Adjunctive Corticosteroids for Lyme Neuroborreliosis Peripheral Facial Palsy – a prospective study with historical controls

2021 ◽  
Author(s):  
Sanna Avellan ◽  
Daniel Bremell
Keyword(s):  
Facial Palsy ◽  
Bell’S Palsy ◽  
Lyme Neuroborreliosis ◽  
Control Group ◽  
Study Group ◽  
Bell's Palsy ◽  
Oral Doxycycline ◽  
Peripheral Facial Palsy ◽  
Historical Controls

Abstract Background Lyme neuroborreliosis peripheral facial palsy (LNB PFP) and idiopathic peripheral facial palsy, Bell’s palsy (BP), are the most common causes of facial palsy in borrelia-endemic areas and are clinically similar. Early treatment with corticosteroids has been shown to be effective in Bell’s palsy and antibiotics improve outcome in LNB, but there is a lack of knowledge on how the addition of corticosteroids to standard antibiotic treatment affects outcome in LNB PFP. Methods This prospective open trial with historical controls was conducted at two large hospitals in western Sweden between 2011 and 2018. Adults presenting with LNB PFP were included in the study group and were treated with oral doxycycline 200 mg b.i.d. for 10 days and prednisolone 60 mg o.d. for 5 days, then tapered over 5 days. The historical controls were adult patients with LNB PFP included in previous studies and treated with oral doxycycline. Both groups underwent a follow-up lumbar puncture and were followed until complete recovery or for 12 months. Results Fifty-seven patients were included, 27 in the study group and 30 in the control group. Two patients (6%) in the study group and 6 patients (20%) in the control group suffered from sequelae at end follow up. There was no statistically significant difference between the groups, neither in the proportion of patients with sequelae, nor in the decline in CSF mononuclear cell count. Conclusions Adjunctive corticosteroids neither improve nor impair the outcome for patients with Lyme neuroborreliosis peripheral facial palsy treated with doxycycline.

scholarly journals Facial Diplegia as Initial Manifestation of Acute, Myelomonocytic Leukemia with Isolated Trisomy 47, XY,+11[14]/46, XY[6]

2017 ◽  
Vol 08 (03) ◽  
pp. 451-454
Author(s):  
Josef Finsterer ◽  
Michael Panny
Keyword(s):  
Clinical Manifestation ◽  
Facial Palsy ◽  
Leukocyte Count ◽  
Bell’S Palsy ◽  
Bell's Palsy ◽  
Initial Manifestation ◽  
Neurologic Manifestation ◽  
Peripheral Facial Palsy ◽  
Facial Diplegia ◽  
Myelomonocytic Leukemia

ABSTRACTBilateral peripheral facial palsy (facial diplegia) has been repeatedly reported as a neurologic manifestation of acute myeloid leukemia but has not been reported as the initial clinical manifestation of myelomonocytic leukemia. A 71-year-old male developed left-sided peripheral facial palsy being interpreted and treated as Bell’s palsy. C-reactive protein (CRP) and leukocyte count 4 days later were 2.5 mg/l and 16 G/l, respectively. Steroids were ineffective. Seven days after onset, he developed right-sided peripheral facial palsy. Three days later, CRP and leukocyte count were 234.3 mg/l and 59.5 G/l, respectively. Cerebrospinal fluid investigations revealed pleocytosis (62/3) and elevated protein (54.9 mg/dl). Two days later, pleocytosis and leukocytosis were attributed to myelomonocytic leukemia. Leukemic meningeosis was treated with cytarabine and methotrexate intrathecally. In addition, cytarabine and idarubicin were applied intravenously. Under this regimen, facial diplegia gradually improved. Facial diplegia may be the initial clinical manifestation of myelomonocytic leukemia, facial diplegia obligatorily requires lumbar puncture, and unilateral peripheral facial palsy is not always Bell’s palsy. Patients with alleged unilateral Bell’s palsy and slightly elevated leukocytes require close follow-up and more extensive investigations than patients without abnormal blood tests.

scholarly journals A rare case of acquired infantile Bell’s palsy

2021 ◽  
Vol 8 (7) ◽  
pp. 1316
Author(s):  
Lakshmi Mulinja ◽  
Thanzir Mohammed ◽  
Varun Govindarajan ◽  
Mallesh Kariyappa
Keyword(s):  
Case Report ◽  
Facial Palsy ◽  
Rare Case ◽  
Bell’S Palsy ◽  
Acute Onset ◽  
Spontaneous Resolution ◽  
Bell's Palsy ◽  
Peripheral Facial Palsy ◽  
Oral Corticosteroids ◽  
Viral Illness

Bell’s palsy, an acute onset, acquired, isolated peripheral facial palsy, usually follows a viral illness, is common disorder post infancy to adolescence. It has a favourable prognosis with spontaneous resolution, or with use of oral corticosteroids. Its presentation in early infancy is very unusual, as in our case report of 3 month old infant with an ovoid mass lesion in parotid, which disappeared after therapy with corticosteroids with no residual deficit.

scholarly journals Protracted COVID-19 during Treatment of Facial Palsy

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Mehrdad Hasibi ◽  
Maral Seyed Ahadi ◽  
Hamed Abdollahi ◽  
Mehrdad Jafari
Keyword(s):  
Facial Palsy ◽  
Antiviral Treatment ◽  
Complete Recovery ◽  
Bell’S Palsy ◽  
Concomitant Treatment ◽  
Neurologic Manifestations ◽  
Bell's Palsy ◽  
Peripheral Facial Palsy ◽  
Case Summary

Neurologic manifestations are increasingly reported as the coronavirus disease 2019 (COVID-19) pandemic continues. This is a report of a COVID-19 patient with Bell's palsy. Case Summary. A 52-year-old man with fever and malaise was tested positive for COVID-19. After a week, he developed right-sided peripheral facial palsy and was treated with corticosteroids in conjunction with antiviral treatment which resulted in complete recovery. Discussion. Concomitant treatment of corticosteroids and antiviral treatment can decrease morbidity in patients with COVID-19-related Bell's palsy.

scholarly journals 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

2021 ◽  
Vol 8 (3) ◽  
Author(s):  
Abu Talib ◽  
Gohar Baloch ◽  
Iftikhar Haider Naqvi ◽  
Muhammad Ubaid
Keyword(s):  
Quality Of Life ◽  
Utility Score ◽  
Health Utility ◽  
Complete Recovery ◽  
Bell’S Palsy ◽  
Control Group ◽  
Study Group ◽  
Facial Appearance ◽  
Bell's Palsy

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.

scholarly journals Melkersson–Rosenthal syndrome misdiagnosed as recurrent Bell’s palsy: a case report and review of literature

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Yared Zenebe Zewde
Keyword(s):  
Facial Palsy ◽  
Addis Ababa ◽  
Corticosteroid Treatment ◽  
Bell’S Palsy ◽  
High Dose ◽  
Bell's Palsy ◽  
Timely Initiation ◽  
Peripheral Facial Palsy ◽  
Facial Swelling ◽  
Fissured Tongue

Abstract Background Melkersson–Rosenthal syndrome (MRS) is a rare neuro-mucocutaneous disorder of unknown cause, clinically characterized by a triad of recurrent facial palsy, orofacial swelling, and fissured tongue. It is frequently seen in females in their second and third decades of life. MRS is diagnosed based on clinical features and it is rarely possible to observe all the classical triad symptoms at the same time. The disorder may cause recurring peripheral facial palsy that is wrongly diagnosed as recurrent Bell’s palsy Case presentation A 25-year-old female patient was presented to the neurology clinic of Tikur Anbessa Specialized Hospital in Addis Ababa complaining of recurrent left-side peripheral facial weakness, facial swelling and fissured tongue of 5 days duration. Her past medical history was positive for similar symptoms, for which she was diagnosed with Bell’s palsy and received oral corticosteroid treatment. On examination left side lower facial swelling with flat naso-labial fold and fissured tongue were identified. After excluding other mimickers, she was diagnosed with Melkersson–Rosenthal syndrome and completely recovered with high dose of corticosteroid treatment. Conclusion Melkersson–Rosenthal syndrome may present with the classic triads of symptoms, but mostly it shows an incomplete clinical pattern. Therefore, when clinicians including allergists encountered patients with facial swelling and facial palsy, they should have to consider MRS in their differential diagnosis and specifically assess for recurrent facial palsy and fissured tongue. Unlike true angioedema, the facial swelling in MRS often develops gradually and it might cause permanent swelling with cosmetic disfigurement from multiple relapses, which can be prevented by early detection and timely initiation of treatment.

EFFECTIVENESS OF NUEROMUSCULAR RE EDUCATION TECHNIQUE TO REDUCE FACIAL DISABILITY IN PATIENTS WITH BELL'S PALSY

2021 ◽  
pp. 78-80
Author(s):  
Singam Siva Sankar ◽  
Pasala Gopikrishna
Keyword(s):  
Facial Palsy ◽  
Conventional Therapy ◽  
Bell’S Palsy ◽  
Cranial Neuropathy ◽  
Facial Nerve Paralysis ◽  
Bell's Palsy ◽  
Nerve Paralysis ◽  
Peripheral Facial Palsy ◽  
Seventh Cranial Nerve ◽  
Group A

BACKGROUND AND OBJECTIVES: Facial nerve paralysis, because of the dysfunctional problems that can occur at the level of a very special part of the patients body, who gives their personality needs special consideration. Peripheral facial palsy is the most frequent cranial neuropathy, and can origin from various kinds of damage to the seventh cranial nerve. Idiopathic facial palsy or Bell's palsy is the most frequent cause of facial paralysis occurs in 15 - 30 Persons per 100,000 per year. METHODS: 30 subjects having facial disability who full lled with the inclusion criteria and randomly assigned. Group A and B with 15 subjects in each group. Group A subjects are treated with conventional therapy and Group B subjects are treated with Neuromuscular reeducation techniques for 4 weeks. The outcome of this intervention was measured with Facial Disability Index (FDI). These recorded before and after the session of 4 weeks of intervention. RESULTS: Statistical analysis of the data revealed that within group comparison both groups showed signicant reduction of facial disability in conventional therapy and Neuromuscular re-education. CONCLUSION: Finally the study concluded that 4 weeks of training program with Neuromuscular re-education showed signicant improvement when compared to conventional therapy.

Evaluation of an Algorithm for the Diagnosis and Therapy of Lyme Neuroborreliosis: A Follow-up Study

2021 ◽  
Vol 8 (2) ◽  
Author(s):  
Linauer L ◽  
◽  
Brunner J ◽  
Keyword(s):  
Antibiotic Treatment ◽  
Facial Palsy ◽  
German Society ◽  
Lyme Neuroborreliosis ◽  
Diagnosis And Therapy ◽  
Peripheral Facial Palsy ◽  
Paediatric Department ◽  
Paediatric Practice ◽  
Csf Pleocytosis

Background: Although Lyme Neuroborreliosis (LNB) is often seen in paediatric practice, diagnostic criteria for LNB in children are not clearly defined. The guidelines for LNB in adults are based on a combination of clinical picture, CSF pleocytosis and the detection of specific antibodies against Borrelia burgdorferi in CSF and serum. Diagnostic procedure takes several days, thus it isn´t useful in deciding for the need of prompt antibiotic treatment. Aim of study was a retrospective evaluation of an algorithm for the diagnosis and therapy of lyme’s disease, which is used since 2005 at the paediatric department of Innsbruck. Patients and Methods: All patients presenting with acute peripheral facial palsy from January 2006 to December 2014 were reviewed. The patients were diagnosed according to the algorithm, based on the criteria of the German Society of Neurology. The focus lay on evaluation of diagnosis and therapy according to the algorithm and whether overtreatment and underdiagnosis could therefore be avoided. Results: 120 patients were enrolled with peripheral facial palsy. 65 (54%) were handled as bell´s palsy and 55 (46 %) as B. burgdorferi s.l. infection. 19 cases were classified as confirmed LNB, 10 as probable and 26 as possible LNB. A total of 69 patients (58 %) were treated correctly according to the algorithm, 16 (13%) were over treated and 14 (11%) under treated with antibiotics. 21 (18%) could not be classified, according to the algorithm, due to the lack of CSF results. Although receiving proper treatment, 3 cases had a persistent defect after recovery. Conclusions: The algorithm is an appropriate diagnostic tool for the diagnosis and therapy of LNB, particularly with regard to the necessity of a prompt antibiotic treatment, and therefore helpful to avoid underdiagnosis and overtreatment.

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