Botulinum Toxin for the Treatment of Hemifacial Spasm: An Update on Clinical Studies

Hemifacial spasm (HFS) is a movement disorder characterized by involuntary contractions of the facial muscles innervated by the seventh cranial nerve. Generally, it is associated with a poor quality of life due to social embarrassment and can lead to functional blindness. Moreover, it is a chronic condition, and spontaneous recovery is rare. Intramuscular injections of Botulinum Toxin (BoNT) are routinely used as HFS treatment. Methods: We reviewed published articles between 1991 and 2021 regarding the effectiveness and safety of BoNT in HFS as well as any reported differences among BoNT formulations. Results: The efficacy of BoNT for HFS treatment ranged from 73% to 98.4%. The mean duration of the effect was around 12 weeks. Effectiveness did not decrease over time. Adverse effects were usually mild and transient. The efficacy and tolerability of the different preparations appeared to be similar. Among the studies, dosage, injected muscles, intervals of treatment, and rating scales were variable, thus leading to challenges in comparing the results. Conclusions: BoNT was the treatment of choice for HFS due to its efficacy and safety profile. Further studies are needed to investigate the factors that influence the outcome, including the optimal timing of treatment, injection techniques, dosage, and the best selection criteria for formulations.

A Study on Seasonal Variation of Bell’s Palsy in a District Area of Bangladesh

Introduction: Bell’s palsy is a common cranial neuropathy causing acute onset of unilateral lower motor neuron type of seventh cranial nerve palsy that result in ipsilateral facial muscle weakness. The aim of this study was to determine the possible correlation of Bell’s palsy and seasonal influence in a district area of Bangladesh. Materials & Methods: This is an observational study in which we collect, compiled and analyzed the patients information who attended in outpatient department of neuromedicine unit at Cumilla medical college hospital Cumilla from January 2018 to December 2019. Results: In our study, out of 214 patients male were 117(54.7%) and female were 97(45.3%). Age range from 4 to 90 yrs, median age was 40.0±17.6 Number of patients with Bell’s palsy presented in various seasons include 44% during winter, 35% during summer, 9% during fall monsoon and 12% during autumn period. We analyzed the data by using Mean±SD and chi-square test. A significant association was evident in winter and summer season (P=0.04 and P=0.045) respectively. Conclusion: In our present study we found significant relation between seasonal variation and occurrence of Bell’s palsy. Medicine Today 2021 Vol.33(2): 129-132

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

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.

Isolated 6th cranial nerve palsy: a rare manifestation of tuberculosis

<p>Tuberculosis (TB) is a contagious infection that is usually caused by <em>Mycobacterium tuberculosis</em> bacteria. It usually affects the lungs and also spreads to the brain and spine. In the central nervous system, the neurological manifestations are numerous and varied and usually occur in two major forms, tuberculous meningitis and tuberculoma. Tuberculoma are well defined, granulomatous, space occupying lesions, which can occur anywhere in the central nervous system. Usually, brainstem tuberculoma can cause sixth and seventh cranial nerve affections along with motor and sensory symptoms, which are usually unilateral. Isolated abducens nerve palsy could be attributed to lesions of the nerve along their extra axial course and cause diplopia. Here we are presenting a case report of an 18-year-old boy with isolated sixth nerve palsy due to tuberculosis. The diagnosis of tuberculosis was achieved using interventional radiology for the purpose of biopsy. Using an image guided technique, we could avoid an open surgical procedure. </p>

Impact of Physical Therapy on a Patient with Bell’s Palsy: A Case Report

Affecting the seventh cranial nerve, known as Bell's palsy and its neuropathy. It is a disfiguring disorder with significant impact on patient’s physical mental and social health. It is normally caused by inflammation caused by traumatic, infectious, inflammatory or compressive conditions, and cranial nerve edema may lead to compression and eventual ischemia. In comparison with the central cause peripheral cause leads to more serious form of Bell’s palsy. The symptoms usually include reduced production of tears, altered taste, facial pain, otalgia and aural pressure. the recovery is usually complete while in some cases incomplete recovery is seen. For treating Bell’s palsy a multidisciplinary approach is required to completely return back to normal. A case of female patient whose age 43 year old came to the right hemifacial palsy department has been identified. There was a affected movement of right side eyebrows and affected right forehead movement during clinical evaluation, spontaneously opening and closing of the right eye, difficulty to close the right eye. No conclusive etiology could be traced out after a series of investigations, hence diagnosed as right side Bell’s palsy. We address the clinical characteristics and modalities of care for Bell’s palsy in this article. Education, facial muscle strengthening exercise, eye defense exercises, modalities and acupuncture were included in the physiotherapy intervention.

Right Sided Facial Nerve Palsy, Bilateral Microtia with Polydactyly in an Infant – A Rare Case Report

Congenital facial palsy (CFP) is facial palsy of the seventh cranial nerve present at birth. It is commonly believed to be either developmental or originally acquired. Facial palsy of developmental origin is associated with other anomalies including ear, eye or cardiac anomalies. But it is rarely associated with polydactyly. We report a 10- month-old female infant who had right CFP with bilateral microtia and polydactyly. Congenital facial nerve palsy unilaterally manifesting as weakness of entire face on one side due to infranuclear cause is a rare occurrence in paediatric population.1 The facial palsy of lower motor neuron type involves weakness of same side of muscles of face of one side. Facial nerve as it emerges out of cranium traverses through facial canal medial to mastoid process and divides into multiple branches. It supplies ear, autonomic fibres for lacrimal gland, salivary glands, and motor supply to the face. Any pathology, congenital or acquired causing compression of facial nerve in this pathway can lead to facial palsy. Microtia is a congenital condition that varies from minor structural defects to full ear absence in severity and may occur as an individual defect or as part of a syndrome. Polydactyly is the most common hereditary limb anomaly characterized by extra fingers or toes. Here, we report a case presented with bilateral microtia and right-side facial nerve palsy.

Ramsay Hunt's Syndrome in Pediatric Age

The Ramsay Hunt's syndrome (RHS), caused by the reactivation of the varicella-zoster virus (VZV), is an infrequent cause of peripheral facial palsy in the pediatric patients. A 16-year-old adolescent boy presented with headache, right earache, and signs of lower motor neuron type facial palsy. He was medicated with deflazacort. Four days later, he developed blurry vision in the right eye, gait imbalance, and vesicular lesions in the right ear with decreased ipsilateral hearing acuity. A diagnosis of RHS was considered. Cerebrospinal fluid (CSF) analysis showed pleocytosis, as well as VZV DNA. Magnetic resonance imaging of the brain identified abnormal uptake of gadolinium contrast in the right seventh cranial nerve, reinforcing the diagnosis. The patient was treated with acyclovir (14 days) and prednisone, with progressive clinical improvement. We emphasize the importance of recognizing this syndrome in patients with facial palsy, since the early antiviral treatment significantly improves the prognosis.

Use of Dexmedetomidine as an Adjuvant to Propofol along with Neurophysiological Monitoring of the Seventh Cranial Nerve during Cerebello- Pontine Tumour Excision Surgery

Cerebello‑Pontine Angle (CPA) surgeries are very challenging for neurosurgeons as it lies very close to brain stem so various cranial nerves are at risk of damage. Generally, such surgeries require neuromuscular monitoring of various cranial nerves. For that we have to discontinue neuromuscular blocking agents and inhalational agents. Total Intravenous Anaesthesia (TIVA) avoids the use of neuromuscular blocking agents as well as inhalational agents. However, prolonged infusion of propofol is associated with risks, such as hypotension, delayed awakening, and metabolic acidosis, known as “Propofol Infusion Syndrome”. Dexmedetomidine now‑a‑days is used very commonly as an adjuvant to propofol and it significantly reduces the anaesthetic requirement. Addition of dexmedetomidine provides haemodynamic stability during such neurosurgeries. Here, authors have described anaesthetic management of a 46‑year‑old female patient posted for CPA excision along with seventh cranial nerve monitoring using dexmedetomidine with propofol.

Successful treatment of highly recurrent facial baroparesis in a frequent high-altitude traveler: a case report

Background Facial baroparesis is a palsy of the seventh cranial nerve resulting from increased pressure compressing the nerve along its course through the middle ear cavity. It is a rare condition, most commonly reported in barotraumatic environments, in particular scuba diving and high-altitude air travel. We report here an unusual case of highly frequent baroparesis, workup, and successful treatment. Case presentation A 57-year-old Caucasian male frequent commercial airline traveler presented with a 4-year history of recurrent episodes of right-sided facial paralysis and otalgia, increasing in both frequency and severity. Incidents occurred almost exclusively during rapid altitude changes in aircraft, mostly ascent, but also during rapid altitude change in an automobile. Self-treatment included nasal and oral decongestants, nasal corticosteroids, and warm packs. Temporal bone computed tomography (CT) scan revealed possible right-sided dehiscence of the tympanic bone segment; audiogram and magnetic resonance imaging of the internal auditory canals were unremarkable. After a diagnosis of facial nerve baroparesis was made, the patient underwent myringotomy with insertion of a pressure equalization tube (PET) into the right tympanic membrane. Despite re-exposure to altitude change multiple times weekly post-treatment, the patient reported being symptom-free for more than 6 months following intervention. Conclusions Prompt PET insertion may represent the preferred treatment for individuals who suffer recurrent episodes of facial baroparesis. Education regarding this rare condition may prevent unnecessary testing and treatment of affected patients. Future studies should explore the pathophysiology and risk factors, compare therapeutic options, and provide follow-up data to optimize the management of affected patients.