Bell’s palsy

Abstract   There is insufficient evidence concerning the efficacy of antiviral treatment of Bell’s palsy (BP). We therefore compared the efficacy of prednisone and famciclovir to prednisone treatment alone in BP. A total of 167 consecutive patients with untreated acute BP were included. Severity of BP was evaluated using the House-Brackmann scale (HBS) and virus antibody tests (herpes simplex virus, varicella zoster virus) were performed. Patients admitted on even dates were treated with prednisone (“P group”) and patients admitted on odd dates were treated with prednisone and famciclovir (“P+F group”). 117 patients completed the follow-up after 3 months or later (67 P/51 P+F). While most patients showed at least partial recovery with both treatment types, improvement of at least 4 grades in the HBS was more common in the “P+F group” (29.4 % vs. 11.9 %), whereas smaller changes of less than 3 grades were more common in the “P group” (29.9 % vs. 17.6 %; Chi-square test, p = 0.02). Patients with complete BP (HBS grade of 5 or 6) had significantly better chances of reaching normal function if treated with famciclovir additionally instead with prednisone alone (73.7 % vs. 47.1 %; Cochran-Armitage trend test, p = 0.03). These results suggest that the combined treatment of famciclovir and prednisolone should be considered (at least) in patients with severe BP.     

Interesting sign of Bell’s palsy in an ear wiggler

Bell’s palsy is a common disorder involving facial nerve. Branches of the facial nerve innervating auriculares muscles could be involved in patients with Bell’s palsy. Functions of auriculares muscles were degenerated in the most of human beings, therefore, paralysis of the auriculares muscles in patients with Bell’s palsy may be unnoticeable. However, unilateral loss of ear wiggling may be an interesting sign of Bell’s palsy in natural ear wigglers who can move their ears voluntarily. The mechanism and muscles responsible for the ear wiggling and the innervations to these muscles were illustrated.     

Vestibular evoked myogenic potentials in Bell’s palsy

The aim of the present study was to evaluate vestibular nerve involvement in patients with Bell’s palsy with ocular and cervical vestibular evoked myogenic potentials (oVEMP and cVEMP). Ten patients who were diagnosed with Bell’s palsy and ten healthy controls were included. All patients underwent VEMP recordings within 6 days after their initial presentation. Patients with Bell’s palsy had greater oVEMP asymmetry ratio comparing to healthy controls (?38.4 ± 28.7 % vs ?1.3 ± 19.3 %, p = 0.005). As well N10 latencies of the oVEMP response were prolonged comparing to healthy controls (11.575 vs 9.72 ms). There was no difference in cVEMP asymmetry ratio or latencies between groups. We found no correlation between House–Brackmann grading scale and oVEMP asymmetry ratio (r = 0.003, p = 0.994). There are three possible explanations for increased oVEMP amplitudes on the affected side: (1) oVEMP response on the ipsilateral eye could be contaminated by facial nerve activity (blink reflex); (2) the amplitude of N10-P33 could be affected through the stapedial reflex; and (3) increased oVEMP amplitude could be the consequence of the vestibular nerve dysfunction itself, with prolonged latencies of the N10 oVEMP further supporting this explanation. The results of this study indicate possible involvement of the superior branch of the vestibular nerve in patients with Bell’s palsy.     

The etiology of Bell’s palsy: a review

Journal of Neurology - Bell’s palsy is the most common condition involving a rapid and unilateral onset of peripheral paresis/paralysis of the seventh cranial nerve. It affects...     

PML-IRIS in an HIV-2-infected patient presenting as Bell’s palsy

We present the case of an HIV-2-infected patient who developed progressive multifocal leukoencephalopathy (PML) in the setting of immune reconstitution inflammatory syndrome (IRIS) presenting as Bell’s palsy. The brain MRI showed a single lesion in the facial colliculus considered initially to be ischemic in nature. This case report should alert clinicians that PML can occur in the setting of HIV-2 infection. It also illustrates the difficulty of establishing the diagnosis of PML.     

Metagenomic next-generation sequencing of viruses,bacteria, and fungi in the epineurium of the facial nerve with Bell’s palsy patients

Journal of NeuroVirology - Bell’s palsy (BP) represents a major cause leading to facial paralysis in the world. The etiology of BP is still unknown, and virology is the prevailing theory. The...     

Prevalence of Pervasive Developmental Disorder in Down’s Syndrome

The frequencies of pervasive developmental disorder (PDD) in Down’s syndrome (DS) have been reported from 1% to 11%. However, it is not clear if the frequency of this co-occurrence is higher or lower than in other mental retardations. We study a large sample of DS population, finding a PDD frequency of 15.6%, with 5.58% of autism (eight males and two females) and 10.05% of PDD non autism (nine males and nine females. The meaning of this frequency is discussed.     

A comparison of facial nerve disability between patients with Bell’s palsy and vestibular schwannoma

We compared self-assessed morbidity of facial nerve dysfunction arising from surgical intervention with those in non-surgical clinical scenarios in a cross-sectional observational study. The validated patient-graded Facial Clinimetric Evaluation (FaCE) scale and a supplementary questionnaire were mailed to adult subjects with a history of facial nerve dysfunction. Seventy-five completed survey packets were returned: 53 (71%) cases of facial nerve dysfunction were caused by surgery for vestibular schwannoma and 22 (29%) were the result of Bell’s palsy. The vestibular schwannoma cohort reported less paralysis-related morbidity in the subscale domains of facial movement and social function (p < 0.03, one-way analysis of variance [ANOVA]). Within the surgical cohort, those patients expecting “likely” postoperative facial dysfunction experienced less morbidity in oral function and social function compared to those expecting “unlikely” postoperative facial dysfunction or those who did not recall having a preoperative discussion at all (p < 0.05, one-way ANOVA). Patient age, gender, history of rehabilitative measures, and duration of paralysis did not correlate with morbidity. We concluded that patients with facial nerve dysfunction arising from surgical intervention experienced less morbidity than those caused by non-surgical etiologies. Patient participation in the informed consent process and health provider setting of expectations were important factors to reduce perceived morbidity.     

Prevalence of obstructive sleep apnea in Alzheimer’s disease patients

Journal of Neurology - To assess the prevalence of obstructive sleep apnea (OSA) in patients with mild-moderate Alzheimer’s Disease (AD) and to evaluate cognitive characteristics according to...     

Prevalence of depression in Parkinson’s disease in a Lebanese tertiary clinic

Introduction: Diagnosis of Parkinson’s disease can be emotionally and psychologically challenging to patients. The aim of this study is to investigate the association between Parkinson’s disease and depression and the impact of the disease stage and patients’ age and gender on this association. Method: This is a cross-sectional retrospective study on 200 patients aged above 35 years old from 10 different nationalities. Results: Depression was diagnosed in 46% of the patients enrolled. Most of these patients were treated with an antidepressant. Young age, female gender, and moderate Parkinson’s disease stage were found to be significantly associated with depression (odds ratio of 1.19, 1.23, and 1.22, respectively, p < .05). Conclusion: This study, the first of its kind in Lebanon and the Middle East and North Africa region, highlights the importance of studying depression in Parkinson’s disease and the need for identifying and treating depression symptoms when treating Parkinson’s disease patients.     

Bell’s palsy following a single dose of mRNA SARS-CoV-2 vaccine: a case report

Journal of Neurology -     

Prevalence of non-motor symptoms in young-onset versus late-onset Parkinson’s disease

Non-motor symptoms (NMS) of Parkinson’s disease (PD) have only recently been increasingly recognized for their impact on a patient’s quality of life. In this study, we applied the validated, comprehensive self-completed NMS questionnaire for PD (NMS Quest) to 101 patients with young-onset PD (onset between 21 and 45 years, YOPD) and 107 patients with late-onset PD (onset of PD ≥ 55 years, LOPD). The mean total NMS (NMSQ-T) was 11.9 ± 6.0 (range: 0 to of a maximum of 26) in LOPD and 7.7 ± 5.8 (range: 0 to of a maximum of 26) in YOPD (p < 0.05). Compared to YOPD, dribbling of saliva, loss of taste/smell, nocturia, forgetfulness, loss of interest, hallucinations, lack of concentration, anxiety, change in libido and difficulty in sexual activities, were significantly more prevalent in LOPD. The only NMS more prevalent in YOPD were restless legs and sweating, although such findings might be associated with drug effects. Among the nine NMS Quest domains, in both LOPD and YOPD patients the three most prevalent domains were depression/anxiety, urinary and sexual. Also, in both groups, hallucinations/delusions had the lowest frequency. In the multivariate linear regression model, the Hoehn and Yahr (HY) stage of the disease and activities of daily living scores in YOPD patients, while only the HY stage in LOPD patients appeared to be statistically significant predictors of increasing number of NMS. In contrast to a previous suggestion that YOPD patients might have an increased risk for NMS, we found a higher prevalence of NMS in LOPD patients than in those with YOPD.     

Can Systemic Immune-Inflammation Index (SII) be a prognostic factor of Bell’s palsy patients?

Neurological Sciences - Recent studies showed that the neutrophil-to-lymphocyte ratio (NLR) and that platelet-to-lymphocyte ratio (PLR) can be used as inflammatory markers in Bell’s palsy. In...     

A double-labeling immunohistochemical study of tau exon 10 in Alzheimer’s disease, progressive supranuclear palsy and Pick’s disease

Neurofibrillary tangles (NFT), one of the histopathological hallmarks of Alzheimer’s disease (AD) and progressive supranuclear palsy (PSP), and Pick bodies in Pick’s disease (PiD) are composed of microtubule-associated protein tau, which is the product of alternative splicing of a gene on chromosome 17. Alternative expression of exon 10 leads to formation of three- or four-repeat tau isoforms. To study the differential expression of exon 10, we performed double-labeling immunohistochemistry of the hippocampal formation in nine AD, four PSP and three PiD cases. Cryostat sections were processed with and without formic acid (FA) treatment, and double-stained with anti-tau (Alz-50 or PHF-1) or anti-amyloid P component antibodies and one of two specific anti-exon 10 antibodies (E-10). The effect of proteinase-K treatment was also evaluated. The results suggest the following. First, in AD, E-10 immunoreactivity is present in most intracellular NFT, but not in most dystrophic neurites and neuropil threads, suggesting differential expression of tau isoforms in specific cellular domains. Second, in AD, E-10 immunoreactivity is lost or blocked in most extracellular NFT, possibly due to proteolysis. Third, in PSP, E-10 immunoreactivity is hidden or blocked in NFT and tau-positive glial inclusions, but FA treatment exposes the epitope consistent with the hypothesis that PSP inclusions contain four-repeat tau. Fourth, E-10 immunoreactivity is present in dentate fascia NFT in AD and PSP, but not in Pick bodies in the dentate fascia or other areas. The results suggest that expression of exon 10 in tau is specific for cellular domains in a disease-specific manner. Received: 26 July 1999 / Revised, accepted: 25 November 1999