Bell’s Palsy/Idiopathic Facial Palsy

To determine if the effect of manipulative acupuncture monitored by laser speckle contrast imaging (LSCI) can improve facial blood perfusion in patients with severe Bell’s palsy. This randomized, single-blind, controlled trial included 120 newly diagnosed patients (within 14 days) with severe Bell’s palsy (House–Brackmann grading system (HBGS) ≥ grade IV). The patients were randomized (1 : 1) to receive either acupoints acupuncture combined with manipulations of twirling, lifting, and thrusting treatments (manipulative acupuncture) or acupoints acupuncture therapy alone (simple acupuncture). These treatments consisted of a total of 24 sessions, three times per week, and each treatment lasted for 30 min. Following 8 weeks of treatment and 6 months after the initial onset of facial palsy, facial nerve functioning was scored (HBGS) and clinical efficacy was measured. The patients’ facial blood perfusion significantly improved following manipulative acupuncture assisted by LSCI compared with that at baseline ( P < 0.01 ). At the conclusion of the 8-week treatment, both groups showed improvement; however, the recovery rate was significantly different (manipulative acupuncture 53.3% vs. simple acupuncture 33.9%, P < 0.05 ). Follow-up analysis at 6 months after the onset of facial palsy revealed a significantly higher recovery rate (91.7% vs. 78.0%; P < 0.05 ). In addition, the number of treatments in the observation group was less than that in the simple acupuncture therapy group ( P < 0.05 ). Compared with simple acupuncture therapy, manipulative acupuncture therapy led to a more significant recovery rate in the treatment of severe Bell’s palsy and required a shorter course of treatment. This trial was registered with ChiCTR1800019463.

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

Journal of Neurosciences in Rural Practice ◽

10.4103/jnrp.jnrp_410_16 ◽

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.

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Current management of idiopathic facial palsy (Bell’s palsy)

Polski Przegląd Otorynolaryngologiczny ◽

10.5604/01.3001.0010.1027 ◽

2017 ◽

Vol 6 (2) ◽

pp. 25-30

Author(s):

Arkadiusz Paprocki ◽

Robert Bartoszewicz ◽

Kazimierz Niemczyk

Keyword(s):

Facial Nerve ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Combined Treatment ◽

Bell’S Palsy ◽

Diagnostic Techniques ◽

Etiologic Factor ◽

Bell's Palsy ◽

Idiopathic Facial Palsy ◽

Facial Nerve Decompression

Idiopathic facial nerve palsy, known also as Bell’s palsy, is a common condition encountered in everyday otolaryngological practice, and although the prognosis is fair, in case of incomplete recovery remains a marked physical disability for the patient. Despite of the development of diagnostic techniques, in most cases it is still impossible to point the etiologic factor, and therapy has to remain on empirical treatment. Material and method: In this article the review of literature on pathogenesis and therapy of idiopathic facial nerve palsy, published in years 2006–2016 was performed, presenting the articles with direct implications for everyday clinical practice. Results: According to presented articles, the importance of usage of combined treatment with steroids and antivirals, extended diagnostics for the presence of metabolic disorders(IGT) and surgical treatment with early facial nerve decompression in cases with severe degeneration of the fibers or recurrent paralysis were emphasized

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Lyme disease and Bell’s palsy: an epidemiological study of diagnosis and risk in England

British Journal of General Practice ◽

10.3399/bjgp17x690497 ◽

2017 ◽

Vol 67 (658) ◽

pp. e329-e335 ◽

Cited By ~ 11

Author(s):

Lilli Cooper ◽

Michael Branagan-Harris ◽

Richard Tuson ◽

Charles Nduka

Keyword(s):

Lyme Disease ◽

Facial Palsy ◽

International Classification Of Diseases ◽

Disease Diagnosis ◽

Bell’S Palsy ◽

Bell's Palsy ◽

Health And Social Care ◽

Classification Of Diseases ◽

Patients At Risk ◽

High Index Of Suspicion

BackgroundLyme disease is caused by a tick-borne spirochaete of the Borrelia species. It is associated with facial palsy, is increasingly common in England, and may be misdiagnosed as Bell’s palsy.AimTo produce an accurate map of Lyme disease diagnosis in England and to identify patients at risk of developing associated facial nerve palsy, to enable prevention, early diagnosis, and effective treatment.Design and settingHospital episode statistics (HES) data in England from the Health and Social Care Information Centre were interrogated from April 2011 to March 2015 for International Classification of Diseases 10th revision (ICD-10) codes A69.2 (Lyme disease) and G51.0 (Bell’s palsy) in isolation, and as a combination.MethodPatients’ age, sex, postcode, month of diagnosis, and socioeconomic groups as defined according to the English Indices of Deprivation (2004) were also collected.ResultsLyme disease hospital diagnosis increased by 42% per year from 2011 to 2015 in England. Higher incidence areas, largely rural, were mapped. A trend towards socioeconomic privilege and the months of July to September was observed. Facial palsy in combination with Lyme disease is also increasing, particularly in younger patients, with a mean age of 41.7 years, compared with 59.6 years for Bell’s palsy and 45.9 years for Lyme disease (P = 0.05, analysis of variance [ANOVA]).ConclusionHealthcare practitioners should have a high index of suspicion for Lyme disease following travel in the areas shown, particularly in the summer months. The authors suggest that patients presenting with facial palsy should be tested for Lyme disease.

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