Refractory Bell’s palsy responding to late treatment with high-dose intravenous steroids

Bell’s palsy is an acute peripheral facial paralysis with no detectable cause. Although the prognosis of Bell’s palsy is generally good, some patients experience poor recoveries and there is no established treatment for those that do not recover even after receiving the conventional treatment. Here we present two cases of refractory Bell’s palsy with facial nerve enhancement in magnetic resonance imaging who showed symptomatic improvement after the late administration of high-dose intravenous methylprednisolone.

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Magnetic Resonance Imaging in Patients with Bell's Palsy

Acta Oto-Laryngologica ◽

10.3109/00016488909139085 ◽

1989 ◽

Vol 108 (sup468) ◽

pp. 403-405 ◽

Cited By ~ 2

Author(s):

Lars Jonsson ◽

Anders Hemmingsson ◽

Lars Thomander ◽

Kjell Bergström ◽

Erik Stålberg ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Bell’S Palsy ◽

Resonance Imaging ◽

Bell's Palsy

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Magnetic Resonance Imaging of the Facial Nerve During Bell's Palsy

Otolaryngology ◽

10.1177/019459989110500506 ◽

1991 ◽

Vol 105 (5) ◽

pp. 667-674 ◽

Cited By ~ 29

Author(s):

Terrence P. Murphy ◽

David C. Teller

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Facial Nerve ◽

Bell’S Palsy ◽

Resonance Imaging ◽

Bell's Palsy

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High-dose corticosteroids improve the prognosis of Bell's palsy compared with low-dose corticosteroids: A propensity score analysis

Nippon Jibiinkoka Gakkai Kaiho ◽

10.3950/jibiinkoka.122.258 ◽

2019 ◽

Vol 122 (3) ◽

pp. 258-259

Author(s):

Takashi Fujiwara ◽

Yasuharu Haku ◽

Takuya Miyazaki ◽

Atsuhiro Yoshida ◽

Shin-ich Sato ◽

...

Keyword(s):

Propensity Score ◽

Low Dose ◽

Propensity Score Analysis ◽

Bell’S Palsy ◽

High Dose ◽

Bell's Palsy ◽

Score Analysis

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Functional Connectivity Modulation by Acupuncture in Patients with Bell’s Palsy

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2016/5928758 ◽

2016 ◽

Vol 2016 ◽

pp. 1-10 ◽

Cited By ~ 5

Author(s):

Yunpeng Bian ◽

Xiaoxuan He ◽

Sheng Hu ◽

Chuanfu Li ◽

Chunsheng Xu ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Functional Connectivity ◽

Resting State ◽

Bell’S Palsy ◽

Potential Mechanism ◽

Functional Magnetic Resonance ◽

Resonance Imaging ◽

Bell's Palsy ◽

Before And After

Bell’s palsy (BP), an acute unilateral facial paralysis, is frequently treated with acupuncture in many countries. However, the mechanism of treatment is not clear so far. In order to explore the potential mechanism, 22 healthy volunteers and 17 BP patients with different clinical duration were recruited. The resting-state functional magnetic resonance imaging scans were conducted before and after acupuncture at LI4 (Hegu), respectively. By comparing BP-induced functional connectivity (FC) changes with acupuncture-induced FC changes in the patients, the abnormal increased FC that could be reduced by acupuncture was selected. The FC strength of the selected FC at various stages was analyzed subsequently. Our results show that FC modulation of acupuncture is specific and consistent with the tendency of recovery. Therefore, we propose that FC modulation by acupuncture may be beneficial to recovery from the disease.

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Conservative treatment of Bell's palsy. High dose steroid infusion with low-molecular dextran.

Nippon Jibiinkoka Gakkai Kaiho ◽

10.3950/jibiinkoka.92.694 ◽

1989 ◽

Vol 92 (5) ◽

pp. 694-702 ◽

Cited By ~ 1

Author(s):

MINORU KINISHI ◽

HIDEO HOSOMI ◽

MUTSUO AMATSU

Keyword(s):

Conservative Treatment ◽

Bell’S Palsy ◽

High Dose ◽

Bell's Palsy ◽

High Dose Steroid

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Time-Dependent Recovery of Human Synovial Membrane Mesenchymal Stem Cell Function After High-Dose Steroid Therapy: Case Report and Laboratory Study

The American Journal of Sports Medicine ◽

10.1177/0363546517741307 ◽

2017 ◽

Vol 46 (3) ◽

pp. 695-701 ◽

Cited By ~ 4

Author(s):

Yukihiko Yasui ◽

David A. Hart ◽

Norihiko Sugita ◽

Ryota Chijimatsu ◽

Kota Koizumi ◽

...

Keyword(s):

Stem Cell ◽

Case Report ◽

Mesenchymal Stem Cell ◽

Steroid Therapy ◽

Laboratory Study ◽

Expression Profiles ◽

Bell’S Palsy ◽

High Dose ◽

Bell's Palsy ◽

High Dose Steroid

Background: The use of mesenchymal stem cells from various tissue sources to repair injured tissues has been explored over the past decade in large preclinical models and is now moving into the clinic. Purpose: To report the case of a patient who exhibited compromised mesenchymal stem cell (MSC) function shortly after use of high-dose steroid to treat Bell’s palsy, who recovered 7 weeks after therapy. Study Design: Case report and controlled laboratory study. Methods: A patient enrolled in a first-in-human clinical trial for autologous implantation of a scaffold-free tissue engineered construct (TEC) derived from synovial MSCs for chondral lesion repair had a week of high-dose steroid therapy for Bell’s palsy. Synovial tissue was harvested for MSC preparation after a 3-week recovery period and again at 7 weeks after therapy. Results: The MSC proliferation rates and cell surface marker expression profiles from the 3-week sample met conditions for further processing. However, the cells failed to generate a functional TEC. In contrast, MSCs harvested at 7 weeks after steroid therapy were functional in this regard. Further in vitro studies with MSCs and steroids indicated that the effect of in vivo steroids was likely a direct effect of the drug on the MSCs. Conclusion: This case suggests that MSCs are transiently compromised after high-dose steroid therapy and that careful consideration regarding timing of MSC harvest is critical. Clinical Relevance: The drug profiles of MSC donors and recipients must be carefully monitored to optimize opportunities to successfully repair damaged tissues.

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Cerebral volume changes in multiple sclerosis patients treated with high-dose intravenous methylprednisolone

Multiple Sclerosis Journal ◽

10.1191/1352458502ms838oa ◽

2002 ◽

Vol 8 (5) ◽

pp. 415-419 ◽

Cited By ~ 32

Author(s):

E LJ Hoogervorst ◽

C H Polman ◽

F Barkhof

Keyword(s):

Multiple Sclerosis ◽

Brain Volume ◽

Disease Onset ◽

Cerebral Atrophy ◽

Oral Prednisolone ◽

Prolonged Treatment ◽

High Dose ◽

Intravenous Methylprednisolone ◽

Intravenous Steroids ◽

Multiple Sclerosis Patients

Objective: Multiple sclerosis (MS) patients develop varying degrees of cerebral atrophy, which may already begin at disease onset. The purpose of this study is to examine the effect of steroid treatment on cerebral volume in MS patients. Methods: Thirty-five MS patients participating in a clinical trial of oral interferon beta, which included monthly MRI, were included in this study. They suffered from an acute relapse and were treated with intravenous methylprednisolone (IV-MP); 13 of the patients were treated with oral prednisolone tapering after IV-MP. The last MRI scan before and the first (and second for oral tapering patients) scan after IV-MP treatment were used for measuring parenchymal fraction (PF) and ventricular fraction (VF). Changes in PF and VF were analysed using Student’s t test. Results: For the total population no significant changes in PF or VF were found. However, the subgroup of patients receiving oral tapering after IV-MP showed changes, compatible with atrophy in both PF and VF, that were significant immediately after IV-MP treatment and still persisted (though not statistically significant anymore) after a mean interval of 30 days. The magnitude of these changes was about the same as the annual change in cerebral volume as reported in natural history studies. Conclusion: Our data indicate that short courses of intravenous steroids (restricted to three or five days) have no major impact, whereas prolonged treatment with oral tapering does significantly affect brain volume. These findings are important for longitudinal studies and clinical trials in which brain volume is used as an outcome measure.

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