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Kanona H, Saeed SR, Randhawa P, Kimber R, Rodger A, Khalil S, Andrews P. Evaluation of the Patient with Facial Palsy: A Multidisciplinary Approach. Facial Plast Surg 2024; 40:400-406. [PMID: 38301715 DOI: 10.1055/s-0044-1779046] [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: 02/03/2024] Open
Abstract
This article aims to provide an overview of the management of facial palsy within a multidisciplinary team setting and discusses considerations used to develop patient-specific management plans. The national landscape of facial function services is also discussed including suggestions on what may enable a more equitable and sustainable service for the future.
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Affiliation(s)
- Hala Kanona
- The Royal National ENT Hospital, University College London Hospitals, London, United Kingdom
| | - Shakeel R Saeed
- The Royal National ENT Hospital, University College London Hospitals, London, United Kingdom
- The Royal National ENT Hospital and National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom
| | - Premjit Randhawa
- The Royal National ENT Hospital, University College London Hospitals, London, United Kingdom
| | - Rebecca Kimber
- The Royal National ENT Hospital and National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom
| | - Anne Rodger
- The Royal National ENT Hospital and National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom
| | - Sherif Khalil
- The Royal National ENT Hospital, University College London Hospitals, London, United Kingdom
- The Royal National ENT Hospital and National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom
| | - Peter Andrews
- The Royal National ENT Hospital, University College London Hospitals, London, United Kingdom
- The Royal National ENT Hospital and National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom
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2
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Abdelrehim AB, Kananeh S, Landau D. The Vital Role of Clinical Examination in Unmasking Bell's Palsy: Beyond Pattern Recognition. Cureus 2024; 16:e55311. [PMID: 38559504 PMCID: PMC10981794 DOI: 10.7759/cureus.55311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
While multiple sclerosis (MS) commonly manifests with optic nerve involvement, it can also masquerade as diverse cranial nerve (CN) palsies. We present the case of a young male initially diagnosed with Bell's palsy based on unilateral facial nerve paralysis. Despite the presence of typical clinical features, the patient's evaluation took an unexpected turn. Subsequent brain MRI revealed demyelinating lesions, ultimately confirming the diagnosis of MS. This case underscores the importance of maintaining vigilance in diagnosing atypical presentations of MS, illustrating how meticulous evaluation and neuroimaging play pivotal roles in uncovering underlying pathologies when conventional diagnoses such as Bell's palsy raise uncertainties.
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Affiliation(s)
| | - Salman Kananeh
- Internal Medicine Residency Program, Capital Health Regional Medical Center, Trenton, USA
| | - Daniel Landau
- Neurology, Capital Health Regional Medical Center, Trenton, USA
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Jeong J, Chung JH, Ryu S, Lee JD, Kim J, Lee HY, Song CI, Cho YS, Lee SA, Jun B. Monthly Variation in Bell's Palsy Based on Population Data of Korea. Audiol Neurootol 2024; 29:290-296. [PMID: 38402865 PMCID: PMC11309058 DOI: 10.1159/000536365] [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: 08/06/2023] [Accepted: 01/09/2024] [Indexed: 02/27/2024] Open
Abstract
INTRODUCTION Several studies have reported that the number of patients with Bell's palsy varied significantly by month and season. However, few studies have reported the monthly variation in Bell's palsy based on the whole population. We investigated the monthly variation in Bell's palsy in Korea during a long-term period based on whole population data. METHODS This retrospective study used the data of the National Health Insurance Service of Korea, which included the entire Korean population from 2008 to 2020. The monthly incidence of Bell's palsy per 100,000 was evaluated in total and according to sex, age, and residence. RESULTS The total average monthly incidence differed significantly by month, with the highest observed in January (9.1 per 100,000) and the lowest in June (7.7 per 100,000) (p < 0.001). The average monthly incidence according to sex, age, and residence also varied significantly by month, with most of the highest values noted in January and the lowest in June. CONCLUSION There was significant monthly variation in the incidence of Bell's palsy, with the highest in January during the winter and the lowest in June during the summer, based on whole population data over a long-term period in Korea.
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Affiliation(s)
- Junhui Jeong
- Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Jae Ho Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, South Korea
| | - Soorack Ryu
- Biostatistical Consulting and Research Lab, Medical Research Collaborating Center, Hanyang University, Seoul, South Korea
| | - Jong Dae Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, South Korea
| | - Jin Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea
| | - Ho Yun Lee
- Department of Otolaryngology-Head and Neck Surgery, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Chan Il Song
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Sang Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Se A Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, South Korea
| | - Beomcho Jun
- Department of Otorhinolaryngology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, South Korea
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Choi Y, Lee S, Yang C, Ahn E. The Impact of Early Acupuncture on Bell's Palsy Recurrence: Real-World Evidence from Korea. Healthcare (Basel) 2023; 11:3143. [PMID: 38132033 PMCID: PMC10743002 DOI: 10.3390/healthcare11243143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
Evidence-based treatment for Bell's palsy includes the administration of steroids within 3 days of symptom onset. Additionally, a few studies have suggested the importance of combining early acupuncture treatment in the acute phase of Bell's palsy with steroids. This study aimed to observe the impact of early acupuncture for Bell's palsy using real-world health insurance data in Korea. This retrospective study extracted data from 45,986 adult patients with Bell's palsy who received steroids between 2015 and 2017 with a follow-up period of at least 3 years until 2020 from the Korea National Health Insurance database. They were divided into the early acupuncture group (n = 28,267) and the comparison group (n = 17,719) based on the presence of an acupuncture treatment code within 7 days of diagnosis. The impact of early acupuncture on the likelihood of Bell's palsy recurrence was evaluated using multivariate logistic regression. The patients in the early acupuncture group had a lower likelihood of recurrence (odds ratio: 0.81, 95% confidence interval: 0.69-0.95). This study observed a beneficial impact of early acupuncture on Bell's palsy using real-world health insurance data in Korea. Further research is required to confirm these findings.
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Affiliation(s)
- Yujin Choi
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea; (Y.C.); (C.Y.)
| | - Suji Lee
- Department of Acupuncture and Moxibustion, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea;
| | - Changsop Yang
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea; (Y.C.); (C.Y.)
| | - Eunkyoung Ahn
- KM Data Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea
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Lan D, Huang C, Yu N, Lao J, Li Z. Research trends of acupuncture therapy on facial paralysis in a decade spanning 2013-2023: A bibliometric analysis. Complement Ther Med 2023; 79:103006. [PMID: 37972694 DOI: 10.1016/j.ctim.2023.103006] [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: 06/08/2023] [Revised: 10/22/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE This study aimed to employ bibliometric approaches to assess the worldwide scientific achievements in acupuncture for facial paralysis research from 2013 to 2023, and explore the hotspots and frontiers. METHODS Articles related to acupuncture facial paralysis were retrieved from the Web of Science Core Collection (WoSCC). CiteSpace was utilized to examine journals, publication year, country, institution, cited authors, as well as authors.Research hotspots and trends were analyzed by mapping co-citation networks and keywords. RESULTS The period from January 1, 2013, to July 31, 2023, yielded nearly 145 research records on acupuncture treatment for facial paralysis, with a steady increase in the number of annual publications.In terms of the number of publications, OTOLARYNGOLOGY HEAD NECK had the highest publication count, while AM J CHINESE MED exhibited the highest centrality and citation frequency among the cited journals. Further, 54.4 % of publications originated from China, followed by USA (8.2 %) and Germany (8.2 %). Guangzhou University of Chinese Medicine stood out with the highest publication volume among institutions. Guntinas-lichius, Orlando was the most prolific author, and PEITERSEN E was the most cited author. The keywords "Randomized controlled trials" and "multicenter" displayed high frequency and centrality, indicating that clinical trials with a randomized controlled design and multicenter studies were prevalent research methods, likely to remain a future trend. CONCLUSION Acupuncture's potential in the treatment of facial paralysis merits further research. Authors from different countries/regions and organizations need to eliminate language and academic barriers and strengthen collaboration and communication. Current research hotspots focus on "brain", "nerve", "electrical stimulation", "RCT" and "guidelines". The study of acupuncture mechanisms, especially based on the central nervous system mechanism, may be the future research hotspot.
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Affiliation(s)
- Danchun Lan
- Department of Acupuncture and Moxibustion, Foshan Hospital of Traditional Chinese Medicine, Foshan, China
| | - Cheng Huang
- Acupuncture and Rehabilitation Clinical School of Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Na Yu
- Department of Acupuncture and Moxibustion, Foshan Hospital of Traditional Chinese Medicine, Foshan, China
| | - Jinxiong Lao
- Department of Acupuncture and Moxibustion, Foshan Hospital of Traditional Chinese Medicine, Foshan, China.
| | - Ziyong Li
- Department of Acupuncture and Moxibustion, Foshan Hospital of Traditional Chinese Medicine, Foshan, China.
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Silverman E, Matsumoto C, Wang HC, Ma L. Incomplete Bell's Palsy Following Influenza Vaccination in a 7-Month-Old. Clin Pediatr (Phila) 2023; 62:1318-1322. [PMID: 36994991 PMCID: PMC10548764 DOI: 10.1177/00099228231158366] [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] [Indexed: 03/31/2023]
Affiliation(s)
- Elizabeth Silverman
- Department of Emergency Medicine, School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Chika Matsumoto
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, USA
| | - Helen C. Wang
- Department of Pediatrics, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Lawrence Ma
- Department of Pediatrics, School of Medicine, University of California San Diego, San Diego, CA, USA
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Chamboux M, Simon C, Beau-Salinas F, Maurier A, Agier MS, Thillard EM, Largeau B, Jonville-Bera AP. Peripheral facial palsy post SARS-CoV-2 vaccine: A regional pharmacovigilance cases series. Therapie 2023; 78:705-709. [PMID: 36849281 PMCID: PMC9933875 DOI: 10.1016/j.therap.2023.02.005] [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: 12/21/2022] [Revised: 02/01/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023]
Abstract
Peripheral facial palsy (PFP) is a rare adverse reaction identified from clinical trials of coronavirus disease 2019 (COVID-19) vaccines (messenger ribonucleic acid [mRNA] and viral vector). Few data are available on their onset patterns and risk of recurrence after re-injection of a COVID-19 vaccine; the objective of this study was to describe PFP cases attributed to COVID-19 vaccines. All cases of facial paralysis reported to the Regional Pharmacovigilance Center of Centre-Val de Loire area between January and October 2021, in which the role of a COVID-19 vaccine was suspected, were selected. Based on initial data and following additional information requested, each case was reviewed and analyzed to include only confirmed cases of PFP for which the role of the vaccine could be retained. From the 38 cases reported, 23 were included (15 excluded because of diagnosis not retained). They occurred in 12 men and 11 women (median age of 51 years). The first clinical manifestations occurred with a median time of 9 days after COVID-19 vaccine injection, and the paralysis was homolateral to the vaccinated arm in 70%. The etiological workup, always negative, included brain imaging (48%), infectious serologies (74%) and Covid-19 PCR (52%). Corticosteroid therapy was prescribed for 20 (87%) patients, combined with aciclovir in 12 (52%). At 4-month follow-up, clinical manifestations had regressed completely or partially in 20 (87%) of the 23 patients (median time of 30 days). From them 12 (60%) received another dose of COVID-19 vaccine and none had a recurrence and the PFP regressed despite the second dose in 2 of the 3 patients not fully recovered at 4 months. The potential mechanism of PFP after COVID-19 vaccine, which don't have a specific profile, is probably the interferon-γ. Moreover, the risk of recurrence after a new injection appears to be very low, which makes it possible to continue the vaccination.
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Affiliation(s)
- Morgane Chamboux
- Department of Pharmacosurveillance, Pharmacovigilance Regional Center of Centre-Val de Loire, University Hospital of Tours, 37000 Tours, France
| | - Corinne Simon
- Department of Pharmacosurveillance, Pharmacovigilance Regional Center of Centre-Val de Loire, University Hospital of Tours, 37000 Tours, France
| | - Frédérique Beau-Salinas
- Department of Pharmacosurveillance, Pharmacovigilance Regional Center of Centre-Val de Loire, University Hospital of Tours, 37000 Tours, France
| | - Anaïs Maurier
- Department of Pharmacosurveillance, Pharmacovigilance Regional Center of Centre-Val de Loire, University Hospital of Tours, 37000 Tours, France
| | - Marie Sara Agier
- Department of Pharmacosurveillance, Pharmacovigilance Regional Center of Centre-Val de Loire, University Hospital of Tours, 37000 Tours, France
| | - Eve Marie Thillard
- Department of Pharmacosurveillance, Pharmacovigilance Regional Center of Centre-Val de Loire, University Hospital of Tours, 37000 Tours, France
| | - Bérenger Largeau
- Department of Pharmacosurveillance, Pharmacovigilance Regional Center of Centre-Val de Loire, University Hospital of Tours, 37000 Tours, France
| | - Annie Pierre Jonville-Bera
- Department of Pharmacosurveillance, Pharmacovigilance Regional Center of Centre-Val de Loire, University Hospital of Tours, 37000 Tours, France.
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Varga E, Battamir U, Szegedi I, Hudák L, Kovács N, Nagy AC. Seasonal patterns in the epidemiology of Bell's palsy in Hungary. Front Neurol 2023; 14:1188137. [PMID: 37409014 PMCID: PMC10318583 DOI: 10.3389/fneur.2023.1188137] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/06/2023] [Indexed: 07/07/2023] Open
Abstract
Introduction Epidemiological data on Bell's palsy are vital for elucidating disease prevalence and enhancing therapeutic options. Our objective was to explore the prevalence and possible risk factors associated with Bell's palsy recurrence in the Clinical Center of the University of Debrecen service area. Secondary data analysis was performed using hospital discharge data, including patient information and comorbidities. Methods Data was obtained from the Clinical Center of the University of Debrecen, on Bell's palsy patients who were treated at the hospital between January 1, 2015 and December 31, 2021. Multiple logistic regression analysis was used to examine the factors associated with Bell's palsy recurrence. Results Of the 613 patients analyzed, 5.87% had recurrent paralysis, and the median time interval between episodes was 315 days. Hypertension was significantly associated with Bell's palsy recurrence. Moreover, seasonal distribution analysis revealed that the number of Bell's palsy episodes was higher in colder seasons, with spring and winter having a significantly higher number of episodes than summer and autumn. Discussion This study provides insights into the prevalence and associated risk factors of Bell's palsy recurrence, which could aid in its management and help reduce the long-term consequences of the disease. Further research is necessary to determine the precise mechanisms underlying these findings.
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Affiliation(s)
- Eszter Varga
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ulambayar Battamir
- Department of Health Informatics, Faculty of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - István Szegedi
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Lilla Hudák
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Nóra Kovács
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Attila Csaba Nagy
- Department of Health Informatics, Faculty of Health Sciences, University of Debrecen, Debrecen, Hungary
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Xiong X, Huang L, Herd DW, Borland ML, Davidson A, Hearps S, Mackay MT, Lee KJ, Dalziel SR, Dalziel K, Cheek JA, Babl FE. Cost-effectiveness of Prednisolone to Treat Bell Palsy in Children: An Economic Evaluation Alongside a Randomized Controlled Trial. Neurology 2023; 100:e2432-e2441. [PMID: 37072220 PMCID: PMC10264054 DOI: 10.1212/wnl.0000000000207284] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/27/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Bell palsy is the third most frequent diagnosis in children with sudden-onset neurologic dysfunction. The cost-effectiveness of treating Bell palsy with prednisolone in children is unknown. We aimed to assess the cost-effectiveness of prednisolone in treating Bell palsy in children compared with placebo. METHODS This economic evaluation was a prospectively planned secondary analysis of a double-blinded, randomized, placebo-controlled superiority trial (Bell Palsy in Children [BellPIC]) conducted from 2015 to 2020. The time horizon was 6 months since randomization. Children aged 6 months to <18 years who presented within 72 hours of onset of clinician-diagnosed Bell palsy and who completed the trial were included (N = 180). Interventions were oral prednisolone or taste-matched placebo administered for 10 days. Incremental cost-effectiveness ratio comparing prednisolone with placebo was estimated. Costs were considered from a health care sector perspective and included Bell palsy-related medication cost, doctor visits, and medical tests. Effectiveness was measured using quality-adjusted life-years (QALYs) based on Child Health Utility 9D. Nonparametric bootstrapping was performed to capture uncertainties. Prespecified subgroup analysis by age 12 to <18 years vs <12 years was conducted. RESULTS The mean cost per patient was A$760 in the prednisolone group and A$693 in the placebo group over the 6-month period (difference A$66, 95% CI -A$47 to A$179). QALYs over 6 months were 0.45 in the prednisolone group and 0.44 in the placebo group (difference 0.01, 95% CI -0.01 to 0.03). The incremental cost to achieve 1 additional recovery was estimated to be A$1,577 using prednisolone compared with placebo, and cost per additional QALY gained was A$6,625 using prednisolone compared with placebo. Given a conventional willingness-to-pay threshold of A$50,000 per QALY gained (equivalent to US$35,000 or £28,000), prednisolone is very likely cost-effective (probability is 83%). Subgroup analysis suggests that this was primarily driven by the high probability of prednisolone being cost-effective in children aged 12 to <18 years (probability is 98%) and much less so for those <12 years (probability is 51%). DISCUSSION This provides new evidence to stakeholders and policymakers when considering whether to make prednisolone available in treating Bell palsy in children aged 12 to <18 years. TRIAL REGISTRATION INFORMATION Australian New Zealand Clinical Trials Registry ACTRN12615000563561.
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Affiliation(s)
- Xiuqin Xiong
- From the Centre for Health Policy (X.X., L.H., K.D.), Melbourne School of Population and Global Health, The University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.W.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.B.), University of Western Australia, Perth; Department of Emergency Medicine (A.D., S.H., M.T.M., J.A.C., F.E.B.), Royal Children's Hospital; Murdoch Children's Research Institute (A.D., M.T.M., K.J.L., J.A.C., F.E.B., S.H.), Parkville, Victoria; Department of Anesthesia (A.D.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria; Department of Pediatrics (K.J.L.), Melbourne Medical School, University of Melbourne, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand; and Departments of Paediatrics and Critical Care (J.A.C., F.E.B.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - Li Huang
- From the Centre for Health Policy (X.X., L.H., K.D.), Melbourne School of Population and Global Health, The University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.W.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.B.), University of Western Australia, Perth; Department of Emergency Medicine (A.D., S.H., M.T.M., J.A.C., F.E.B.), Royal Children's Hospital; Murdoch Children's Research Institute (A.D., M.T.M., K.J.L., J.A.C., F.E.B., S.H.), Parkville, Victoria; Department of Anesthesia (A.D.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria; Department of Pediatrics (K.J.L.), Melbourne Medical School, University of Melbourne, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand; and Departments of Paediatrics and Critical Care (J.A.C., F.E.B.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - David W Herd
- From the Centre for Health Policy (X.X., L.H., K.D.), Melbourne School of Population and Global Health, The University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.W.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.B.), University of Western Australia, Perth; Department of Emergency Medicine (A.D., S.H., M.T.M., J.A.C., F.E.B.), Royal Children's Hospital; Murdoch Children's Research Institute (A.D., M.T.M., K.J.L., J.A.C., F.E.B., S.H.), Parkville, Victoria; Department of Anesthesia (A.D.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria; Department of Pediatrics (K.J.L.), Melbourne Medical School, University of Melbourne, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand; and Departments of Paediatrics and Critical Care (J.A.C., F.E.B.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - Meredith L Borland
- From the Centre for Health Policy (X.X., L.H., K.D.), Melbourne School of Population and Global Health, The University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.W.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.B.), University of Western Australia, Perth; Department of Emergency Medicine (A.D., S.H., M.T.M., J.A.C., F.E.B.), Royal Children's Hospital; Murdoch Children's Research Institute (A.D., M.T.M., K.J.L., J.A.C., F.E.B., S.H.), Parkville, Victoria; Department of Anesthesia (A.D.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria; Department of Pediatrics (K.J.L.), Melbourne Medical School, University of Melbourne, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand; and Departments of Paediatrics and Critical Care (J.A.C., F.E.B.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - Andrew Davidson
- From the Centre for Health Policy (X.X., L.H., K.D.), Melbourne School of Population and Global Health, The University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.W.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.B.), University of Western Australia, Perth; Department of Emergency Medicine (A.D., S.H., M.T.M., J.A.C., F.E.B.), Royal Children's Hospital; Murdoch Children's Research Institute (A.D., M.T.M., K.J.L., J.A.C., F.E.B., S.H.), Parkville, Victoria; Department of Anesthesia (A.D.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria; Department of Pediatrics (K.J.L.), Melbourne Medical School, University of Melbourne, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand; and Departments of Paediatrics and Critical Care (J.A.C., F.E.B.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - Stephen Hearps
- From the Centre for Health Policy (X.X., L.H., K.D.), Melbourne School of Population and Global Health, The University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.W.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.B.), University of Western Australia, Perth; Department of Emergency Medicine (A.D., S.H., M.T.M., J.A.C., F.E.B.), Royal Children's Hospital; Murdoch Children's Research Institute (A.D., M.T.M., K.J.L., J.A.C., F.E.B., S.H.), Parkville, Victoria; Department of Anesthesia (A.D.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria; Department of Pediatrics (K.J.L.), Melbourne Medical School, University of Melbourne, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand; and Departments of Paediatrics and Critical Care (J.A.C., F.E.B.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - Mark T Mackay
- From the Centre for Health Policy (X.X., L.H., K.D.), Melbourne School of Population and Global Health, The University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.W.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.B.), University of Western Australia, Perth; Department of Emergency Medicine (A.D., S.H., M.T.M., J.A.C., F.E.B.), Royal Children's Hospital; Murdoch Children's Research Institute (A.D., M.T.M., K.J.L., J.A.C., F.E.B., S.H.), Parkville, Victoria; Department of Anesthesia (A.D.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria; Department of Pediatrics (K.J.L.), Melbourne Medical School, University of Melbourne, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand; and Departments of Paediatrics and Critical Care (J.A.C., F.E.B.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - Katherine J Lee
- From the Centre for Health Policy (X.X., L.H., K.D.), Melbourne School of Population and Global Health, The University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.W.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.B.), University of Western Australia, Perth; Department of Emergency Medicine (A.D., S.H., M.T.M., J.A.C., F.E.B.), Royal Children's Hospital; Murdoch Children's Research Institute (A.D., M.T.M., K.J.L., J.A.C., F.E.B., S.H.), Parkville, Victoria; Department of Anesthesia (A.D.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria; Department of Pediatrics (K.J.L.), Melbourne Medical School, University of Melbourne, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand; and Departments of Paediatrics and Critical Care (J.A.C., F.E.B.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - Stuart R Dalziel
- From the Centre for Health Policy (X.X., L.H., K.D.), Melbourne School of Population and Global Health, The University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.W.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.B.), University of Western Australia, Perth; Department of Emergency Medicine (A.D., S.H., M.T.M., J.A.C., F.E.B.), Royal Children's Hospital; Murdoch Children's Research Institute (A.D., M.T.M., K.J.L., J.A.C., F.E.B., S.H.), Parkville, Victoria; Department of Anesthesia (A.D.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria; Department of Pediatrics (K.J.L.), Melbourne Medical School, University of Melbourne, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand; and Departments of Paediatrics and Critical Care (J.A.C., F.E.B.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - Kim Dalziel
- From the Centre for Health Policy (X.X., L.H., K.D.), Melbourne School of Population and Global Health, The University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.W.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.B.), University of Western Australia, Perth; Department of Emergency Medicine (A.D., S.H., M.T.M., J.A.C., F.E.B.), Royal Children's Hospital; Murdoch Children's Research Institute (A.D., M.T.M., K.J.L., J.A.C., F.E.B., S.H.), Parkville, Victoria; Department of Anesthesia (A.D.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria; Department of Pediatrics (K.J.L.), Melbourne Medical School, University of Melbourne, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand; and Departments of Paediatrics and Critical Care (J.A.C., F.E.B.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - John A Cheek
- From the Centre for Health Policy (X.X., L.H., K.D.), Melbourne School of Population and Global Health, The University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.W.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.B.), University of Western Australia, Perth; Department of Emergency Medicine (A.D., S.H., M.T.M., J.A.C., F.E.B.), Royal Children's Hospital; Murdoch Children's Research Institute (A.D., M.T.M., K.J.L., J.A.C., F.E.B., S.H.), Parkville, Victoria; Department of Anesthesia (A.D.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria; Department of Pediatrics (K.J.L.), Melbourne Medical School, University of Melbourne, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand; and Departments of Paediatrics and Critical Care (J.A.C., F.E.B.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - Franz E Babl
- From the Centre for Health Policy (X.X., L.H., K.D.), Melbourne School of Population and Global Health, The University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.W.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.B.), University of Western Australia, Perth; Department of Emergency Medicine (A.D., S.H., M.T.M., J.A.C., F.E.B.), Royal Children's Hospital; Murdoch Children's Research Institute (A.D., M.T.M., K.J.L., J.A.C., F.E.B., S.H.), Parkville, Victoria; Department of Anesthesia (A.D.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria; Department of Pediatrics (K.J.L.), Melbourne Medical School, University of Melbourne, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand; and Departments of Paediatrics and Critical Care (J.A.C., F.E.B.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.
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10
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P P, Muthukrishnan A. Assessment of Nerve Conduction in Patients With Lower Motor Neuron Facial Paralysis. Cureus 2023; 15:e35422. [PMID: 36987490 PMCID: PMC10040237 DOI: 10.7759/cureus.35422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2023] [Indexed: 03/30/2023] Open
Abstract
Introduction Bell's palsy (BP), a lower motor neuron facial paralysis, commonly causes dysfunction of muscles of facial expression. Nerve conduction electrodiagnostic studies differentiate early-stage minor conduction blocks from later-stage Wallerian degeneration. Nerve conduction studies (NCSs) assess facial nerve function by delivering supramaximal electrical stimulus at the stylomastoid foramen. The amplitude loss percentage of the affected side is calculated with reference to the normal side. Aim The study's aim was to characterize the ncs in BP cases and to evaluate the correlation between the Compound Muscle Action Potential (CMAP) of the muscles affected. Materials and methods One hundred and four NCS data of BP cases were retrospectively collected over the period of two years. Statistical analyses of variables were done using the Chi-square test, one-way ANOVA, and Pearson correlation coefficient. Result The greater amplitude loss was seen in the orbicularis oris muscle innervated by buccal and mandibular branches of the facial nerve. The bivariate correlation between the Right Nasalis versus Right Orbicularis Oculi and Left Orbicularis Oculi versus Left Nasalis showed a highly significant moderately Strong Positive Correlation with an R-value of 0.687 and 0.558, respectively. The amplitude drop percentage was statistically significant in the affected left and right sides with P values of 0.008 and 0.007 respectively (P value < 0.05). The amplitude drop between the nasalis, orbicularis oculi and orbicularis oris muscles of both sides was statistically significant with a P value of 0.001. Conclusion NCS should be mandatorily included as an assessment protocol in BP cases for quantification of nerve degeneration and as a prognostic tool during the course of treatment.
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Affiliation(s)
- Poornachitra P
- Oral Medicine and Radiology, Saveetha Dental College and Hospital, Chennai, IND
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11
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Association of Overweight and Obesity With Bell Palsy in Children. Pediatr Neurol 2023; 139:43-48. [PMID: 36508882 DOI: 10.1016/j.pediatrneurol.2022.11.007] [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: 04/12/2022] [Revised: 08/14/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND In the Division of Pediatric Neurology at the University Medical Center Göttingen we observed that many patients with Bell palsy are overweight or obese. To evaluate whether overweight and obesity are associated with increased risk of Bell palsy in children we conducted this single-centered retrospective study by performing a database search for International Classification of Diseases (ICD)-10 primary and secondary diagnosis of G51.0 (facial nerve palsy) between January 1, 2010, and December 31, 2020. METHODS For risk assessment, patients' body mass indices (BMIs) were compared with BMI data of controls from a nationwide child health survey. RESULTS In total, 202 patients with peripheral facial nerve palsies (pFPs) were included, of which nearly half were classified as Bell palsies; 38% and 24% of the patients with Bell palsy and pFP had a BMI above the 90th percentile, respectively. High BMI was associated with statistically increased odds of Bell palsy in the group of overweight and obese patients (BMI >90th percentile; odds ratio [OR], 2.42; 95% confidence interval [CI], 1.6 to 3.8; P < 0.001) and solely obese patients (BMI >97th percentile; OR, 2.43; 95% CI, 1.4 to 4.3; P = 0.003). CONCLUSIONS We could confirm our observation that overweight and obesity are associated with increased risk of Bell palsy in children.
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12
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Alanazi F, Kashoo FZ, Alduhishy A, Aldaihan M, Ahmad F, Alanazi A. Incidence rate, risk factors, and management of Bell's palsy in the Qurayyat region of Saudi Arabia. PeerJ 2022; 10:e14076. [PMID: 36221264 PMCID: PMC9548320 DOI: 10.7717/peerj.14076] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/27/2022] [Indexed: 01/20/2023] Open
Abstract
Background Bell's palsy is an idiopathic facial nerve dysfunction causing temporary paralysis of muscles of facial expression. This study aimed to determine the incidence rate, common risk factors, and preferred treatment by the Saudi patients with Bell's palsy. Method This cross-sectional study was carried out in the Qurayyat region of Saudi Arabia. The retrospective medical records were searched from 2015-2020 of patients diagnosed with Bell's palsy at Qurayyat General Hospital and King Fahad hospital. A 28-item questionnaire was developed by a team of experts and pre-tested among patients with Bell's palsy before being sent to the eligible participants. The data were analyzed using summary statistics, Chi-square test, Fisher exact test and Likelihood ratio test. Results We identified 279 cases of Bell's palsy from the medical records of the hospitals from the years 2015 to 2020, accounting for 46.5 cases per year and an incidence rate of 25.7 per 100,000 per year. Out of 279 patients with Bell's palsy, only 171 returned the questionnaire accounting for a response rate of 61.2%. Out of 171 patients with Bell's palsy, females (n = 147, 86.0%) accounted for the majority of cases. The most affected age group among participants with Bell's palsy was 21-30 years (n = 76, 44.4%). There were 153 (89.5%) cases who reported Bell's palsy for the first time. The majority of the participants experienced right-sided facial paralysis (n = 96, 56.1%). Likelihood ratio test revealed significant relationship between exposure to cold air and common cold with age groups (χ 2(6, N = 171) = 14.92, p = 0.021), χ 2(6, N = 171) = 16.35, pp = 0.012 respectively. The post hoc analyses revealed that participants in the age group of 20-31-years were mostly affected due to exposure to cold air and common cold than the other age groups. The main therapeutic approach preferred was physiotherapy (n = 149, 87.1%), followed by corticosteroids and antivirals medications (n = 61, 35.7%), acupressure (n = 35, 20.5%), traditional Saudi herb medicine (n = 32, 18.7%), cauterization by hot iron rod (n = 23, 13.5%), supplementary therapy (n = 2, 1.2%), facial cosmetic surgery (n = 1, 0.6%) and no treatment (n = 1, 0.6%). The most preferred combined therapy was physiotherapy (87.6%) with corticosteroid and antiviral drugs (35.9%), and acupressure (17.6%). Conclusion The rate of Bell's palsy was approximately 25.7 per 100,000 per year in the Qurayyat region of Saudi Arabia. Exposure to cold air and common cold were the significant risk factors associated with Bell's palsy. Females were predominantly affected by Bell's palsy in the Qurayyat region of Saudi Arabia. Bell's palsy most commonly occurred in the age group 21-30 years. The most favored treatment was physiotherapy following Bell's palsy.
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Affiliation(s)
- Fahad Alanazi
- Department of Physical Therapy and Rehabilitation Sciences, College of Applied Medical Sciences, Jouf University, Al Jouf, Saudi Arabia
| | - Faizan Z. Kashoo
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah, Riyadh, Saudi Arabia
| | - Anas Alduhishy
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mishal Aldaihan
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Fuzail Ahmad
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah, Riyadh, Saudi Arabia
| | - Ahmad Alanazi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah, Riyadh, Saudi Arabia
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Jančić J, Zeković J, Ćetković M, Nikolić B, Ivančević N, Vučević D, Nešić Z, Milovanović S, Radenković M, Samardžić J. Acute Peripheral Facial Nerve Palsy in Children and Adolescents: Clinical Aspects and Treatment Modalities. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2022; 22:CNSNDDT-EPUB-126028. [PMID: 36045521 DOI: 10.2174/1871527321666220831095204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/07/2022] [Accepted: 07/17/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Peripheral facial nerve palsy is a relatively frequent, rather idiopathic, and isolated nonprogressive disorder with a tendency toward spontaneous recovery in children. It is primarily characterized by unilateral paresis or paralysis of the mimic musculature affecting verbal communication, social interactions, and quality of life. OBJECTIVE This study aimed to evaluate the clinical aspects and efficacy of different therapeutic modalities in the population of children and adolescents with acute peripheral facial nerve palsy, the quality and recovery rate in comparison to different therapy modalities and etiological factors as well as to determine parameters of recovery according to the age of patients. METHODS The retrospective study included children and adolescents (n=129) with an acute onset of peripheral facial nerve palsy, diagnosed and treated in the Clinic of Neurology and Psychiatry for Children and Youth in Belgrade (2000-2018). The mean age of the patients was 11.53 years (SD±4.41). Gender distribution: 56.6% female and 43.4% male patients. RESULTS There were 118 (91.5%) patients with partial and 11 (8.5%) patients with complete paralysis. Left-sided palsy occurred in 67 (51.9%) patients, right-sided in 58 (45.0%), while there were 4 (3.1%) bilateral paralyses. The most common etiological factor was idiopathic (Bell's palsy) - 74 (57.4%) patients followed by middle ear infections - 16 (12.4%). Regardless of etiology, age, and therapy protocols, there was a significant recovery in most of the patients (p<0.001), without significant differences in recovery rate. Comparison of inpatient and outpatient populations showed significant differences regarding the number of relapses, severity of clinical presentation, and recovery rate in relation to etiology. CONCLUSION Bell's palsy is shown to be the most common cause of peripheral facial nerve palsy in children and adolescents, regardless of gender. It is followed by mid-ear infections, respiratory infections, and exposure to cold. Most children and adolescents recovered in three weeks after initial presentation, regardless of etiology, age, and therapy.
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Affiliation(s)
- Jasna Jančić
- Clinic of Neurology and Psychiatry for Children and Youth, Faculty of Medicine, University of Belgrade, Serbia
| | - Janko Zeković
- Institute of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Serbia
| | - Mila Ćetković
- Institute of Histology and Embryology, Faculty of Medicine, University of Belgrade, Serbia
| | - Blažo Nikolić
- Clinic of Neurology and Psychiatry for Children and Youth, Faculty of Medicine, University of Belgrade, Serbia
| | - Nikola Ivančević
- Clinic of Neurology and Psychiatry for Children and Youth, Faculty of Medicine, University of Belgrade, Serbia
| | - Danijela Vučević
- Institute of Pathophysiology \\\'Ljubodrag Buba Mihailovic\\\', Faculty of Medicine, University of Belgrade, Serbia
| | - Zorica Nešić
- Institute of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Serbia
| | - Srđan Milovanović
- Clinic of Psychiatry, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Serbia
| | - Miroslav Radenković
- Institute of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Serbia
| | - Janko Samardžić
- Clinic of Neurology and Psychiatry for Children and Youth, Faculty of Medicine, University of Belgrade, Serbia
- Institute of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Serbia
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14
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Evaluating the effectiveness and acceptability of information and therapy guides for improving the psychosocial well-being of people with facial palsy. J Plast Reconstr Aesthet Surg 2022; 75:3356-3364. [PMID: 35623976 DOI: 10.1016/j.bjps.2022.04.022] [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: 12/15/2021] [Accepted: 04/12/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Facial palsy (FP) can have a negative impact on an individual's psychological and social well-being, irrespective of esthetic severity. There is a lack of psychological interventions tailored specifically for this population and individuals with FP report difficulties accessing specialist psychological treatment. This paper describes a pilot study evaluating the effectiveness, acceptability, and feasibility of information and therapy guides for this population. DESIGN Quasi-experimental, repeated measures design. METHODS Six separate information and therapy guides were designed, drawing on cognitive behavioral therapy, acceptance and commitment therapy, and social skills training approaches. These were tested by 132 participants with FP, over a 4-to-6-week period. Participants completed self-report measures assessing psychological well-being, social function, and appearance-related distress before and after the testing period, as well as provided feedback on the perceived effectiveness, acceptability, and feasibility of the intervention. RESULTS After completing an information and therapy guide, participants reported significant improvements in psychological well-being and social function, as well as improvements in appearance-related distress. Ninety percent of participants reported having found it helpful to complete a guide, while 79.7% reported feeling more able to cope with FP and 95.3% agreed that the guide had been easy to understand and use. CONCLUSIONS Self-guided information and therapy guides are an acceptable and effective intervention for improving the psychosocial well-being of people with FP. They provide a low-intensity, universal, and cost-effective option for supporting the psychological needs of this population. CLINICAL TRIAL REGISTRATION NUMBER NCT03943953.
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Walsh PS, Gray JM, Ramgopal S, Lipshaw MJ. Risk of malignancy following emergency department Bell's palsy diagnosis in children. Am J Emerg Med 2022; 53:63-67. [PMID: 34992025 DOI: 10.1016/j.ajem.2021.12.044] [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: 11/02/2021] [Revised: 12/14/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To quantify the risk of malignancy following the emergency department (ED) diagnosis of Bell's Palsy (BP) using a large retrospective cohort. STUDY DESIGN We performed a cohort study using the Pediatric Health Information System database. We included all children (6 months - 17 years) from 2011 to 2020 with an ED diagnosis of BP. We excluded children with previous neurologic chronic condition or malignancy diagnosed during or prior to the index visit. Our primary outcome was diagnosis of malignancy within 60 days following the index ED visit. We compared clinical characteristics between children with and without new-onset malignancy. RESULTS Of 12,272 encounters for BP, 41 had a new oncologic diagnosis within 60 days (0.33%, 95% confidence interval [CI]: 0.25-0.45%). Median time to oncologic diagnosis was 22 days. Primary CNS malignancy (59%) and leukemia (17.1%) were the most common diagnoses. Younger children had a higher incidence of new oncologic diagnosis compared with older children. Incidences were 0.68% (95% CI 0.36-1.3%), 0.70% (95% CI 0.38-1.3%), 0.26% (95% CI 0.15-0.47%), and 0.21% (95% CI 0.12-0.37%) for children aged <2 years, 2-5 years, 6-11 years, and 12-17 years respectively. CONCLUSIONS We found a small but potentially clinically significant rate of new-onset oncologic diagnosis within 60 days after BP diagnosis in the ED, especially in children younger than 5 years. Further studies of the diagnostic utility of laboratory testing or neuroimaging and the risk of empiric steroids in children with BP are needed.
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Affiliation(s)
- Patrick S Walsh
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America.
| | - James M Gray
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America
| | - Sriram Ramgopal
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States of America
| | - Matthew J Lipshaw
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
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Acute Facial Nerve Palsy in Children: Gold Standard Management. CHILDREN 2022; 9:children9020273. [PMID: 35204994 PMCID: PMC8870855 DOI: 10.3390/children9020273] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/07/2022] [Accepted: 02/14/2022] [Indexed: 11/16/2022]
Abstract
Facial nerve palsy (FNP) is a common illness in the paediatric emergency department. Missed or delayed diagnosis can have a serious impact on a patient’s quality of life. The aim of this article is to give a recent overview of this pathology in terms of the causes, diagnosis, red flag symptoms, complementary examinations, treatments and follow-up in the child population. In cases of acquired, acute onset and isolated FNP, Bell’s palsy can be assumed, and no further investigation is required. In any other scenario, complementary examinations are required. Treatment depends on the aetiology. Corticosteroids, in addition to antiviral medication, are recommended to treat Bell’s palsy whenever a viral infection is suspected. However, the lack of randomised control trials in the paediatric population does not allow us to comment on the effectiveness of these treatments. In all cases, treated or not, children have a very good recovery rate. This review emphasises the necessity of randomised control trials concerning this frequent neurological pathology in order to better treat these children.
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Therapie der idiopathischen Fazialisparese („Bell’s palsy“). DGNEUROLOGIE 2022; 5. [PMCID: PMC9554855 DOI: 10.1007/s42451-022-00489-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Moretto L, Herzig R, Beckmann K, Wolfer N, Dennler M, Glaus TM. Reversible facial nerve paralysis in a cat suspected to be associated with systemic hypertension. JFMS Open Rep 2021; 7:20551169211063454. [PMID: 34925872 PMCID: PMC8679037 DOI: 10.1177/20551169211063454] [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] [Indexed: 11/16/2022] Open
Abstract
Case summary This report describes the appearance of facial nerve paralysis in a 16-year-old hypertensive cat. MRI was helpful in visualising and characterising mesencephalic and facial nerve lesions thought to be induced by hypertension. Neurological signs rapidly resolved under antihypertensive therapy. Relevance and novel information Systemic hypertension is an important medical condition in geriatric cats causing damage in various target organs, including the brain. Hypertensive encephalopathy is an umbrella term for a multitude of different clinical manifestations of cerebral target organ damage. Facial nerve paralysis secondary to hypertension is recognised in human medicine, particularly in children, but so far has not been reported in veterinary medicine.
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Affiliation(s)
- Laura Moretto
- Division of Cardiology, Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Robert Herzig
- Division of Neurology, Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Katrin Beckmann
- Division of Neurology, Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Nadja Wolfer
- Clinic of Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Matthias Dennler
- Clinic of Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Tony M Glaus
- Division of Cardiology, Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Ji J, Liu Y, Wen W, Wang F, Tang R. The efficacy and safety of acupoint catgut embedding for peripheral facial paralysis sequela: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e27769. [PMID: 34889228 PMCID: PMC8663896 DOI: 10.1097/md.0000000000027769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 10/28/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Peripheral facial paralysis sequela (PFPS) is a group of sequence syndrome after the acute onset of peripheral facial paralysis. Nearly 70% of patients with peripheral facial paralysis recover completely, but nearly 30% of patients leave multiple sequelae, which have serious negative impacts on the physical and psychological health of patients. Without a high risk of side effect, acupoint catgut embedding (ACE), a common acupuncture therapy, is widely used to treat this disorder. And a number of studies have shown the efficacy of this therapy for PFPS. But in fact, the evidence of the overall effect of ACE in the treatment of PFPS is still insufficient. Therefore, the purpose of this study is to evaluate the efficiency and safety of ACE for PFPS. METHODS Two reviewers will collect randomized controlled trials (RCTs) on ACE for PFPS by searching the following databases, including The Cochrane Library, PubMed, Web of Science, EMBASE, China Biomedical Literature (CBM), China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), and Wanfang database, from their initiation to May 2021. The searching of publications will include English and Chinese without any restriction of countries and regions. Besides, 2 reviewers will independently include in studies that meet the inclusion criteria and extract data we need, then use Cochrane Collaboration's Risk of Bias Tool to assess their methodological quality. The efficacy and safety of ACE as a treatment for PFPS will be assessed according to the synthetic risk ratio (RR), odds ratio (OR), or weighted mean difference (WMD), standardized mean difference (SMD) with consistent 95% confidence intervals (95% CI). And the Review Manager 5.3 software will be adopted to conduct the statistical analysis. RESULTS The protocol for meta-analysis will systematically evaluate the efficacy and safety of ACE for PFPS. And the final result of this search will provide sufficient evidence and an authentic assessment focusing on the problem. CONCLUSION This search will explore whether ACE could be used as an effective and non-drug external therapy of TCM for PFPS and offer supports for clinical practice. PROSPERO REGISTRATION NUMBER CRD42021240004.
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Affiliation(s)
- Jingyun Ji
- Clinical Medical School of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yuchen Liu
- Clinical Medical School of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Weijie Wen
- Clinical Medical School of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Fengyi Wang
- The Bao‘an District TCM Hospital, The Seventh Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Rundong Tang
- The Bao‘an District TCM Hospital, The Seventh Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
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20
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Kafle DR, Thakur SK. Evaluation of prognostic factors in patients with Bell's palsy. Brain Behav 2021; 11:e2385. [PMID: 34571586 PMCID: PMC8613409 DOI: 10.1002/brb3.2385] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/23/2021] [Accepted: 09/14/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Bell's palsy is a common neurological problem that leads to peripheral palsy of the facial nerve. Most patients have a favorable response with or without treatment while some are left with significant facial deformity. Identification of factors which influence the outcome in patients with Bell's palsy may help clinicians counsel better. METHODS A prospective cross-sectional study was carried out in the Department of Neurology Nobel Medical College, Biratnagar, between February 2020 and February 2021 after obtaining ethical clearance from the institutional review committee. Patients were assessed at the time of presentation to hospital and followed up at 1 week, 1 month, and 3 months after the onset of illness to evaluate for recovery. RESULTS Sixty-two (61.4%) of 101 patients had a favorable outcome at the follow up on the third month, achieving H-B grade 2 or lower, while 33 (32.7%) had moderate dysfunction and 6 (5.9%) had severe dysfunction. The following factors were associated with favorable outcome: younger age of onset (p < .001), lower initial H-B grade of III or IV (p = .001), lesser degree of amplitude reduction on affected side as compared to unaffected side (p = .001) and absence of hypertension and diabetes. The following factors did not influence outcome at three months: duration of Bell's palsy (p = 0.142), side of face affected, and gender (p = .09). CONCLUSIONS Most of the patients with Bell's palsy have favorable outcomes. Age, hypertension, initial H-B grade, and extent of facial nerve degeneration as recorded by nerve conduction studies are important predictors of outcome.
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Affiliation(s)
- Dilli Ram Kafle
- Institute of Neuroscience, Nobel Medical College, Biratnagar, Nepal
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21
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Butler M, Tamborska A, Wood GK, Ellul M, Thomas RH, Galea I, Pett S, Singh B, Solomon T, Pollak TA, Michael BD, Nicholson TR. Considerations for causality assessment of neurological and neuropsychiatric complications of SARS-CoV-2 vaccines: from cerebral venous sinus thrombosis to functional neurological disorder. J Neurol Neurosurg Psychiatry 2021; 92:1144-1151. [PMID: 34362855 DOI: 10.1136/jnnp-2021-326924] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/21/2021] [Indexed: 12/26/2022]
Affiliation(s)
- Matt Butler
- Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Arina Tamborska
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK.,University of Liverpool, Liverpool, UK
| | - Greta K Wood
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK.,University of Liverpool, Liverpool, UK
| | - Mark Ellul
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Rhys H Thomas
- Department of Neuroscience, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK.,Translational and Clinical Research Institute, Newcastle upon Tyne, UK
| | - Ian Galea
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Sarah Pett
- MRC CTU at UCL, Institute for Global Health and Institute for Clinical Trials Methodology, University College London, London, UK
| | | | - Tom Solomon
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Thomas Arthur Pollak
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK
| | - Benedict D Michael
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK.,University of Liverpool, Liverpool, UK
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22
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Qin Y, Yang L, Zhang M, Bai Y, Li Z, Zhao N, Li Z, Xu T, Xie Y, Du Y. Efficacy evaluation and mechanism study of electroacupuncture intervention in acute phase of IFP: study protocol for a randomized controlled trial. Trials 2021; 22:663. [PMID: 34583756 PMCID: PMC8477363 DOI: 10.1186/s13063-021-05632-8] [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: 02/19/2021] [Accepted: 09/15/2021] [Indexed: 11/30/2022] Open
Abstract
Background Previous studies had already reported the efficacy of electroacupuncture treatment for idiopathic facial nerve palsy (IFP) in a recovery phase; however, the initial use of electroacupuncture in the acute phase remains controversial. Hence, in the present study, we will add electroacupuncture intervention based on oral prednisone tablets in the acute phase of IFP and compare the clinical effects with simple oral prednisone tablets. Besides, the prognosis and safety will be evaluated. The present study aims to evaluate the clinical efficacy, prognosis, and safety of electroacupuncture combined with oral prednisone tablets in the acute phase of IFP, using surface electromyography (sEMG) to objectively observe the recovery of facial expression muscle function. In addition, the morphological changes of the facial nerve were observed dynamically by magnetic resonance imaging (MRI) in the acute phase to reveal the effect mechanism of this therapy. Methods Randomized controlled trials will be conducted in the first teaching hospital of Tianjin University of Traditional Chinese Medicine in China from September 2020 to April 2021. The treatment will be carried out in two phases, including the acute phase and the recovery phase. Eighty IFP patients will be recruited and randomized into two groups with a 1:1 ratio. Subjects in the acute phases of the control group will be given oral prednisone tablets, based on the control group, and subjects of the experimental group will be given electroacupuncture therapy simultaneously in the acute phase. Both groups will be stopped taking prednisone tablets and turn to electroacupuncture therapy in a recovery phase. Patients in the experimental group will receive treatment at least 6 times in the acute phase and both groups will receive treatment 9 times in the recovery phase, and there will be a follow-up period of 15 days after the treatment. The primary outcome is supposed to be related to the changes observed in the Sunnybrook (Toronto) Facial Grading System (SFGS) on the baseline and day 30 after the onset. Secondary outcome measures will include House-Brackmann Facial Nerve Grading System (H-B), measurement of Numerical Rating Scale (NRS), Facial Disability Index scale (FDI, including physical function subscore, FDIP, and social functioning and well-being subscore, FDIS), surface electromyogram (sEMG), and magnetic resonance imaging (MRI). Adverse events will be recorded for safety assessment. Discussion The results of this trial will allow the present study to compare the difference in efficacy and prognosis between the strategy of combined electroacupuncture in the acute phase and only oral prednisone tablets. The findings from this trial will be published in peer-reviewed journals. Trial registration CHICTR ChiCTR2000038472. Registered on 23 September 2020
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Affiliation(s)
- Yinan Qin
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300073, China.,Shaanxi University of Chinese Medicine, Xianyang, 712046, Shaanxi, China
| | - Lihong Yang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300073, China
| | - Man Zhang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300073, China
| | - Yang Bai
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300073, China.,Department of Acupuncture and Massage, Qingyang Hospital of Traditional Chinese Medicine, Qingyang, 745000, Gansu, China
| | - Zexin Li
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300073, China
| | - Nana Zhao
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300073, China
| | - Zhimei Li
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300073, China
| | - Tianyu Xu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300073, China
| | - Yue Xie
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300073, China
| | - Yuanhao Du
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China. .,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300073, China. .,Shaanxi University of Chinese Medicine, Xianyang, 712046, Shaanxi, China.
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23
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Clinical Prognostic Factors Associated with Good Outcomes in Pediatric Bell's Palsy. J Clin Med 2021; 10:jcm10194368. [PMID: 34640384 PMCID: PMC8509832 DOI: 10.3390/jcm10194368] [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: 08/03/2021] [Revised: 08/30/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022] Open
Abstract
The prognosis of children with Bell’s palsy remains unclear due to its relatively low incidence, and thus, the small number of patients included in individual studies. To evaluate the prognosis of children with Bell’s palsy and identify the predictive value of specific factors that contribute to complete recovery, a retrospective cohort study was conducted of all patients with Bell’s palsy who visited the outpatient clinic of our university hospital between January 2005 and December 2020. We identified the parameters associated with a favorable recovery after 6 months in pediatric patients with Bell’s palsy. Factors recorded for each patient included age, sex, side affected by palsy, time between symptom onset and start of treatment, treatment methods, and the House–Brackmann grade (H–B) grade. The results of the multivariable analysis revealed that the lower degree of initial facial nerve paralysis presented as H–B grade II–IV was a significant favorable prognostic factor (OR: 3.86; 95% CI: 1.27–11.70; p < 0.05). Our results showed that the most important factor influencing the complete recovery of Bell’s palsy in children was the lower initial H–B grade at initial presentation.
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24
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Liu X, Feng J, Zhang R, Luan J, Wu Z. Quantitative assessment of Bell's palsy-related facial thermal asymmetry using infrared thermography: A preliminary study. J Therm Biol 2021; 100:103070. [PMID: 34503807 DOI: 10.1016/j.jtherbio.2021.103070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/26/2021] [Accepted: 08/03/2021] [Indexed: 11/28/2022]
Abstract
The temperature distribution of normal human skin is symmetrical. Facial paralysis generally changes this thermal symmetry. The aim of this study is to analyze facial thermal asymmetry during the early onset of Bell's palsy, and to assess the feasibility of the diagnosis of early-onset Bell's palsy using infrared thermography (IRT). Fifteen subjects with Bell's palsy and 15 healthy volunteers were considered in this study. The infrared thermal images of the front, left, and right sides of all the subjects were collected and analyzed. Each group of facial thermograms was divided into 16 symmetrical regions of interest (ROIs) with respect to the left and right sides. Three different temperature difference calculation methods were used to express the degree of thermal symmetry between the left- and right-side ROIs, namely, the mean temperature difference (ΔTroi), maximum temperature difference (ΔTmax), and minimum temperature difference (ΔTmin). Among the facial ROIs, there were significant differences in the thermal symmetries of the frontal region, medial canthus region, and infraorbital region between subjects with and without Bell's palsy (p < 0.05). Based on the results, ΔTroi was more effective than the other two methods for the diagnosis of early-onset Bell's palsy. The area under the ROC curve (AUC) of ΔTroi in the infraorbital region was 0.818; and the sensitivity and specificity were 0.867 and 0.800, respectively. Subjects with early-onset Bell's palsy exhibited thermal asymmetry on the left and right sides of their faces. The diagnosis of early-onset Bell's palsy using IRT is therefore necessary. Nevertheless, more effective thermal symmetry analysis methods will be investigated further in future research.
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Affiliation(s)
- Xulong Liu
- Department of Biomedical Engineering, School of Computer and Communication Engineering, Northeastern University, Qinhuangdao, Hebei, China.
| | - Jinghui Feng
- Department of Biomedical Engineering, School of Computer and Communication Engineering, Northeastern University, Qinhuangdao, Hebei, China
| | - Ruohui Zhang
- Department of Radiotherapy, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jingmin Luan
- Department of Biomedical Engineering, School of Computer and Communication Engineering, Northeastern University, Qinhuangdao, Hebei, China
| | - Zhenying Wu
- Department of Acupuncture and Massage, Qinhuangdao Hospital of Traditional Chinese Medicine, Qinhuangdao, Hebei, China
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25
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Steroids with and Without Antivirals in the Treatment of Bell’s Palsy: Does It Make any Difference in Recovery? A Study at a Tertiary Care Center, Karachi, Pakistan. ARCHIVES OF NEUROSCIENCE 2021. [DOI: 10.5812/ans.115645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: To compare the pharmacological effects of steroids in comparison to steroids with antiviral drugs for the treatment of Bell’s Palsy. Methods: A total 60 patients were enrolled and segregated equally into two groups, where patients on prednisolone were labeled as group A (Control group), whereas patients on prednisolone + acyclovir were labeled as group B (study group). All patients had House Brackmann score. The control group started oral prednisolone 1 mg/kg for 10 days, whereas the study group started acyclovir 400 mg 4 times a day for 10 days along with prednisolone tablets. Patients were regularly observed till the study was completed. Primary outcome measure was facial nerve recovery. Health-related quality of life and facial appearance were considered secondary outcomes. Results: The primary outcomes assessed as complete recovery from Bell’s Palsy by Brackmann score at week 4 were found in 17/30 (57%) patients and 23/30 (77%) patients at week 8 in the control group. Complete recovery from Bell’s Palsy was also shown in the experimental group (Prednisolone + acyclovir) where 25/30 (83%) patients completed recovery at week 4, while 27/30 (90%) patients at week 8. Comparison of the two groups showed a significant improvement in the study group (prednisolone + acyclovir) (P = 0.047) at week 4 and (P = 0.02) at week 8. The secondary outcomes were assessed as improvement in the quality of life and facial appearance from Bell’s Palsy. Health utility score was 0.84 ± 0.01 in the control group (On prednisolone) with facial appearance score of (Derriford appearance scale 59) 61 ± 28. At week 4, the study group (on prednisolone+ acyclovir) showed 0.88 ± 0.12 score on Health utility index scale-3 and 46 ± 26 score on Derriford appearance scale. Comparison of the quality of life (Health quality index scale-3) and facial appearance among both control and study groups showed a significant improvement in the study group (P = 0.001 and P = 0.005, respectively). Moreover, when health utility score and Derriford appearance were compared among both groups, it showed a significant improvement in the study group (P = 0.001 and 0.016, respectively). Conclusions: The combination of prednisolone with acyclovir is found superior to prednisolone alone, and this combination treatment results in improvement in both recovery and quality of life.
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26
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Wang CS, Sakai M, Khurram A, Lee K. Facial nerve palsy in children: A case series and literature review. OTOLARYNGOLOGY CASE REPORTS 2021. [DOI: 10.1016/j.xocr.2021.100297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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27
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Maghbooli M, Esmaeilzadeh A, Zarandi FK, Jafarzadeh A, Biglari S, Shalbaf NA, Farhoudi N. Is There Any Relation between Serum Levels of Interleukin-10 and Neurophysiological Abnormalities in Bell's Palsy? Acta Med Litu 2021; 28:262-271. [PMID: 35474925 PMCID: PMC8958650 DOI: 10.15388/amed.2021.28.2.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/29/2021] [Accepted: 09/18/2021] [Indexed: 12/02/2022] Open
Abstract
Background Bell's palsy is the most common cause of peripheral facial palsy. The etiology and treatment of Bell's palsy are still controversial. Previous studies emphasize the role of herpes simplex and herpes zoster viruses in this ailment. The role of Interleukin-10 (IL-10) in Bell's palsy is yet unknown, and few studies have shed light on the matter. This study intended to assess the prognostic value of IL-10 and its relation to the intensity of electrodiagnostic abnormalities and evaluate its potential use as a factor for judging the need for medical or surgical interventions. Materials and Methods 30 patients in the acute phase of Bell's palsy participated in this study. Peripheral blood samples were obtained for IL-10 assessment within the first 72 hours (before commencing treatment), and a nerve conduction study (NCS) was performed six days after symptom onset. Results There was no significant correlation between IL-10 serum levels and the severity of nerve conduction pathology in Orbicularis oculi and Orbicularis oris muscles. Also, IL-10 serum levels did not show any meaningful relationships with participants' age, gender, or symptoms. Conclusion The IL-10 serum levels are not relevant to the pathology of Bell's palsy, and the assessment of IL-10 serum levels cannot be used as an alternative to NCS for evaluating the severity of acute Bell's palsy.
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Affiliation(s)
- Mehdi Maghbooli
- Zanjan University of Medical Sciences, Vali-e-Asr University Hospital, Neurology Department, Zanjan, IranORCID ID: https://orcid.org/0000-0003-0482-9062
| | - Abdolreza Esmaeilzadeh
- Zanjan University of Medical Sciences, Immunology Department and Cancer Gene Therapy Research Center, Zanjan, Iran ORCID ID: http://orcid.org/0000-0002-5402-3967
| | - Fatemeh Karami Zarandi
- Zanjan University of Medical Sciences, Vali-e-Asr University Hospital, Neurology Department, Zanjan, Iran
| | | | | | - Nazanin Azizi Shalbaf
- Zanjan University of Medical Sciences, Zanjan, Iran ORCID ID: http://orcid.org/0000-0001-8872-0093
| | - Negar Farhoudi
- Zanjan University of Medical Sciences, Vali-e-Asr University Hospital, Neurology Department, Zanjan, Iran
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28
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Meissner Y, Schäfer M, Schneider M, Wilden E, Zinke S, Zink A, Strangfeld A. Incidence of facial nerve palsies stratified by DMARD treatment in patients with rheumatoid arthritis: data from the RABBIT register. RMD Open 2021; 6:rmdopen-2020-001403. [PMID: 33070117 PMCID: PMC7722388 DOI: 10.1136/rmdopen-2020-001403] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Yvette Meissner
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Martin Schäfer
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | | | | | | | - Angela Zink
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Anja Strangfeld
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
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Population-based study and a scoping review for the epidemiology and seasonality in and effect of weather on Bell's palsy. Sci Rep 2021; 11:16941. [PMID: 34417505 PMCID: PMC8379238 DOI: 10.1038/s41598-021-96422-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 08/09/2021] [Indexed: 11/16/2022] Open
Abstract
The association between weather-related variables or seasons and the development of Bell’s palsy (BP) is controversial. This study aimed to evaluate the incidence and clinical characteristics of BP and assess the effects of meteorological factors on seasonal and monthly incidence. This retrospective population-based study used data from the Korean Health Insurance claims database (NHICD) from 2010 to 2018, in which annual, seasonal, and monthly incidence rates and age and sex distributions were calculated. A multivariate linear regression and autoregressive integrated moving average (ARIMA) model was used to determine the association between the seasonal and monthly incidence of BP and meteorological factors, including average wind speed, temperature, relative humidity, and atmospheric pressure. We also conducted a scoping review of the literature on epidemiological and seasonality studies of BP in the past 30 years and summarized them in a table for easy comparison with other studies. In this study, the incidence rate of BP increased over 9 years (from 12.86 to 19.92 per 100,000 persons) and was the highest in patients in their 60s (31.6/100,000 persons). The seasonal incidence of BP was the highest in autumn and showed a significant difference compared with spring (coefficient − 0.318, p = 0.003) and summer (coefficient − 0.463, p < 0.001), adjusting the year. In the ARIMA analysis, the autocorrelation of the monthly and seasonal lag in the raw data disappeared after adjustment of the seasonal (or monthly) and longitudinal changes, indicating no additional trends outside the seasonal (or monthly) longitudinal changes. The seasonal and monthly incidence of BP was related to low temperature (p = 0.002), high atmospheric pressure (p = 0.034), and low relative humidity (p < 0.001) in the multivariate linear regression. In contrast, in the ARIMA analysis, after adjusting for seasonality, month, and trends, there were no significant meteorological factors associated with the monthly or seasonal incidence rate. In the past 30 years, 12 studies have reported on the prevalence or incidence of BP, and 14 have reported on the relationship between seasons, weather, and incidence. These results indicate that BP is more common among the elderly, and the incidence of BP is increasing due to an aging society, increased medical accessibility, and lifestyle changes. The data also indicate that the onset of BP is associated with low temperature and humidity; however, in the climate zone with extreme temperature and humidity differences between the coldest and hottest months, it is assumed that the marked decrease in temperature (autumn) has more influence on the outbreak of BP than does the actual cold temperature (winter).
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30
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Association between Influenza Vaccination and the Risk of Bell's Palsy in the Korean Elderly. Vaccines (Basel) 2021; 9:vaccines9070746. [PMID: 34358162 PMCID: PMC8310133 DOI: 10.3390/vaccines9070746] [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: 05/30/2021] [Revised: 06/30/2021] [Accepted: 07/02/2021] [Indexed: 11/24/2022] Open
Abstract
Previous studies have shown controversial results on the risk of Bell’s palsy after influenza vaccination. Since the antigenic components of influenza vaccine can vary from season to season, continuous safety monitoring is required. The aim of the present study was to determine whether there was an increased risk of Bell’s palsy in the elderly after influenza vaccination between the 2015/2016 and 2017/2018 flu seasons. This study included the elderly who received influenza vaccinations for three flu seasons using a large-linked database of vaccination registration data from the Korea Disease Control and Prevention Agency and the National Health Insurance Service claims data. We used a self-controlled risk interval design with a risk interval of 1 to 42 days and a control interval of 57 to 98 days postvaccination and calculated the incidence rate ratio. To ensure the robustness of the results, sensitivity analyses were also carried out with different risk and control intervals. Of 4,653,440 elderly people who received the influenza vaccine, there was no statistically significant increase in the risk of Bell’s palsy (IRR: 0.99, 95% CI: 0.92–1.07). Similar results were found in analysis results for each season and the results of the sensitivity analyses excluding the 2017/2018 season. In conclusion, we found no evidence of an increased risk of Bell’s palsy after influenza vaccination. The results of our study provide reassurance about the safety of the influenza vaccine NIP program. However, it is necessary to continuously monitor the risk of Bell’s palsy during future flu seasons.
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31
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Coyle PK, Gocke A, Vignos M, Newsome SD. Vaccine Considerations for Multiple Sclerosis in the COVID-19 Era. Adv Ther 2021; 38:3550-3588. [PMID: 34075554 PMCID: PMC8169434 DOI: 10.1007/s12325-021-01761-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/24/2021] [Indexed: 02/06/2023]
Abstract
People with multiple sclerosis (MS) are at risk for infections that can result in amplification of baseline symptoms and possibly trigger clinical relapses. Vaccination can prevent infection through the activation of humoral and cellular immune responses. This is particularly pertinent in the era of emerging novel vaccines against severe acute respiratory syndrome coronavirus 2, the virus that causes coronavirus disease 2019 (COVID-19). MS disease-modifying therapies (DMTs), which affect the immune system, may impact immune responses to COVID-19 vaccines in people with MS. The objective of this article is to provide information on immune system responses to vaccinations and review previous studies of vaccine responses in people with MS to support the safety and importance of receiving currently available and emerging COVID-19 vaccines. Immunological studies have shown that coordinated interactions between T and B lymphocytes of the adaptive immune system are key to successful generation of immunological memory and production of neutralizing antibodies following recognition of vaccine antigens by innate immune cells. CD4+ T cells are essential to facilitate CD8+ T cell and B cell activation, while B cells drive and sustain T cell memory. Data suggest that some classes of DMT, including type 1 interferons and glatiramer acetate, may not significantly impair the response to vaccination. DMTs-such as sphingosine-1-phosphate receptor modulators, which sequester lymphocytes from circulation; alemtuzumab; and anti-CD20 therapies, which rely on depleting populations of immune cells-have been shown to attenuate responses to conventional vaccines. Currently, three COVID-19 vaccines have been granted emergency use authorization in the USA on the basis of promising interim findings of ongoing trials. Because analyses of these vaccines in people with MS are not available, decisions regarding COVID-19 vaccination and DMT choice should be informed by data and expert consensus, and personalized with considerations for disease burden, risk of infection, and other factors.
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Affiliation(s)
- Patricia K Coyle
- Department of Neurology, Stony Brook University Medical Center, Stony Brook, NY, USA
| | | | - Megan Vignos
- Biogen, Cambridge, MA, USA.
- US Medical MS Franchise and Interferons, Biogen, 133 Boston Post Rd, Weston, MA, 20493, USA.
| | - Scott D Newsome
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Lee JS, Kim YH. Epidemiological trends of Bell's palsy treated with steroids in Korea between 2008 and 2018. Muscle Nerve 2021; 63:845-851. [PMID: 33651414 DOI: 10.1002/mus.27213] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 02/24/2021] [Accepted: 02/27/2021] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Contemporary epidemiological data on Bell's palsy are crucial to clarify disease burden and improve management strategies. We aimed to examine the epidemiology of, and factors associated with, Bell's palsy treated with steroids in Korea. METHODS Using the National Health Insurance claims data from 2008 to 2018, we determined the incidence, recurrence rate, and management trends of Bell's palsy treated with steroids. We defined Bell's palsy cases based on diagnostic codes and concurrent treatment with steroids. RESULTS The incidence of Bell's palsy showed an increasing trend (from 23.0 per 100 000 persons in 2008 to 30.8 per 100 000 persons in 2018). Age (60-69 y), sex (men), and month (January) were risk factors of Bell's palsy. The recurrence rate of Bell's palsy over the 11-y period was 1.5%. Male sex (hazard ratio [HR], 1.1; 95% confidence interval [CI], 1.0-1.2) and physiotherapy (HR, 0.9; 95% CI, 0.8-0.99) were independently associated with the recurrence of Bell's palsy. During the study period, the use of electrodiagnostic testing steadily increased, whereas that of physiotherapy steadily decreased, and antiviral therapy fluctuated,. DISCUSSION The incidence and recurrence rates presented in this study are comparable with those reported in earlier studies that included patients with Bell's palsy, regardless of the use of steroids, and documented an increase in the burden of Bell's palsy. Further randomized controlled trials are required to ascertain the long-term effects of physiotherapy on recurrent Bell's palsy.
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Affiliation(s)
- Jung Soo Lee
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yeo Hyung Kim
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Hamlet C, Williamson H, Hotton M, Rumsey N. 'Your face freezes and so does your life': A qualitative exploration of adults' psychosocial experiences of living with acquired facial palsy. Br J Health Psychol 2021; 26:977-994. [PMID: 33611831 DOI: 10.1111/bjhp.12515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 01/22/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Facial palsy (FP) is a highly visible appearance-affecting condition and can have a significant impact on facial function. Qualitative research focussing on adults' experiences of living with acquired FP is limited. This study aimed to explore the psychosocial impact of acquired FP and to gain a greater understanding of patients' experiences of treatment and care in the United Kingdom. DESIGN A qualitative interview study with individuals living with acquired FP. METHODS Ten adults with acquired FP were recruited. Their experiences were explored using semi-structured telephone interviews. Data were analysed using thematic analysis. RESULTS Five master themes were identified through the thematic analysis: 1) grappling with a new identity, 2) the psychosocial impact of living with facial palsy, 3) isolation: dealing with 'one hell of a problem on your own', 4) a life on hold, 5) coping strategies. Findings indicated high levels of distress and significant challenges in managing the functional and psychosocial changes associated with acquiring FP. Participants expressed grief for their former appearance and identity, with photographs and mirrors acting as agonizing reminders. Many reported a sense of abandonment due to uncoordinated care and, as a result, engaged in an endless and often fruitless pursuit to gain control over FP by experimenting with their own treatment. Many reported the negative impact of their altered facial expressions on social interactions and a fear of being negatively evaluated. CONCLUSIONS This study highlights a pressing need to review how FP is managed in the UK. To improve patient well-being, health care professionals could benefit from FP education, and patients from timely access to psychological support and clearer standards of care following diagnosis.
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Affiliation(s)
- Claire Hamlet
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Heidi Williamson
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Matthew Hotton
- Oxford Facial Palsy Service, Oxford University Hospitals NHS Foundation Trust, UK
| | - Nichola Rumsey
- Centre for Appearance Research, University of the West of England, Bristol, UK
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Cui H, Zhong W, Yang Z, Cao X, Dai S, Huang X, Hu L, Lan K, Li G, Yu H. Comparison of Facial Muscle Activation Patterns Between Healthy and Bell's Palsy Subjects Using High-Density Surface Electromyography. Front Hum Neurosci 2021; 14:618985. [PMID: 33510628 PMCID: PMC7835336 DOI: 10.3389/fnhum.2020.618985] [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: 10/23/2020] [Accepted: 12/17/2020] [Indexed: 12/27/2022] Open
Abstract
Facial muscle activities are essential for the appearance and communication of human beings. Therefore, exploring the activation patterns of facial muscles can help understand facial neuromuscular disorders such as Bell’s palsy. Given the irregular shape of the facial muscles as well as their different locations, it should be difficult to detect the activities of whole facial muscles with a few electrodes. In this study, a high-density surface electromyogram (HD sEMG) system with 90 electrodes was used to record EMG signals of facial muscles in both healthy and Bell’s palsy subjects when they did different facial movements. The electrodes were arranged in rectangular arrays covering the forehead and cheek regions of the face. The muscle activation patterns were shown on maps, which were constructed from the Root Mean Square (RMS) values of all the 90-channel EMG recordings. The experimental results showed that the activation patterns of facial muscles were distinct during doing different facial movements and the activated muscle regions could be clearly observed. Moreover, two features of the activation patterns, 2D correlation coefficient (corr2) and Centre of Gravity (CG) were extracted to quantify the spatial symmetry and the location of activated muscle regions respectively. Furthermore, the deviation of activated muscle regions on the paralyzed side of a face compared to the healthy side was quantified by calculating the distance between two sides of CGs. The results revealed that corr2 of the activated facial muscle region (classified into forehead region and cheek region) in Bell’s palsy subjects was significantly (p < 0.05) lower than that in healthy subjects, while CG distance of activated facial region in Bell’s palsy subjects was significantly (p < 0.05) higher than that in healthy subjects. The correlation between corr2 of these regions and Bell’s palsy [assessed by the Facial Nerve Grading Scale (FNGS) 2.0] was also significant (p < 0.05) in Bell’s palsy subjects. The spatial information on activated muscle regions may be useful in the diagnosis and treatment of Bell’s palsy in the future.
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Affiliation(s)
- Han Cui
- Department of Acupuncture and Moxibustion, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China.,CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,The Fourth Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Weizheng Zhong
- Department of Acupuncture and Moxibustion, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Zhuoxin Yang
- Department of Acupuncture and Moxibustion, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Xuemei Cao
- Department of Acupuncture and Moxibustion, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Shuangyan Dai
- Department of Acupuncture and Moxibustion, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Xingxian Huang
- Department of Acupuncture and Moxibustion, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Liyu Hu
- Department of Acupuncture and Moxibustion, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Kai Lan
- Department of Acupuncture and Moxibustion, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Guanglin Li
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Haibo Yu
- Department of Acupuncture and Moxibustion, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
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Pacheco A, Rutler O, Valenzuela I, Feldman D, Eskin B, Allegra JR. Positive Tests for Lyme Disease and Emergency Department Visits for Bell's Palsy Patients. J Emerg Med 2020; 59:820-827. [PMID: 32978030 DOI: 10.1016/j.jemermed.2020.07.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/03/2020] [Accepted: 07/19/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Etiologies for Bell's palsy include herpes viruses and Lyme disease, with highest incidence in the colder and warmer months, respectively. In New Jersey, a Lyme-endemic area, the months with the most Lyme disease (80% of cases) are May through October ("Lyme months"). OBJECTIVE Our aim was to determine whether positive tests for Lyme disease and visits are greater in the Lyme months than the rest of the year for patients with Bell's palsy in New Jersey emergency departments (EDs). METHODS We conducted a retrospective chart review from two New Jersey suburban EDs with consecutive patients from February 1, 2013 to January 31, 2018.We identified patients having Bell's palsy using the emergency physician diagnosis. We tabulated positive Lyme tests and visits for Bell's palsy by month of year. We calculated the ratio of positive tests and visits between the Lyme months and the rest of the year along with 95% confidence intervals (CIs). RESULTS There were 442 visits for Bell's palsy, 359 (81%) of these patients were tested for Lyme disease and 57 (16%) of the tests were positive. The Lyme months had 7.1 (95% CI 3.5-14.4) times more positive tests and 1.3 (95% CI 1.1-1.4) times more Bell's palsy visits than the rest of the year. Both measures peaked in July. CONCLUSIONS In a Lyme-endemic area, positive Lyme tests and ED visits for Bell's palsy are greatest in the Lyme months, peaking in July. This finding can help guide testing and treatment for patients in the ED with Bell's palsy during various months of the year.
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Affiliation(s)
| | | | | | | | - Barnet Eskin
- Morristown Medical Center, Morristown, New Jersey
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Zhang CY, Huang Y, Zhang K, Dong F. Evaluation on curative effects of combined acupuncture plus physical therapy for treating idiopathic facial paralysis: A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e23121. [PMID: 33181683 PMCID: PMC7668508 DOI: 10.1097/md.0000000000023121] [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] [Received: 10/02/2020] [Accepted: 10/15/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The present study primarily aims to evaluate how effective acupuncture combined with physical therapy for the treatment of idiopathic facial paralysis. METHODS The PubMed database was searched (1946 to September 2020), the EMBASE data were also searched (January 1946 to September 2020), moreover, the Cochrane Central Register of Controlled Trials was searched (all years), and finally, the China National Knowledge Infrastructure (CNKI) was also included in the searching of electronic databases. The searching of publications did not include any language constraints. The titles and abstracts were scrutinized by a pair of authors to identify relevant studies. The efficacy of the association in the combination of acupuncture and physical therapy as a method of treatment for idiopathic facial paralysis was evaluated according to the pooled risk ratio (RR), mean differences (MD), or standardized mean difference (SMD) with the corresponding 95% confidence intervals (95% CI). A pair of authors conducted an autonomous risk assessment of the bias that would be introduced when the Cochrane Risk of Bias Tool is used. A pair of authors autonomously extracted data with the aid of a customized data extraction form. The RevMan 5.3 statistical analysis software was utilized for conducting the statistical analysis. RESULTS The final results will be presented in a scientific journal that will be peer-reviewed. CONCLUSION It is expected that the proposed systematic review and meta-analysis of acupuncture combined with physical therapy for treating idiopathic facial paralysis will provide reliable evidence for clinical application. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/RPCSE (https://osf.io/rpcse/).
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Affiliation(s)
- Cui-Yi Zhang
- Department of Neurology, Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen
| | - Yan Huang
- Department of neurology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou
| | - Ke Zhang
- Department of traditional Chinese medicine, Shenzhen Far East Maternity Hospital
| | - Fang Dong
- Medical Records Statistics Division, Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, Guangdong, China
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Magazi D, Longombenza B, Mda S, Van der Meyden K, Motshwane M, Nanjoh M, Towobola O. HIV infection, seasonality and younger age predicting incident Bell's palsy among black South Africans. BMC Neurol 2020; 20:381. [PMID: 33087095 PMCID: PMC7576736 DOI: 10.1186/s12883-020-01965-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 10/16/2020] [Indexed: 11/10/2022] Open
Abstract
Background Although South Africa (SA) is facing a high prevalence of HIV infection, there is no literature from this region on a link between Bell’s palsy and HIV. The aim of this study was to identify the occurrence of Bell’s palsy in relation to demographics, seasons and HIV status among black South Africans. Methods This retrospective cohort was conducted among adult black patients, without Bell’s palsy in 2003, presenting to the neurology outpatients department at Dr. George Mukhari Academic hospital, Pretoria, South Africa, between 2004 (study baseline) and 2012 (end test). Gender, age, HIV status, and seasons were potential predictors of Bell’s palsy using Cox regression model and Kaplan Meier curves. Results From the baseline of 1487 patients, 20.9% (n = 311) experienced Bell’s palsy onset by the end of the study. In univariate analysis, male gender (RR = 2.1 95% CI 1.7–2.5; P < 0.0001), age less than 30 years (RR = 2.9 95% CI 2.4–3.6; P < 0.0001), HIV seropositivity (RR =2.9 95% CI 2.3–4.9; P < 0.0001). The highest incidence in winter (30.3% n = 136/450) vs. incidences during other seasons with Intermediate values during Summer (25.3% n = 136/450) and Autumn (20.7% n = 64/308) and the lowest incidence in Spring (23.7% n = 16/353) P < 0.0001) were predictors of Bell’s palsy. In multivariate analysis at adjusting for gender, the most significant and independent predictors of incident Bell’s palsy were HIV seropositivity (HR = 6.3 95% CI 4.8–8.3; P < 0.0001), winter (HR = 1.6 95% CI 1.2–2.1; P < 0.0001) vs. other seasons, and younger age < 30 years (HR = 7.1 95% CI 5.6–9.1; P < 0.0001) vs. older age groups. Conclusion Seasonality, younger age and HIV positivity are important and independent risk factors of Bell’s palsy. Education and awareness programs on the possible effects of HIV and seasons on the development of Bell’s palsy are necessary. This would lead to a better understanding and even a possible development of avoidance measures for this condition amongst young black South Africans.
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Affiliation(s)
- Dali Magazi
- Department of Neurology, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
| | - Benjamin Longombenza
- Department of Internal Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Siyazi Mda
- Department of Paediatrics, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Kees Van der Meyden
- Department of Neurology, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Marcus Motshwane
- Department of statistics, Tshwane University of technology, Pretoria, South Africa
| | - Mirabel Nanjoh
- Faculty of health Sciences, Walter Sisulu University, Mthatha, South Africa
| | - Olakunle Towobola
- Department of Internal Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Arnason S, Hultcrantz M, Nilsson A, Laestadius Å. Peripheral facial nerve palsy in children in a Borrelia high-endemic area, a retrospective follow-up study. Acta Paediatr 2020; 109:1229-1235. [PMID: 31630437 DOI: 10.1111/apa.15063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/27/2019] [Accepted: 10/16/2019] [Indexed: 12/24/2022]
Abstract
AIM To identify the incidence, aetiology and prognosis of acute peripheral facial nerve palsy (FNP) in children in the Borrelia high-endemic region of Stockholm. METHODS The present study identified children from 0 to 18 years of age who visited a paediatric emergency department for acute peripheral FNP during a 1-year period from 2014 to 2015. Data were collected retrospectively. The Sunnybrook and House-Brackmann facial grading systems were used to measure clinical outcome. RESULTS A total of 77 children were identified with FNP, an estimated incidence of 30 per 100 000 children/year. Forty-five children (58%) were diagnosed with neuroborreliosis, 28 (36%) with idiopathic FNP and four (6%) with other rarer causes. Neuroborreliosis was common from June to November and mainly seen in children below 10 years of age. Six patients (8%) had remaining symptoms at least 3 months after onset; three had idiopathic facial palsy (IFP) and were all older than 10 years, one had neuroborreliosis and two had other causes. CONCLUSION Neuroborreliosis and IFP were the major causes of FNP during the study period. Neuroborreliosis-associated facial palsy had a seasonal variation and dominated in younger ages.
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Affiliation(s)
- Sigurdur Arnason
- Astrid Lindgren Children’s Hospital Karolinska University Hospital Stockholm Sweden
| | | | - Anna Nilsson
- Astrid Lindgren Children’s Hospital Karolinska University Hospital Stockholm Sweden
- Childhood Cancer Research Unit Department of Women’s and Children’s Health Karolinska Institutet Stockholm Sweden
| | - Åsa Laestadius
- Astrid Lindgren Children’s Hospital Karolinska University Hospital Stockholm Sweden
- Department of Women and Children’s Health Karolinska Institutet Stockholm Sweden
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Munro APS, Dorey RB, Owens DR, Steed DJ, Petridou C, Herdman T, Jones CE, Patel SV, Pryde K, Faust SN. High frequency of paediatric facial nerve palsy due to Lyme disease in a geographically endemic region. Int J Pediatr Otorhinolaryngol 2020; 132:109905. [PMID: 32035348 DOI: 10.1016/j.ijporl.2020.109905] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 01/22/2020] [Accepted: 01/22/2020] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Idiopathic facial nerve palsy (FNP) is an uncommon but important presentation in children, with Lyme disease known to be a common cause. The UK county of Hampshire is a high incidence area of Lyme disease. We conducted a retrospective review of the investigation and management of paediatric FNP at a large University hospital, including serologic testing and treatment of Lyme disease. METHODS We conducted a retrospective chart review of children under 18 presenting between January 1st, 2010 and December 31st, 2017 with a diagnosis of FNP. Patients with clear non-Lyme aetiology at presentation were excluded. Data was collected on demographics, initial presentation, investigations including Lyme serology, and management. RESULTS A total of 93 children were identified, with an even proportion of male to female and median age 9.3 years (IQR 4.6-12 years). A history of rash was present in 5.4%, tick bite in 14% and recent travel to, or residence in the New Forest in 22.6%. Lyme serology was performed in 81.7% of patients, of which 29% were positive. Antibiotics were prescribed for 73.1% of patients, oral steroids for 44% and aciclovir for 17.2%. CONCLUSION Lyme disease is a significant cause of FNP in this endemic area of the UK, and there was a large degree of variability in management prior to national guideline publication. Areas with endemic Lyme disease should consider introducing local guidelines supporting routine investigation and management for FNP, including empiric treatment for Lyme disease in accordance with NICE guidelines to improve care and reduce variability.
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Affiliation(s)
- Alasdair P S Munro
- NIHR Southampton Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; Paediatric Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, United Kingdom.
| | - Robert B Dorey
- NIHR Southampton Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; Paediatric Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Daniel R Owens
- NIHR Southampton Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Duncan J Steed
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Christina Petridou
- Public Health England Rare and Imported Diseases Laboratory, Porton Down, Salisbury, United Kingdom
| | - Trent Herdman
- Public Health England Rare and Imported Diseases Laboratory, Porton Down, Salisbury, United Kingdom
| | - Christine E Jones
- Paediatric Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Sanjay V Patel
- Paediatric Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Kate Pryde
- Paediatric Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Saul N Faust
- NIHR Southampton Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; Paediatric Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, United Kingdom
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Guess KE, Harada Y, Hill A, Ferry J, Veerapandiyan A. A Toddler With Bilateral Facial Weakness. Clin Pediatr (Phila) 2020; 59:529-531. [PMID: 31948285 DOI: 10.1177/0009922819901007] [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] [Indexed: 11/15/2022]
Affiliation(s)
- Katherine E Guess
- Arkansas Children's Hospital, Little Rock, AR, USA
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Yohei Harada
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Aubrey Hill
- Arkansas Children's Hospital, Little Rock, AR, USA
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jennifer Ferry
- Arkansas Children's Hospital, Little Rock, AR, USA
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Aravindhan Veerapandiyan
- Arkansas Children's Hospital, Little Rock, AR, USA
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Abstract
OBJECTIVES The aim of the study was to determine the prognosis of children with Bell's palsy and analyze the prognostic factors affecting early recovery. METHODS The records of children with a diagnosis of Bell's palsy were retrospectively analyzed. Demographic and clinical features including age, gender, House-Brackmann Facial Nerve Grading System House-Brackmann Grading Scale (HBGS) grade at admission and follow-up, and the dosage and onset of steroid treatment were reviewed. Laboratory findings such as red blood cell distribution width and neutrophil-to-lymphocyte ratio were noted. The patients who were recovered within the first month (early recovery) were compared with the patients who were recovered after first month (late recovery) in terms of demographic, clinical characteristics, laboratory findings and treatment modalities in order to determine the risk factors affecting early recovery. RESULTS A total of 102 children (65 girls and 37 boys) with a mean age of 10.37 ± 4.2 years were included in the study. The complete recovery was detected in 101 children (%99) with Bell's palsy. Statistically significant difference was found in terms of dosage and time of onset of steroid treatment (P = .04, P = .035, respectively) and House-Brackmann Facial Nerve Grading System grade on the 10th day (P = .001) between the early and late recovery groups. CONCLUSION The prognosis of Bell's palsy in children was very good. The prognostic factors affecting the early recovery were being House-Brackmann Facial Nerve Grading System grade 2 or 3 on the 10th day and receiving steroid treatment in the first 24 hours. Neutrophil-to-lymphocyte ratio and red blood cell distribution width were not found to be predictive factors for early recovery.
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Affiliation(s)
- Elif Karatoprak
- Department of Pediatric Neurology, Faculty of Medicine, Medeniyet University, Istanbul, Turkey
| | - Sila Yilmaz
- Department of Pediatric Neurology, Faculty of Medicine, Medeniyet University, Istanbul, Turkey
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Georg Heckmann J, Paul Urban P, Pitz S, Guntinas-Lichius O, Gágyor I. The Diagnosis and Treatment of Idiopathic Facial Paresis (Bell's Palsy). DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:692-702. [PMID: 31709978 PMCID: PMC6865187 DOI: 10.3238/arztebl.2019.0692] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 04/01/2019] [Accepted: 07/15/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Peripheral facial nerve palsy is the most com- mon functional disturbance of a cranial nerve. 60-75% of cases are idiopathic. METHODS This review is based on a selective literature search proceeding from the current, updated German-language guideline on the diagnosis and treatment of idiopathic facial nerve palsy. RESULTS The recommended drug treatment consists of prednisolone 25 mg bid for 10 days, or 60 mg qd for 5 days followed by a taper to off in decrements of 10 mg per day. This promotes full recovery (number needed to treat [NNT] = 10; 95% confidence interval [6; 20]) and lessens the risk of late sequelae such as synkinesia, autonomic disturbances, and contractures. Virostatic drugs are optional in severe cases (intense pain or suspicion of herpes zoster sine herpete) and mandatory in cases of varicella-zoster virus (VZV) infection. Corneal protection with dexpanthenol ophthalmic ointment, artificial tears, and a nocturnal moisture- retaining eye shield has been found useful in practice. In cases of incomplete recovery with residual facial weakness, both static and microsurgical dynamic methods can be used to restore facial nerve function. CONCLUSION Because 25-40% of cases of facial nerve palsy are not idiopathic, differential diagnosis is very important; key diagnostic methods include a clinical neurological examin- ation, otoscopy, and a lumbar puncture for cerebrospinal fluid examination. High-level evidence supports corticosteroid treatment for the idiopathic form of the disorder.
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Affiliation(s)
| | | | | | | | - Ildik? Gágyor
- Department of General Practice, Julius-Maximilians-Universität Würzburg
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Zimmermann J, Jesse S, Kassubek J, Pinkhardt E, Ludolph AC. Differential diagnosis of peripheral facial nerve palsy: a retrospective clinical, MRI and CSF-based study. J Neurol 2019; 266:2488-2494. [DOI: 10.1007/s00415-019-09387-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/13/2019] [Accepted: 05/16/2019] [Indexed: 10/26/2022]
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The role of EEG and EMG combined virtual reality gaming system in facial palsy rehabilitation - A case report. J Bodyw Mov Ther 2019; 23:425-431. [PMID: 31103130 DOI: 10.1016/j.jbmt.2019.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND The recovery rates for facial palsy are usually excellent; however, regularly patients present with problems with their fine facial movements that affect their emotional expressions. OBJECTIVE To discover the viability and ease of using an Electroencephalogram (EEG) and Electromyography (EMG) combined Virtual Reality (VR) gaming system - the 'Oculus Rift' device in the evaluation and rehabilitation of facial palsy. DESIGN Single case study. PATIENT INFORMATION A young 23-year-old female with facial palsy. CLINICAL FINDINGS Most of the patient's facial features were re-established within the recovery time frame, except for her right forehead and eyebrow movements. INTERVENTION A 10 day exercise program (Day 2-11) with an immersive virtual reality device, which randomly shoots virtually animated white balls in an unpredictable and testing pattern. OUTCOME MEASURES EEG and EMG patterns corresponding to the facial upper quadrant were taken at baseline, post-intervention, and at follow up. RESULTS EMG and EEG investigation revealed a progressive improvement in the muscle activation in response to the impulsive and unpredictable activities in the virtual environment provided through the immersive VR device. CONCLUSION The case report found a positive relationship between VR, facial upper quadrant EMG activation and EEG pattern changes following the intervention.
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Norris JH, Longmire NM, Kilcoyne S, Johnson D, Fitzpatrick R, Klassen AF. Exploring Patient Experience of Facial Nerve Palsy to Inform the Development of a PROM. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2072. [PMID: 30859034 PMCID: PMC6382227 DOI: 10.1097/gox.0000000000002072] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 10/19/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is currently a mandate globally to incorporate patient's perceptions of their illness into outcome measures, in order to provide a deeper insight into medical practice. Facial nerve palsy (FNP) is a devastating condition that can significantly impact quality of life. However, no measure currently exists that comprehensively assesses outcome in FNP using patient perception. The aim of this study is to explore patients' experiences of FNP with the aim of informing the development of a patient-reported outcome measure. METHODS Presented is a qualitative study, using in-depth semi-structured interviews with FNP patients. An interview guide was developed using expert opinion and a literature review. Interpretative description was used as the qualitative approach. Interviews were audio-recorded, transcribed, and coded line-by-line. Codes were refined using the constant comparison approach. Interviews continued until data saturation was reached. The data were used to develop a conceptual framework of patient perceived issues relating to FNP. RESULTS The sample included 5 men and 9 women aged 57.7 years (range, 36-78) with a range of causes of FNP, including Bell's palsy (n = 5), acoustic neuroma (n = 3), trauma (n = 2), meningioma (n = 1), muscular dystrophy (n = 1), congenital (n = 1), and Ramsay Hunt syndrome (n = 1). Analysis of the 14 participant interviews led to identification of 5 major domains including "facial function concerns," "appearance concerns," "psychological function," "social function," and "experience of care." CONCLUSION This study provides a conceptual framework covering outcomes that matter to patients with FNP, which can be used to inform the development of a new comprehensive FNP-specific patient-reported outcome measure.
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Affiliation(s)
- Jonathan H. Norris
- From the Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Sarah Kilcoyne
- Speech and Language Therapy Department, Oxford Craniofacial Unit and Spires Cleft Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - David Johnson
- Plastic Surgery Department, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Anne F. Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Mustafa AHK, Sulaiman AM. The Epidemiology and Management of Bell's Palsy in the Sudan. Open Dent J 2018; 12:827-836. [PMID: 30505363 PMCID: PMC6210498 DOI: 10.2174/1874210601812010827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/24/2018] [Accepted: 09/13/2018] [Indexed: 12/01/2022] Open
Abstract
Background: Bell’s palsy is an acute idiopathic facial nerve paralysis of sudden onset. It is the most common cause of lower motor neuron facial nerve paralysis with an annual incidence of 15-30 per 100,000. The objective of this work is to study the prevalence and the management of Bell’s palsy in the Sudan. A descreptive retrospective cross-sectional study was carried at Khartoum Teaching Dental Hospital, Khartoum General Teaching Hospital. In the retrospective, the records and files of 698 patients with Bell’s palsy, were reviewed in relation to age, gender, site, risk factors, season, and type of treatment. In addition, 48 patients with Bell’s palsy were evaluated using the House–Brackman scale in relation to the above-mentioned variables. Therefore, a total number of 746 cases were studied. Fifty five percent of them were females and the remaining 45% were males, around 38% of them were in the age group 21-40 year. Fifty seven percent of the patients were affected on the right side of the face. Winter was the commonest season of onset where 53.5% of the cases occurred. Steroids are the commonly prescribed drugs in majority of the cases, accounting for 47.3%. Study Design: The study is a retrospective cross sectional hospital based study. The study was carried out in Khartoum Teaching Dental Hospital and in the Physiotherapy Department of Khartoum Teaching General hospital. The files and records of the patients with Bell’s palsy in Khartoum Teaching Dental Hospital in the years 1/1/2004 -31/12/2008, and Khartoum Teaching General Hospital (physiotherapy department) in the years 2007- July 2009 (total number 746). Results: A total number of 746 cases were studied . Fifty five percent of them were females and the remaining 45% were male. Around 38% of them were in the group 21-40 year. Fifty seven percent of the patients were affected on the right side of the face. Winter was the commonest season of the onset where 53.5% of the cases occurred. Conclusion: The study showed predominance of females. A peak incidence was seen in the age group 21-40 years. A predilection was found for the right side of face.
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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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Babl FE, Mackay MT, Borland ML, Herd DW, Kochar A, Hort J, Rao A, Cheek JA, Furyk J, Barrow L, George S, Zhang M, Gardiner K, Lee KJ, Davidson A, Berkowitz R, Sullivan F, Porrello E, Dalziel KM, Anderson V, Oakley E, Hopper S, Williams F, Wilson C, Williams A, Dalziel SR. Bell's Palsy in Children (BellPIC): protocol for a multicentre, placebo-controlled randomized trial. BMC Pediatr 2017; 17:53. [PMID: 28193257 PMCID: PMC5307816 DOI: 10.1186/s12887-016-0702-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 09/27/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Bell's palsy or acute idiopathic lower motor neurone facial paralysis is characterized by sudden onset paralysis or weakness of the muscles to one side of the face controlled by the facial nerve. While there is high level evidence in adults demonstrating an improvement in the rate of complete recovery of facial nerve function when treated with steroids compared with placebo, similar high level studies on the use of steroids in Bell's palsy in children are not available. The aim of this study is to assess the utility of steroids in Bell's palsy in children in a randomised placebo-controlled trial. METHODS/DESIGN We are conducting a randomised, triple-blinded, placebo controlled trial of the use of prednisolone to improve recovery from Bell's palsy at 1 month. Study sites are 10 hospitals within the Australian and New Zealand PREDICT (Paediatric Research in Emergency Departments International Collaborative) research network. 540 participants will be enrolled. To be eligible patients need to be aged 6 months to < 18 years and present within 72 hours of onset of clinician diagnosed Bell's palsy to one of the participating hospital emergency departments. Patients will be excluded in case of current use of or contraindications to steroids or if there is an alternative diagnosis. Participants will receive either prednisolone 1 mg/kg/day to a maximum of 50 mg/day or taste matched placebo for 10 days. The primary outcome is complete recovery by House-Brackmann scale at 1 month. Secondary outcomes include assessment of recovery using the Sunnybrook scale, the emotional and functional wellbeing of the participants using the Pediatric Quality of Life Inventory and Child Health Utility 9D Scale, pain using Faces Pain Scale Revised or visual analogue scales, synkinesis using a synkinesis assessment questionnaire and health utilisation costs at 1, 3 and 6 months. Participants will be tracked to 12 months if not recovered earlier. Data analysis will be by intention to treat with primary outcome presented as differences in proportions and an odds ratio adjusted for site and age. DISCUSSION This large multicenter randomised trial will allow the definitive assessment of the efficacy of prednisolone compared with placebo in the treatment of Bell's palsy in children. TRIAL REGISTRATION The study is registered with the Australian New Zealand Clinical Trials Registry ACTRN12615000563561 (1 June 2015).
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Affiliation(s)
- Franz E. Babl
- Department of Emergency Medicine, Royal Children’s Hospital, Flemington Rd, Parkville, VIC 3052 Australia
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
| | - Mark T. Mackay
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
- Department of Neurology, Royal Children’s Hospital, Parkville, VIC Australia
| | - Meredith L. Borland
- Princess Margaret Hospital for Children, Perth, Australia
- Schools of Paediatric and Child Health and Primary, Aboriginal and Rural Health Care, University of Western Australia, Perth, Western Australia Australia
| | - David W. Herd
- Lady Cilento Children’s Hospital, Brisbane, Australia
- University of Queensland, Brisbane, Australia
- Mater Research Institute, Brisbane, Australia
| | - Amit Kochar
- Women’s & Children’s Hospital, Adelaide, Australia
| | - Jason Hort
- The Children’s Hospital at Westmead, Sydney, Australia
| | - Arjun Rao
- Sydney Children’s Hospital, Randwick, New South Wales, Australia
| | - John A. Cheek
- Department of Emergency Medicine, Royal Children’s Hospital, Flemington Rd, Parkville, VIC 3052 Australia
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
- Monash Medical Centre, Clayton, Victoria, Australia
| | - Jeremy Furyk
- Townsville Hospital and James Cook University College of Medicine and Dentistry, Townsville, Australia
| | - Lisa Barrow
- Sunshine Hospital, St Albans, Victoria Australia
| | - Shane George
- Gold Coast University Hospital, Southport, Queensland Australia
| | - Michael Zhang
- John Hunter Hospital, Newcastle, New South Wales Australia
| | - Kaya Gardiner
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
| | - Katherine J. Lee
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
| | - Andrew Davidson
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
- Department of Anaesthesia, Royal Children’s Hospital, Parkville, Victoria Australia
| | - Robert Berkowitz
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
- Department of Otolaryngology, Royal Children’s Hospital, Parkville, Victoria Australia
| | - Frank Sullivan
- Department of Family & Community Medicine, North York General Hospital, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Emily Porrello
- Pharmacy Department, Royal Children’s Hospital, Parkville, Victoria Australia
| | - Kim Marie Dalziel
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
- Centre for Health Policy Melbourne School of Global and Population Health, The University of Melbourne, Carlton, Victoria Australia
| | - Vicki Anderson
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
- Psychological Sciences & Paediatrics, University of Melbourne, The Royal Children’s Hospital, Melbourne, VIC Australia
| | - Ed Oakley
- Department of Emergency Medicine, Royal Children’s Hospital, Flemington Rd, Parkville, VIC 3052 Australia
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
| | - Sandy Hopper
- Department of Emergency Medicine, Royal Children’s Hospital, Flemington Rd, Parkville, VIC 3052 Australia
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
| | - Fiona Williams
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
| | - Catherine Wilson
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
| | - Amanda Williams
- Department of Emergency Medicine, Royal Children’s Hospital, Flemington Rd, Parkville, VIC 3052 Australia
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
| | - Stuart R Dalziel
- Starship Hospital, Auckland, New Zealand
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - for the PREDICT (Paediatric Research In Emergency Departments International Collaborative) research network
- Department of Emergency Medicine, Royal Children’s Hospital, Flemington Rd, Parkville, VIC 3052 Australia
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
- Department of Neurology, Royal Children’s Hospital, Parkville, VIC Australia
- Princess Margaret Hospital for Children, Perth, Australia
- Schools of Paediatric and Child Health and Primary, Aboriginal and Rural Health Care, University of Western Australia, Perth, Western Australia Australia
- Lady Cilento Children’s Hospital, Brisbane, Australia
- University of Queensland, Brisbane, Australia
- Mater Research Institute, Brisbane, Australia
- Women’s & Children’s Hospital, Adelaide, Australia
- The Children’s Hospital at Westmead, Sydney, Australia
- Sydney Children’s Hospital, Randwick, New South Wales, Australia
- Monash Medical Centre, Clayton, Victoria, Australia
- Townsville Hospital and James Cook University College of Medicine and Dentistry, Townsville, Australia
- Sunshine Hospital, St Albans, Victoria Australia
- Gold Coast University Hospital, Southport, Queensland Australia
- John Hunter Hospital, Newcastle, New South Wales Australia
- Department of Anaesthesia, Royal Children’s Hospital, Parkville, Victoria Australia
- Department of Otolaryngology, Royal Children’s Hospital, Parkville, Victoria Australia
- Department of Family & Community Medicine, North York General Hospital, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
- Pharmacy Department, Royal Children’s Hospital, Parkville, Victoria Australia
- Centre for Health Policy Melbourne School of Global and Population Health, The University of Melbourne, Carlton, Victoria Australia
- Psychological Sciences & Paediatrics, University of Melbourne, The Royal Children’s Hospital, Melbourne, VIC Australia
- Starship Hospital, Auckland, New Zealand
- Liggins Institute, University of Auckland, Auckland, New Zealand
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Infections in the differential diagnosis of Bell’s palsy: a plea for performing CSF analysis. Infection 2016; 45:147-155. [DOI: 10.1007/s15010-016-0933-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 07/31/2016] [Indexed: 10/21/2022]
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Cranial Nerve Disorders. Neurology 2016. [DOI: 10.1002/9781118486160.ch13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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