or "ㅘ"[wa] were pronounced as monothong "ㅣ" [i], "ㅐ"[ε], or "ㅏ"[a], and "못"[mot] is slowly pronounced. After 4 weeks, 14 patients still showed pronunciation errors in 5 consonants and 3 vowels. The most common error was substitution.Among 78 patients with idiopathic peripheral facial palsy, 50 patients had dysarthria and 14 out of 50 patients with dysarthria lasted more than 4 weeks. Five consonants ("ㅁ", "ㅊ", "ㅍ", "ㄹ", "ㄲ") and 3 vowels ("ㅘ", "ㅗ", "ㅟ or ㅚ") were still mispronounced after 4 weeks, and most common error was substitution. Therefore, speech evaluation and speech therapy specialized for errors in high frequency of consonants and vowels are needed in patients with idiopathic peripheral facial palsy, in Korea.
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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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Tseng HF, Sy LS, Ackerson BK, Hechter RC, Tartof SY, Haag M, Slezak JM, Luo Y, Fischetti CA, Takhar HS, Miao Y, Cunnington M, Solano Z, Jacobsen SJ. Safety of Quadrivalent Meningococcal Conjugate Vaccine in 11- to 21-Year-Olds. Pediatrics 2017; 139:peds.2016-2084. [PMID: 28025240 DOI: 10.1542/peds.2016-2084] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Meningococcal conjugate vaccination is recommended in the United States. This study evaluates the safety of quadrivalent meningococcal conjugate vaccine in a cohort aged 11 to 21 years. METHODS This cohort study with self-controlled case-series analysis was conducted at Kaiser Permanente Southern California. Individuals receiving MenACWY-CRM, a quadrivalent meningococcal conjugate vaccine, during September 30, 2011 to June 30, 2013, were included. Twenty-six prespecified events of interest (EOIs), including neurologic, rheumatologic, hematologic, endocrine, renal, pediatric, and pediatric infectious disease EOIs, were identified through electronic health records 1 year after vaccination. Of these, 16 were reviewed by case review committees. Specific risk and comparison windows after vaccination were predefined for each EOI. The relative incidence (RI) and 95% confidence intervals (CIs) were estimated through conditional Poisson regression models, adjusted for seasonality. RESULTS This study included 48 899 vaccinated individuals. No cases were observed in the risk window for 14 of 26 EOIs. The RI for Bell's palsy, a case review committee-reviewed EOI, was statistically significant (adjusted RI: 2.9, 95% CI: 1.1-7.5). Stratified analyses demonstrated an increased risk for Bell's palsy in subjects receiving concomitant vaccines (RI = 5.0, 95% CI = 1.4-17.8), and no increased risk for those without concomitant vaccine (RI = 1.1, 95% CI = 0.2-5.5). CONCLUSIONS We observed a temporal association between occurrence of Bell's palsy and receipt of MenACWY-CRM concomitantly with other vaccines. The association needs further investigation as it could be due to chance, concomitant vaccination, or underlying medical history predisposing to Bell's palsy.
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Affiliation(s)
- Hung-Fu Tseng
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California;
| | - Lina S Sy
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Bradley K Ackerson
- Pediatrics and Pediatric Infectious Diseases, Southern California Permanente Medical Group, Harbor City, California
| | - Rulin C Hechter
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Sara Y Tartof
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Mendel Haag
- Seqirus Netherlands B.V., Amsterdam, Netherlands
| | - Jeffrey M Slezak
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Yi Luo
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Christine A Fischetti
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Harp S Takhar
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Yan Miao
- GlaxoSmithKline B.V., Amsterdam, Netherlands; and
| | | | - Zendi Solano
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
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12
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Halsey NA, Talaat KR, Greenbaum A, Mensah E, Dudley MZ, Proveaux T, Salmon DA. The safety of influenza vaccines in children: An Institute for Vaccine Safety white paper. Vaccine 2016; 33 Suppl 5:F1-F67. [PMID: 26822822 DOI: 10.1016/j.vaccine.2015.10.080] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 10/02/2015] [Accepted: 10/06/2015] [Indexed: 01/19/2023]
Abstract
Most influenza vaccines are generally safe, but influenza vaccines can cause rare serious adverse events. Some adverse events, such as fever and febrile seizures, are more common in children than adults. There can be differences in the safety of vaccines in different populations due to underlying differences in genetic predisposition to the adverse event. Live attenuated vaccines have not been studied adequately in children under 2 years of age to determine the risks of adverse events; more studies are needed to address this and several other priority safety issues with all influenza vaccines in children. All vaccines intended for use in children require safety testing in the target age group, especially in young children. Safety of one influenza vaccine in children should not be extrapolated to assumed safety of all influenza vaccines in children. The low rates of adverse events from influenza vaccines should not be a deterrent to the use of influenza vaccines because of the overwhelming evidence of the burden of disease due to influenza in children.
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Affiliation(s)
- Neal A Halsey
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.
| | - Kawsar R Talaat
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; Center for Immunization Research, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Adena Greenbaum
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Eric Mensah
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Matthew Z Dudley
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Tina Proveaux
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Daniel A Salmon
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
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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: 31] [Impact Index Per Article: 3.9] [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]
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14
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Baldauf KJ, Royal JM, Hamorsky KT, Matoba N. Cholera toxin B: one subunit with many pharmaceutical applications. Toxins (Basel) 2015; 7:974-96. [PMID: 25802972 PMCID: PMC4379537 DOI: 10.3390/toxins7030974] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 03/16/2015] [Indexed: 12/22/2022] Open
Abstract
Cholera, a waterborne acute diarrheal disease caused by Vibrio cholerae, remains prevalent in underdeveloped countries and is a serious health threat to those living in unsanitary conditions. The major virulence factor is cholera toxin (CT), which consists of two subunits: the A subunit (CTA) and the B subunit (CTB). CTB is a 55 kD homopentameric, non-toxic protein binding to the GM1 ganglioside on mammalian cells with high affinity. Currently, recombinantly produced CTB is used as a component of an internationally licensed oral cholera vaccine, as the protein induces potent humoral immunity that can neutralize CT in the gut. Additionally, recent studies have revealed that CTB administration leads to the induction of anti-inflammatory mechanisms in vivo. This review will cover the potential of CTB as an immunomodulatory and anti-inflammatory agent. We will also summarize various recombinant expression systems available for recombinant CTB bioproduction.
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Affiliation(s)
- Keegan J Baldauf
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40202, USA.
| | - Joshua M Royal
- Owensboro Cancer Research Program of James Graham Brown Cancer Center at University of Louisville School of Medicine, Owensboro, KY 42303, USA.
| | - Krystal Teasley Hamorsky
- Owensboro Cancer Research Program of James Graham Brown Cancer Center at University of Louisville School of Medicine, Owensboro, KY 42303, USA.
- Department of Medicine, University of Louisville School of Medicine, Louisville, KY 40202, USA.
| | - Nobuyuki Matoba
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40202, USA.
- Owensboro Cancer Research Program of James Graham Brown Cancer Center at University of Louisville School of Medicine, Owensboro, KY 42303, USA.
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15
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Abstract
Spontaneous idiopathic facial nerve (Bell's) palsy leaves residual hemifacial weakness in 29% which is severe and disfiguring in over half of these cases. Acute medical management remains the best way to improve outcomes. Reconstructive surgery can improve long term disfigurement. However, acute and surgical options are time-dependent. As family practitioners see, on average, one case every 2 years, a summary of this condition based on common clinical questions may improve acute management and guide referral for those who need specialist input. We formulated a series of clinical questions likely to be of use to family practitioners on encountering this condition and sought evidence from the literature to answer them. The lifetime risk is 1 in 60, and is more common in pregnancy and diabetes mellitus. Patients often present with facial pain or paraesthesia, altered taste and intolerance to loud noise in addition to facial droop. It is probably caused by ischaemic compression of the facial nerve within the meatal segment of the facial canal probably as a result of viral inflammation. When given early, high dose corticosteroids can improve outcomes. Neither antiviral therapy nor other adjuvant therapies are supported by evidence. As the facial muscles remain viable re-innervation targets for up to 2 years, late referrals require more complex reconstructions. Early recognition, steroid therapy and early referral for facial reanimation (when the diagnosis is secure) are important features of good management when encountering these complex cases.
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Affiliation(s)
- Graeme E Glass
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK and
| | - Kallirroi Tzafetta
- St. Andrews Centre for Plastic Surgery Broomfield Hospital, Chelmsford, UK
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16
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Zalagh M, Boukhari A, Attifi H, Hmidi M, Messary A. Contralateral facial nerve palsy following mandibular second molar removal: is there co-relation or just coincidence? Pan Afr Med J 2014; 18:173. [PMID: 25419300 PMCID: PMC4236920 DOI: 10.11604/pamj.2014.18.173.3750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 02/15/2014] [Indexed: 11/29/2022] Open
Abstract
Peripheral facial nerve palsy (FNP) is the most common cranial nerves neuropathy. It is very rare during dental treatment. Classically, it begins immediately after the injection of local anaesthetic into the region of inferior dental foramen and it's homolateral to the injection. Recovery takes a few hours, normally as long the anaesthetic lasts. The authors present a 44-year-old patient who presented a contralateral delayed-onset facial paralysis arising from dental procedure and discuss the plausible pathogenesis mechanism of happen and a possible relationship between dental procedure and contralateral FNP.
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Affiliation(s)
- Mohammed Zalagh
- Service d'Otorhinolaryngologie, et de Chirurgie Cervico-faciale de l'Hôpital Militaire Moulay Ismaïl, Meknès, Maroc
| | - Ali Boukhari
- Service d'Otorhinolaryngologie, et de Chirurgie Cervico-faciale de l'Hôpital Militaire Moulay Ismaïl, Meknès, Maroc
| | - Hicham Attifi
- Service d'Otorhinolaryngologie, et de Chirurgie Cervico-faciale de l'Hôpital Militaire Moulay Ismaïl, Meknès, Maroc
| | - Mounir Hmidi
- Service d'Otorhinolaryngologie, et de Chirurgie Cervico-faciale de l'Hôpital Militaire Moulay Ismaïl, Meknès, Maroc
| | - Abdelhamid Messary
- Service d'Otorhinolaryngologie, et de Chirurgie Cervico-faciale de l'Hôpital Militaire Moulay Ismaïl, Meknès, Maroc
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17
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Lee CD, Carnahan RM, McPheeters ML. A systematic review of validated methods for identifying Bell's palsy using administrative or claims data. Vaccine 2013; 31 Suppl 10:K7-11. [PMID: 24331076 DOI: 10.1016/j.vaccine.2013.04.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 04/02/2013] [Accepted: 04/05/2013] [Indexed: 11/18/2022]
Abstract
PURPOSE To identify and assess billing, procedural, or diagnosis code, or pharmacy claims-based algorithms used to identify Bell's palsy in administrative and claims databases. METHODS We searched the MEDLINE database via PubMed from 1991 to September 2012 using controlled vocabulary and key terms related to Bell's palsy. We also searched the reference lists of included studies. Two investigators independently assessed the full text of studies against pre-determined inclusion criteria. Two reviewers independently extracted data regarding participant and algorithm characteristics and assessed a study's methodologic rigor. RESULTS One study identified Bell's palsy using an algorithm that included ICD-9 code 351.x and H-ICDA code 350.x, and two other studies analyzed a dataset for ICD-9 code 351.0. The positive predictive values of these studies were 0.81 and 0.88, based on case adjudication of ICD-9 matches. Two further studies calculated incidence rates without validation of their methods, also including ICD-9 code 351.0. No study reported the sensitivity of algorithms to identify Bell's palsy. CONCLUSIONS Few publications used rigorous methods to identify a validated algorithm that could identify cases of Bell's palsy from an administrative database. The best evidence from two different datasets in the literature addressed in this review used ICD-9 code 351.0 or a collection of ICD-9 codes 351.x for facial nerve disorders including Bell's palsy, along with other ICD-9 and H-ICDA codes for facial weakness. Each study had acceptable PPV, suggesting that ICD-9 based-algorithms have some utility in detecting Bell's palsy cases.
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Affiliation(s)
| | - Ryan M Carnahan
- Department of Epidemiology, University of Iowa College of Public Health, S437 CPHB University of Iowa, 105 River Street, Iowa City, IA 52242, USA.
| | - Melissa L McPheeters
- Vanderbilt Evidence-based Practice Center; Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Suite 600, 2525 West End Avenue, Nashville, TN 37203-1738, USA.
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18
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Villa M, Black S, Groth N, Rothman KJ, Apolone G, Weiss NS, Aquino I, Boldori L, Caramaschi F, Gattinoni A, Malchiodi G, Crucitti A, Della Cioppa G, Scarpini E, Mavilio D, Mannino S. Safety of MF59-adjuvanted influenza vaccination in the elderly: results of a comparative study of MF59-adjuvanted vaccine versus nonadjuvanted influenza vaccine in northern Italy. Am J Epidemiol 2013; 178:1139-45. [PMID: 23863759 PMCID: PMC3783089 DOI: 10.1093/aje/kwt078] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
MF59-adjuvanted trivalent influenza vaccine (Novartis Vaccines and Diagnostics, Siena, Italy) has been shown to be more effective than nonadjuvanted vaccine in the elderly population. Here we present results from a large-scale, observational, noninterventional, prospective postlicensure study that evaluated the safety of MF59-adjuvanted vaccine in elderly subjects aged 65 years or more. The study was performed in 5 northern Italian health districts during the 2006–2007, 2007–2008, and 2008–2009 influenza seasons. The choice of vaccine—either adjuvanted vaccine or a nonadjuvanted influenza vaccine—was determined by individual providers on the basis of local influenza vaccination policy. Hospitalizations for potential adverse events of special interest (AESIs) were identified from hospital databases and then reviewed against recognized case definitions to identify confirmed cases of AESI. Cumulative incidences were calculated for AESIs in predefined biologically plausible time windows, as well as in a 6-month window following vaccination. During the 3-year study period, 170,988 vaccine doses were administered to a total of 107,661 persons. Despite the large study size, cases of AESI resulting in hospitalization were rare, and risks of AESI were similar in both the MF59-adjuvanted and nonadjuvanted vaccination groups. In conclusion, similar safety profiles were observed for both nonadjuvanted and MF59-adjuvanted seasonal influenza vaccines in elderly recipients.
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Affiliation(s)
- Marco Villa
- Correspondence to Dr. Marco Villa, Unit of Statistical Analyses and Research Projects, Azienda Sanitaria Locale della Provincia di Cremona, Via San Sebastiano 14, 26100 Cremona, Italy (e-mail: )
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19
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Bremell D, Hagberg L. Clinical characteristics and cerebrospinal fluid parameters in patients with peripheral facial palsy caused by Lyme neuroborreliosis compared with facial palsy of unknown origin (Bell's palsy). BMC Infect Dis 2011; 11:215. [PMID: 21831262 PMCID: PMC3176206 DOI: 10.1186/1471-2334-11-215] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Accepted: 08/10/2011] [Indexed: 11/15/2022] Open
Abstract
Background Bell's palsy and Lyme neuroborreliosis are the two most common diagnoses in patients with peripheral facial palsy in areas endemic for Borrelia burgdorferi. Bell's palsy is treated with corticosteroids, while Lyme neuroborreliosis is treated with antibiotics. The diagnosis of Lyme neuroborreliosis relies on the detection of Borrelia antibodies in blood and/or cerebrospinal fluid, which is time consuming. In this study, we retrospectively analysed clinical and cerebrospinal fluid parameters in well-characterised patient material with peripheral facial palsy caused by Lyme neuroborreliosis or Bell's palsy, in order to obtain a working diagnosis and basis for treatment decisions in the acute stage. Methods Hospital records from the Department of Infectious Diseases, Sahlgrenska University Hospital, for patients with peripheral facial palsy that had undergone lumbar puncture, were reviewed. Patients were classified as Bell's palsy, definite Lyme neuroborreliosis, or possible Lyme neuroborreliosis, on the basis of the presence of Borrelia antibodies in serum and cerebrospinal fluid and preceding erythema migrans. Results One hundred and two patients were analysed; 51 were classified as Bell's palsy, 34 as definite Lyme neuroborreliosis and 17 as possible Lyme neuroborreliosis. Patients with definite Lyme neuroborreliosis fell ill during the second half of the year, with a peak in August, whereas patients with Bell's palsy fell ill in a more evenly distributed manner over the year. Patients with definite Lyme neuroborreliosis had significantly more neurological symptoms outside the paretic area of the face and significantly higher levels of mononuclear cells and albumin in their cerebrospinal fluid. A reported history of tick bite was uncommon in both groups. Conclusions We found that the time of the year, associated neurological symptoms and mononuclear pleocytosis were strong predictive factors for Lyme neuroborreliosis as a cause of peripheral facial palsy in an area endemic for Borrelia. For these patients, we suggest that ex juvantibus treatment with oral doxycycline should be preferred to early corticosteroid treatment.
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Affiliation(s)
- Daniel Bremell
- Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden.
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20
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Pereira LM, Obara K, Dias JM, Menacho MO, Lavado EL, Cardoso JR. Facial exercise therapy for facial palsy: systematic review and meta-analysis. Clin Rehabil 2011; 25:649-58. [PMID: 21382865 DOI: 10.1177/0269215510395634] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
UNLABELLED The effectiveness of facial exercises therapy for facial palsy has been debated in systematic reviews but its effects are still not totally explained. OBJECTIVE To perform a systematic review with meta-analysis to evaluate the effects of facial exercise therapy for facial palsy. DATA SOURCES A search was performed in the following databases: Cochrane Controlled Trials Register Library, Cochrane Disease Group Trials Register, MEDLINE, EMBASE, LILACS, PEDro, Scielo and DARE from 1966 to 2010; the following keywords were used: 'idiopathic facial palsy', 'facial paralysis', 'Bell's palsy', 'physical therapy', 'exercise movement techniques', 'facial exercises', 'mime therapy' 'facial expression', 'massage' and 'randomized controlled trials'. REVIEW METHODS The inclusion criteria were studies with facial exercises, associated or not with mirror biofeedback, to treat facial palsy. RESULTS One hundred and thirty-two studies were found but only six met the inclusion criteria. All the studies were evaluated by two independent reviewers, following the recommendations of Cochrane Collaboration Handbook for assessment of risk of bias (kappa coefficient = 0.8). Only one study presented sufficient data to perform the meta-analysis, and significant improvements in functionality was found for the experimental group (standardized mean difference (SMD) = 13.90; 95% confidence interval (CI) 4.31, 23.49; P = 0.005). CONCLUSION Facial exercise therapy is effective for facial palsy for the outcome functionality.
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Affiliation(s)
- L M Pereira
- 1MSc Programme in Physical Education, Universidade Estadual de Londrina-UEM, Londrina, Brazil
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21
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Lockhart P, Holland NJ, Swan I, Teixeira LJ. Interventions for Bell's Palsy (idiopathic facial paralysis). THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2011. [DOI: 10.1002/14651858.cd008974] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Pauline Lockhart
- University of Dundee; Centre for Primary Care and Population Research, Division of Clinical and Population Sciences and Education; Mackenzie Building Kirsty Semple Way Dundee UK DD2 4BF
| | - N Julian Holland
- St Michael's Hospital; ENT Department; Southwell Street Bristol Avon UK BS2 8EG
| | - Iain Swan
- Glasgow Royal Infirmary; Department of Otolaryngology Royal Infirmary Glasgow UK G31 2ER
| | - Lázaro J Teixeira
- Private Practice; Physiotherapy Office; R. Ana Garcia Pereira, n 167 Camboriu Santa Catarina Brazil 88340-970
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22
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Yu M, Vajdy M. A novel retinoic acid, catechin hydrate and mustard oil-based emulsion for enhanced cytokine and antibody responses against multiple strains of HIV-1 following mucosal and systemic vaccinations. Vaccine 2011; 29:2429-36. [PMID: 21272602 DOI: 10.1016/j.vaccine.2011.01.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Revised: 12/10/2010] [Accepted: 01/12/2011] [Indexed: 01/05/2023]
Abstract
Non-replicating protein- or DNA-based antigens generally require immune-enhancing adjuvants and delivery systems. It has been particularly difficult to raise antibodies against gp120 of HIV-1, which constitutes an important approach in HIV vaccine design. While almost all effort in adjuvant research has focused on mimicking the pathogens and the danger signals they engender in the host, relatively little effort has been spent on nutritive approaches. In this study, a new nutritive immune-enhancing delivery system (NIDS) composed of vitamin A, a polyphenol-flavonoid, catechin hydrate, and mustard oil was tested for its adjuvant effect in immune responses against the gp120 protein of HIV-1(CN54). Following a combination of two mucosal and two systemic vaccinations of mice, we found significant enhancement of both local and systemic antibodies as well as cytokine responses. These data have important implications for vaccine and adjuvant design against HIV-1 and other pathogens.
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Affiliation(s)
- Mingke Yu
- EpitoGenesis, Inc. 1810 North Broadway, Walnut Creek, CA 94596, USA
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Comparative global transcription analysis of Aconitum koreanum Raymond, Typhonium gigantum Engl., and Helianthus tuberosis Linne. Mol Cell Toxicol 2010. [DOI: 10.1007/s13273-010-0054-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lewis DJM, Huo Z, Barnett S, Kromann I, Giemza R, Galiza E, Woodrow M, Thierry-Carstensen B, Andersen P, Novicki D, Del Giudice G, Rappuoli R. Transient facial nerve paralysis (Bell's palsy) following intranasal delivery of a genetically detoxified mutant of Escherichia coli heat labile toxin. PLoS One 2009; 4:e6999. [PMID: 19756141 PMCID: PMC2737308 DOI: 10.1371/journal.pone.0006999] [Citation(s) in RCA: 226] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Accepted: 07/29/2009] [Indexed: 12/03/2022] Open
Abstract
Background An association was previously established between facial nerve paralysis (Bell's palsy) and intranasal administration of an inactivated influenza virosome vaccine containing an enzymatically active Escherichia coli Heat Labile Toxin (LT) adjuvant. The individual component(s) responsible for paralysis were not identified, and the vaccine was withdrawn. Methodology/Principal Findings Subjects participating in two contemporaneous non-randomized Phase 1 clinical trials of nasal subunit vaccines against Human Immunodeficiency Virus and tuberculosis, both of which employed an enzymatically inactive non-toxic mutant LT adjuvant (LTK63), underwent active follow-up for adverse events using diary-cards and clinical examination. Two healthy subjects experienced transient peripheral facial nerve palsies 44 and 60 days after passive nasal instillation of LTK63, possibly a result of retrograde axonal transport after neuronal ganglioside binding or an inflammatory immune response, but without exaggerated immune responses to LTK63. Conclusions/Significance While the unique anatomical predisposition of the facial nerve to compression suggests nasal delivery of neuronal-binding LT–derived adjuvants is inadvisable, their continued investigation as topical or mucosal adjuvants and antigens appears warranted on the basis of longstanding safety via oral, percutaneous, and other mucosal routes.
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Affiliation(s)
- David J M Lewis
- St George's Vaccine Institute, St George's University of London, London, United Kingdom.
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Bell's palsy before Bell: Evert Jan Thomassen à Thuessink and idiopathic peripheral facial paralysis. The Journal of Laryngology & Otology 2009; 123:1193-8. [PMID: 19607737 DOI: 10.1017/s0022215109990454] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Bell's palsy is the eponym for idiopathic peripheral facial paralysis. It is named after Sir Charles Bell (1774-1842), who, in the first half of the nineteenth century, discovered the function of the facial nerve and attracted the attention of the medical world to facial paralysis. Our knowledge of this condition before Bell's landmark publications is very limited and is based on just a few documents. In 1804 and 1805, Evert Jan Thomassen à Thuessink (1762-1832) published what appears to be the first known extensive study on idiopathic peripheral facial paralysis. His description of this condition was quite accurate. He located several other early descriptions and concluded from this literature that, previously, the condition had usually been confused with other afflictions (such as 'spasmus cynicus', central facial paralysis and trigeminal neuralgia). According to Thomassen à Thuessink, idiopathic peripheral facial paralysis and trigeminal neuralgia were related, being different expressions of the same condition. Thomassen à Thuessink believed that idiopathic peripheral facial paralysis was caused by 'rheumatism' or exposure to cold. Many aetiological theories have since been proposed. Despite this, the cold hypothesis persists even today.
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Reply. Plast Reconstr Surg 2008. [DOI: 10.1097/prs.0b013e318181208d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2008. [DOI: 10.1002/pds.1488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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