Vestibular abnormalities in patients with Bell's palsy

In order to assess the extent of the underlying pathology in Bell's palsy, the vestibular function of 24 patients was evaluated within the first week from the onset of facial paralysis. Seven patients had pathological findings by ENG and an additional three had subjective vestibular signs; four of these ten patients also showed abnormal auditory brain stem evoked potentials. There was no correlation between the severity of the paralysis or the prognosis for recovery and the presence of vestibular abnormalities.     

Trigeminal dysfunction in patients with Bell's palsy

The trigeminal function was investigated in 30 consecutive patients with acute unilateral peripheral facial palsy. The patients were tested with electrophysiological methods within 5 weeks after onset of the disease. Trigeminus-evoked potential test (TEP) disclosed trigeminal dysfunction in 47%, while the blink reflex test (BR) showed trigeminal pathology in 60% of the patients. A topographical analysis of the trigeminal system showed that 24% of the patients had BR patterns that were consistent with brainstem involvement. In 2 cases (7%), TEP was pathological though the BR test proved normal. These findings suggest a more central trigeminal affection and may demonstrate multifocal lesions. This was further underlined by the investigation of the auditory brainstem response (ABR) which indicated brainstem involvement in 28%. It is concluded that acute facial palsy is frequently a symptom of a central nervous affection.     

Equilibrium test findings in patients with Bell's palsy

OBJECTIVE: We analyzed equilibrium test findings in patients with Bell's palsy to confirm that such findings occur not only in patients with Hunt's syndrome but also in patients with Bell's palsy. METHODS: Subjects were 83 patients with Bell's palsy, 45 patients with Hunt's syndrome, and 82 patients with unilateral chronic otitis media without history of vertigo or ear surgery (for control). They were treated in our inpatient department and underwent equilibrium testing during the period 1983-2002. All subjects were at least 20 years of age. The following were analyzed: (1) presence of vertigo, (2) presence of abnormal equilibrium test findings, (3) relation between the degree of paralysis and abnormal equilibrium test findings, and (4) relation between the degree of recovery from paralysis and abnormal equilibrium test findings. Equilibrium testing consisted of a gaze nystagmus test, a spontaneous nystagmus test, positional and positioning nystagmus tests, and a caloric test. The incidence of abnormal findings in each test was compared between the three groups. RESULTS: Abnormal equilibrium test findings were observed in patients with Bell's palsy. No association was observed between the results of equilibrium tests and the degree of facial paralysis in patients with Bell's palsy. However, some of the equilibrium test results were significantly associated with the degree of facial nerve recovery. CONCLUSIONS: Although our study was limited in its lack of true control subjects, our data suggest that patients with Bell's palsy show a significantly high incidence of vestibular abnormalities.     

Auditory cortical responses in patients with Bell's palsy

We recorded auditory evoked magnetic responses with a whole-scalp 122-channel SQUID neuromagnetometer in 14 patients with Bell's palsy (9 with left-sided and 5 with right-sided) and in 10 controls. The stimuli were 50-ms 1-kHz tone bursts, delivered first to the left and then to the right ear at interstimulus intervals (ISIs) of 1, 2 and 4 s. In patients, the N100m, the 100-ms response originating in the auditory cortices peaked, on average, 8 ms earlier and the response strengths were, on average, 7 nAm stronger over the contralateral than ipsilateral hemisphere. The response latencies and strengths did not differ significantly from those of controls and there were no significant differences in response latencies and strengths between the stimulation of the affected and healthy side. On average, the response latencies and strengths increased as a function of ISI over both hemispheres both in patients and in controls. These findings suggest that Bell's palsy is an isolated peripheral neuropathy that does not affect the function of the auditory pathways.     

Tick-borne Borrelia infection in patients with Bell's palsy

An enzyme-linked immunosorbent assay was applied to serum samples of 94 patients diagnosed as having Bell's palsy: they were studied throughout two consecutive years in an attempt to establish serologic evidence of a tick-borne spirochetal infection. A strain of Borrelia spirochetes, isolated from Swedish Ixodes ricinus ticks, was used as an antigen, and separate estimations of spirochetal IgG and IgM antibodies were made; serum samples with titers above the 95th-percentile level of 120 healthy individuals were considered positive. Thirteen percent of the patients' serum samples were IgG-positive, 3% were positive for IgM, and 3% were positive for both IgG and IgM. A twofold or greater increase of IgG titers was found in 6%. All the patients who were seropositive experienced the onset of palsy during the period from July to December.     

Intravascular hypercoagulability in patients with recent Bell's palsy

Eighty-four patients were examined for blood coagulability during the acute phase of Bell's palsy. Abnormally high levels of thrombin-antithrombin III complex (TAT) and -2 plasmin inhibitor-plasmin complex (PIC) were found, with these increases statistically significant. Values tended to be higher in patients within 3 days after occurrence of the palsy when compared to values in patients 4 days or more later. Abnormal TAT and PIC levels in the acute phase then tended to become normalized during the convalescent phase of the disease. These findings indicated that activation of intravascular coagulability had occurred, with patients entering a temporary clot-forming state. Among the several hypotheses for the etiology of Bell's palsy, our findings support a circulation disorder as an influential factor.     

Elevated serum interferon levels in patients with Bell's palsy

Serum interferon (IFN) levels were analyzed in patients with Bell's palsy to study the immune response in the disease. Serum samples from 91 patients were assayed for antiviral activity using a bioassay. The IFN levels in the serum were elevated in the acute and convalescent phases as compared with control subjects. The serum IFN-gamma levels were analyzed by radioimmunoassay in 32 of the patients: the IFN-gamma levels were alike in the acute and convalescent phases and the control subjects. Neutralization with specific antisera against IFN-alpha, -beta, and -gamma on 15 serum samples of 11 patients with elevated IFN activity showed a complex pattern that indicates that the antiviral activity was due to a mixture of IFNs and possibly also due to other factors. The elevated IFN levels indicate a low-grade antiviral response that may reflect the reactivation of a viral infection.     

Auditory brain-stem response audiometry in patients with Bell's palsy

To evaluate the hypothesis of central nervous system involvement in Bell's palsy, the auditory brain-stem responses (ABR) of 32 patients were studied. In 14 (43.7%) of these patients ABR abnormalities were found. In each case the ABR deviation suggested prolonged brain-stem conduction time, independent of the side or severity of the paralysis. Site of lesion tests in this sample failed to demonstrate eighth nerve dysfunction and, thus, does not support a theory of a polyneuropathy that involves the auditory nerve.     

威利坦缓释片在孕妇急性贝尔面瘫中的应用

目的 孕妇面瘫是临床棘手的难题,由于患者处于特殊生理阶段,用药选择时需考虑胎儿的安全.本研究的目的旨在寻找一个能在孕期使用的有效治疗面瘫的药物.方法 对2007年3月至2010年6月我院接诊的孕妇急性贝尔面瘫患者,给予威利坦缓释片每次800 mg、每日2次口服治疗,能坚持服药10天者共计21人,治疗前后用Sunnybrook评分系统进行评分,对疗效和不良反应进行记录和统计分析.结果 本组威利坦缓释片面瘫治愈率达76.2％,另有5人疗效较差,仅有1例出现胃肠道不良反应.结论 孕妇急性贝尔面瘫患者使用威利坦缓释片治疗10天是安全有效的,可以作为一种新的保守治疗方法.     

Outcome of treatment with valacyclovir and prednisone in patients with Bell's palsy

Idiopathic facial paralysis, or Bell's palsy, shows a nonepidemic pattern that might indicate reactivation of a latent microorganism such as herpes simplex type I as a causative agent. Thirty percent of patients with Bell's palsy given no treatment will not recover completely, and 5% will have severe sequelae. The aim of this study was to find out whether treatment with an antiviral drug in combination with corticosteroids is more effective than no medical treatment at all in patients with Bell's palsy. Fifty-six consecutive adult patients attending the otorhinolaryngology department of the University Hospital of Lund from 1997 to 1999 were treated with 1 g of valacyclovir hydrochloride 3 times per day for 7 days and 50 mg of prednisone daily for 5 days, with the dose being reduced by 10 mg daily for the next 5 days. Fifty-six adult patients with Bell's palsy attending the same department between 1995 and 1996 who were given no medical treatment were studied retrospectively and used as the control group. Forty-nine patients (87.5%) in the treatment group recovered completely, as compared with 38 patients (68%) in the control group (p < .05). One patient (1.8%) in the treatment group displayed severe sequelae, defined as a House-Brackmann score of IV or worse, as compared with 10 of 56 patients (18%) in the control group (p < .01). Among patients over 60 years old, 10 of 10 in the treatment group had complete recovery, as compared with 5 of 12 patients in the control group (p < .01). The present study showed a significantly better outcome in patients with Bell's palsy treated with valacyclovir and prednisone as compared with patients given no medical treatment. This difference in outcome was especially pronounced among elderly patients.     

Auditory-evoked brain-stem responses and auditory disorders in patients with Bell's palsy

Summary Out of 121 patients examined with acute unilateral facial paralysis, 93 were determined to have idiopathic facial palsy (Bell's palsy). The examination included pure-tone and speech audiometry, stapedial reflex recordings, temporal bone radiography and auditory-evoked brain-stem response testing (ABR). If a retrocochlear lesion was suspected, computed tomography or magnetic resonance imaging was performed. Patients with sensorineural hearing loss affecting all frequencies were compared to one group with hearing loss affecting only high frequencies and to another group with ABR findings suggesting a cochlear lesion. No association could be made between the etiology of these pathological results and the concurrent facial paresis. Most of them were probably caused by unrelated disorders of the auditory system. In cases with prolonged inter-peak latencies representing brain-stem responses, abnormal ABRs could be caused by the same pathology as the paralysis. This might well suggest the presence of a neuropathy in both the central auditory system and the facial tracts.     

Bell's palsy: electrodiagnostics are not indicative of cerebrospinal fluid abnormalities.

Electrodiagnostic testing (electromyography, electroneuronography, and blink reflex) and cerebrospinal fluid (CSF) examination (cell count, immunoglobulins, and antigen-specific intrathecal immunoglobulin G synthesis against herpes simplex virus, varicella zoster virus, cytomegalovirus, and Borrelia burgdorferi sensu latu) were performed in 56 patients with Bell's palsy. The CSF was normal in 45 patients and abnormal in 11 patients. Acute borreliosis was the most common specific pathological CSF finding (4 of 11). Electromyography revealed abolished volitional activity in 22% of patients with normal CSF and in 36% with pathological CSF. Electroneuronographic tests with an amplitude decrease of more than 90% on the affected side or abolished responses were found in 20% of patients with normal CSF and in 18% with pathological CSF. Abolished orbicularis oculi reflexes were seen in 67% of patients with normal CSF and in 82% with pathological CSF Concerning electrodiagnostic testing, no statistically significant difference between patients with normal and abnormal CSF was found, so we conclude that electrodiagnostic testing has no indicative value for abnormal CSF in Bell's palsy.