Can blood parameters be used to assess the recovery time of Bell's palsy patients? A retrospective case-controlled study

Introduction: Inadequate recovery from Bell’s palsy exists in a third of patients and results in physical and social impairments. The controversial nature of existing medical treatment options means that novel, alternative approaches are needed. In basic and clinical studies, low-level laser therapy (LLLT) has proven successful in regenerating peripheral nerves. Laser acupuncture therapy (LAT) is a rapidly growing treatment modality; however, its effectiveness for treating chronic Bell’s palsy is unknown. The feasibility of this innovative approach is the focus of this pilot study. Methods: A two-armed, parallel, randomized, investigator-subject-assessor-blinded, sham-controlled pilot study was conducted, and 17 eligible subjects were randomly allocated to either LAT (n=8) or sham LAT (n=9). The LAT group received three treatments each week for six weeks (18 sessions), while the sham LAT group received the same procedure but with a sham laser device. The change from baseline to week 6 in the social subscale of the Facial Disability Index (FDI) was the primary outcome. Secondary outcomes were changes in the House-Brackmann facial paralysis scale (HB), the Sunnybrook facial grading system (SB) and a stiffness scale at weeks 3 and 6. Results: A significant difference was shown in the HB score (P=0.0438) between baseline and week 3 and borderline significance was observed in both SB and stiffness scores from baseline to week 6 (P=0.0598 and P=0.0980 respectively). There was no significant difference in the FDI score between baseline and week 6. Conclusion: To the best of our knowledge, this clinical trial is the first such investigation on this topic. Our findings suggest that using LAT may have clinical effects on long-term complications of Bell’s palsy and justify further large-scale studies.

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Early Management of Cervical Impairments and the Incidence of Delayed Recovery in Adolescents With Acute Concussion

Neurology ◽

10.1212/01.wnl.0000801840.43840.63 ◽

2021 ◽

Vol 98 (1 Supplement 1) ◽

pp. S12.1-S12

Author(s):

Jacob I. McPherson ◽

Patrick Sparks ◽

Mohammad Nadir Haider ◽

Barry Stewart Willer ◽

John J. Leddy

Keyword(s):

Recovery Time ◽

Sleep Disturbances ◽

Neck Disability Index ◽

Controlled Study ◽

Symptom Scale ◽

Retrospective Case ◽

Blurred Vision ◽

Early Management ◽

Persistent Symptoms ◽

Significant Difference

ObjectiveTo determine if concussed adolescents with positive cervical findings on examination provided with early cervical treatment demonstrate recovery time and incidence of persistent post-concussive symptoms (PPCS, recovery = 30 days) comparable to those without cervical findings.BackgroundCervical impairments resulting from concussive injury are historically associated with longer recovery times. Concomitant cervical injuries may result in symptoms that overlap with concussion, including headache, dizziness, tinnitus, sleep disturbances, and blurred vision. Current recommendations include assessment of the cervical spine; however, there is limited evidence for the effect of immediate cervical intervention on recovery.Design/MethodsRetrospective case-controlled study. Patients included adolescents with acute concussion presenting with (n = 132, 14.99 ± 1.9 years, 58% male, 5.70 ± 3.3 days since injury) and without (n = 138, 14.85 ± 1.8 years, 65% male, 6.13 ± 3.4 days since injury) cervical findings on physical exam. Patients were assessed with the Buffalo Concussion Physical Examination (BCPE), Neck Disability Index (NDI) and Post-Concussion Symptom Scale (PCSS) instruments. Groups were separated based on positive or negative cervical findings on the BCPE. Cervical impairments were addressed by physicians specializing in concussion management using a clinical algorithm. Mild impairments were managed conservatively (over-the-counter analgesics, warm/cold compresses, and/or neck stretching exercises). Patients with moderate or greater impairments were assessed by a physical therapist at the initial clinic encounter and given specific cervical interventions.ResultsPhysician-observed cervical findings had moderate agreement with self-reported function on the NDI (? = 0.414, p < 0.001). Patients with cervical findings reported greater symptom severity on the PCSS (37.9 ± 22.1 vs 30.8 ± 20.2, p = 0.011); however, there was no significant difference in recovery time (34.44 ± 33.2 vs 34.81 ± 39.0 days, p = 0.933) or incidence of persistent symptoms (39% vs 35%, p = 0.511).ConclusionsIn this group of adolescents, cervical impairment managed early after concussion was not associated with prolonged recovery. Early management of cervical impairments may reduce the development of PPCS. Prospective evaluation is warranted.

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Air pollution by NO2 is associated with the risk of Bell’s palsy: A nested case-controlled study

Scientific Reports ◽

10.1038/s41598-020-61232-7 ◽

2020 ◽

Vol 10 (1) ◽

Cited By ~ 1

Author(s):

So Young Kim ◽

Chanyang Min ◽

Jay Choi ◽

Bumjung Park ◽

Hyo Geun Choi

Keyword(s):

Air Pollution ◽

Bell’S Palsy ◽

Controlled Study ◽

Bell's Palsy

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Bell’s Palsy—Nerve Conduction and Recovery Time

Physical Therapy ◽

10.1093/ptj/50.6.799 ◽

1970 ◽

Vol 50 (6) ◽

pp. 799-807 ◽

Cited By ~ 4

Author(s):

Elliott Brown ◽

Stanley Arno ◽

Darwin C. Twedt

Keyword(s):

Nerve Conduction ◽

Recovery Time ◽

Bell’S Palsy ◽

Bell's Palsy

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Valacyclovir and Prednisolone Treatment for Bell's Palsy: A Multicenter, Randomized, Placebo-Controlled Study

Yearbook of Otolaryngology-Head and Neck Surgery ◽

10.1016/s1041-892x(08)79144-3 ◽

2008 ◽

Vol 2008 ◽

pp. 95-96

Author(s):

M.A. Keefe

Keyword(s):

Bell’S Palsy ◽

Controlled Study ◽

Bell's Palsy ◽

Prednisolone Treatment

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Protocol for randomized controlled trial of electric stimulation with high-volt twin peak versus placebo for facial functional recovery from acute Bell’s palsy in patients with poor prognostic factors

Journal of Rehabilitation and Assistive Technologies Engineering ◽

10.1177/2055668320964142 ◽

2020 ◽

Vol 7 ◽

pp. 205566832096414

Author(s):

Myriam Loyo ◽

Margaret McReynold ◽

Jess C Mace ◽

Michelle Cameron

Keyword(s):

Poor Prognosis ◽

Electric Stimulation ◽

Controlled Trial ◽

Complete Recovery ◽

Bell’S Palsy ◽

Controlled Study ◽

Bell's Palsy ◽

High Quality ◽

Patient Reported ◽

Peak Versus

Background Electric stimulation (ES) can prevent muscle atrophy and promote tissue healing and therefore may help prevent sequelae of Bell’s palsy but due to lack of high-quality studies, the effectiveness of ES in Bell’s palsy remains controversial. Here we describe a protocol to evaluate the effects of monophasic high volt ES in patients with Bell’s palsy and poor prognosis for recovery. Results This is a protocol for a prospective, double-blinded, randomized, placebo-controlled study. Participants include adults with acute Bell’s palsy with poor prognosis for full recovery due to complete paralysis or being over age 60. ES will be a monophasic, high-volt pulsed waveform, 100μsec pulse duration, 35 hertz, motor-level intensity. Follow up will be at months 1, 2, 3 and 6. The primary outcome will be the proportion of patients with complete recovery using the eFACES tool. Secondary outcomes include patient reported quality of life measured by FaCE and the synkinesis assessment questionnaires, objective photographs, time to complete recovery, adverse effects, and tolerability. Conclusion This protocol has the potential to provide high quality evidence regarding the effects, up to 6 months after onset, of pulsed monophasic high-volt ES for patients with acute Bell’s palsy and poor prognosis for complete recovery.

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Reappraisal of the Prognostic Factors of Outcome and Recovery Time in Patients with Idiopathic Bell’s Palsy: A Retrospective Single-Center Analysis

Journal of Personalized Medicine ◽

10.3390/jpm11030171 ◽

2021 ◽

Vol 11 (3) ◽

pp. 171

Author(s):

Chi-Hao Peng ◽

Jiun-Liang Chen ◽

Ming-Feng Liao ◽

Jung-Lung Hsu ◽

Hui-Ching Hsu ◽

...

Keyword(s):

Prognostic Factors ◽

Recovery Time ◽

Bell’S Palsy ◽

Final Outcome ◽

Favorable Outcome ◽

Chang Gung Memorial Hospital ◽

Bell's Palsy ◽

Oral Glucocorticoid ◽

Grade Ii ◽

Different Doses

Study Objectives: This retrospective study investigated prognostic factors and recovery time in patients with Bell’s palsy after different doses and durations of oral glucocorticoid treatments. Subjects and Methods: A total of 396 patients initially diagnosed with Bell’s palsy that had visited the Department of Neurology of Chang Gung Memorial Hospital, Taoyuan, a tertiary referral medical center in Taiwan, between January 2014 and December 2018 were included. Medical records, facial electroneurography (fENoG), and blink reflex (BR) tests were reviewed and analyzed. A favorable outcome was defined as patients who improved to grade ≤ II, and an unfavorable outcome was defined as patients who improved to grade ≥ III in 6 months according to the House–Brackmann (HB) grading system. Results: The rate of favorable outcomes was 89.4% (354 of 396 patients) at the 6-month follow-up. A favorable outcome (HB less than grade II) was associated with a delayed BR (odds ratio, OR, 5.38; 95% CI, 1.82 to 15.90) and fENoG values (the lesion side/the healthy side) over 33% (OR, 6.67; 95% CI, 3.02 to 14.71). The recovery time was significantly shorter for those with a delayed BR than for those with an absent BR and shorter for those with good fENoG values (>33%) than for those with poor values (≤33%). However, treatment without or with different doses and durations of oral glucocorticoid did not influence the final outcome or recovery time in this study. Conclusions: The fENoG and BR tests were significant and highly valuable examinations for predicting the final outcome. Moreover, age younger than 60 years, a delayed BR, and fENoG values > 33% were associated with shorter recovery times.

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