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Medicine Feb 2020Unrecovered Bell palsy is difficult to treat, because until now in literature there is not a gold standard. This study aimed to evaluate the effectiveness of... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Unrecovered Bell palsy is difficult to treat, because until now in literature there is not a gold standard. This study aimed to evaluate the effectiveness of neuromuscular electrical stimulation (NMES) and shortwave diathermy (SWD) therapy for chronic Bell palsy.
METHODS
After 5 months of conventional therapy, this 2-arm randomized controlled trial enrolled and randomly allocated 20 patients to a treatment group with NMES+SWD and supervised exercises (n = 10) or a sham group with supervised exercise alone (n = 10). The administration of NMES or sham NMES, as intervention, was performed 30 min/session, 5 sessions/wk, for 4 weeks. The primary outcome was assessed by Sunnybrook scale. The secondary outcomes were evaluated by the Kinovea©, a movement analysis software. All primary and secondary outcomes were measured at baseline (T0), at the end of 4-week treatment (T1).
RESULTS
At the end of 4-week treatment, the patients in the treatment group did not achieve better outcomes in resting symmetry, but we observed an increase of the perceived a significant improvement (P < .05) for symmetry of voluntary movements by the Sunnybrook subscale, with a score of 55.4 ± 9 compared to 46.4 ± 3.7 to control group and an increase in zygomatic muscle movement symmetry ratio (P < .05) by Kinovea©. No adverse events occurred in either group.
CONCLUSION
The improvements in the symmetry of voluntary movements demonstrated that combining diathermy with neuromuscular electrostimulation is valid and reliable in the treatment of chronic Bell palsy.
Topics: Adult; Bell Palsy; Chronic Disease; Combined Modality Therapy; Diathermy; Electric Stimulation Therapy; Exercise Therapy; Female; Humans; Male; Middle Aged; Severity of Illness Index; Single-Blind Method
PubMed: 32080092
DOI: 10.1097/MD.0000000000019152 -
The Cochrane Database of Systematic... Sep 2019Corticosteroids are widely used in the treatment of idiopathic facial paralysis (Bell's palsy), but the effectiveness of additional treatment with an antiviral agent is...
BACKGROUND
Corticosteroids are widely used in the treatment of idiopathic facial paralysis (Bell's palsy), but the effectiveness of additional treatment with an antiviral agent is uncertain. This review was first published in 2001 and most recently updated in 2015. Since a significant benefit of corticosteroids for the early management of Bell's palsy has been demonstrated, the main focus of this update, as in the previous version, was to determine the effect of adding antivirals to corticosteroid treatment. We undertook this update to integrate additional evidence and to better assess the robustness of findings, taking risk of bias fully into account.
OBJECTIVES
To assess the effects of antiviral treatments alone or in combination with any other therapy for Bell's palsy.
SEARCH METHODS
We searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS in July 2019. We reviewed the bibliographies of the identified trials and contacted trial authors to identify additional published or unpublished data. We searched clinical trials registries for ongoing studies.
SELECTION CRITERIA
We considered randomised controlled trials (RCTs) or quasi-RCTs of antivirals with and without corticosteroids versus control therapies for the treatment of Bell's palsy. We excluded trials that followed-up participants for less than three months.
DATA COLLECTION AND ANALYSIS
We independently assessed trials for relevance, eligibility, and risk of bias, using standard Cochrane procedures. We performed sensitivity analyses excluding trials at high or unclear risk of bias in at least five domains, and reported these data as the primary analyses.
MAIN RESULTS
Fourteen trials, including 2488 participants, met the inclusion criteria. Most were small, and most were at high or unclear risk of bias in multiple domains. We included four new studies at this update.Incomplete recoveryA combination of antivirals and corticosteroids may have little or no effect on rates of incomplete recovery in people with Bell's palsy compared to corticosteroids alone (risk ratio (RR) 0.81, 95% confidence interval (CI) 0.38 to 1.74; 3 trials, N = 766; random-effects; low-certainty evidence). We excluded 10 trials that were at high or unclear risk of bias in several domains from this analysis and limited all analyses to studies at lower risk of bias. Recovery rates were better in participants receiving corticosteroids alone than antivirals alone (RR 2.69, 95% CI 0.73 to 10.01; 2 trials, N = 667; random-effects), but the result was imprecise and allowed for the possibility of no effect. The rate of incomplete recovery was lower with antivirals plus corticosteroids than with placebo or no treatment (RR 0.56, 95% CI 0.42 to 0.76; 2 trials, N = 658; random-effects). Antivirals alone had no clear effect on incomplete recovery rates compared with placebo, but the result was imprecise (RR 1.10, 95% CI 0.87 to 1.40; 2 trials, N = 658; fixed-effect). For people with severe Bell's palsy (House-Brackmann score of 5 and 6, or equivalent on other scales), we found that the combination of antivirals and corticosteroids had no clear effect on incomplete recovery at month six compared to corticosteroids alone, although the result was again imprecise (RR 0.82, 95% CI 0.57 to 1.17; 2 trials, N = 98; random-effects).Motor synkinesis or crocodile tearsAntivirals plus corticosteroids reduced the proportion of participants who experienced these long-term sequelae from Bell's palsy compared to placebo plus corticosteroids (RR 0.56, 95% CI 0.36 to 0.87; 2 trials, N = 469; fixed-effect; moderate-certainty evidence). Antivirals plus corticosteroids reduced long-term sequelae compared to placebo but there was no clear difference in this outcome with antivirals alone compared to placebo.Adverse events Adverse event data were available in four studies providing data on 1592 participants. None of the four comparisons showed clear differences in adverse events between treatment and comparison arms (very low-certainty evidence); for the comparison of antivirals plus corticosteroids and corticosteroids alone in studies at lower risk of bias, the RR was 1.17 (95% CI 0.81 to 1.69; 2 trials, N = 656; fixed-effect; very low-certainty evidence).
AUTHORS' CONCLUSIONS
The combination of antivirals and corticosteroids may have little or no effect on rates of incomplete recovery in comparison to corticosteroids alone in Bell's palsy of various degrees of severity, or in people with severe Bell's palsy, but the results were very imprecise. Corticosteroids alone were probably more effective than antivirals alone and antivirals plus corticosteroids were more effective than placebo or no treatment. There was no clear benefit from antivirals alone over placebo.The combination of antivirals and corticosteroids probably reduced the late sequelae of Bell's palsy compared with corticosteroids alone. Studies also showed fewer episodes of long-term sequelae in corticosteroid-treated participants than antiviral-treated participants.We found no clear difference in adverse events from the use of antivirals compared with either placebo or corticosteroids, but the evidence is too uncertain for us to draw conclusions.An adequately powered RCT in people with Bell's palsy that compares different antiviral agents may be indicated.
Topics: Anti-Inflammatory Agents; Antiviral Agents; Bell Palsy; Drug Therapy, Combination; Humans; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 31486071
DOI: 10.1002/14651858.CD001869.pub9 -
Cureus Jan 2023Ramsay Hunt syndrome is the complication of the virus varicella-zoster and the infection caused by it, which shows apparent geniculate ganglion involvement. This article... (Review)
Review
Ramsay Hunt syndrome is the complication of the virus varicella-zoster and the infection caused by it, which shows apparent geniculate ganglion involvement. This article discusses the etiology, epidemiology, and pathology of Ramsay Hunt syndrome. Clinically it may be presented as a vesicular rash on the ear or even in the mouth, pain in the ear, and facial paralysis. Some other rare symptoms may also be present, which are also discussed in this article. Skin involvement is also seen in some cases as patterns due to anastomoses between cervical and cranial nerves. This article provides an overview of how the varicella-zoster virus causes facial paralysis and other neurological symptoms. Knowing about this condition and its clinical features is essential to make an early diagnosis and, thus, provide a good prognosis. A good prognosis is required to reduce the nerve damage, prevent further complications, and start an early therapy of acyclovir and corticosteroid. This review also presents a clinical picture of the disease and its complications. The incidence of Ramsay Hunt syndrome has gradually decreased over time because of the development of the varicella-zoster vaccine and better health facilities. The paper also talks about how the diagnosis of Ramsay Hunt syndrome is made and the various treatment options available. Facial paralysis in Ramsay Hunt syndrome presents differently than Bell's Palsy. If not treated for too long, it may cause permanent muscle weakness and may also cause a loss of hearing. It may be confused with simple herpes simplex virus outbreaks or contact dermatitis.
PubMed: 36793818
DOI: 10.7759/cureus.33688 -
Toxins Feb 2021Unilateral peripheral facial nerve palsy jeopardizes quality of life, rendering psychological consequences such as low self-esteem, social isolation, anxiety, and... (Review)
Review
Unilateral peripheral facial nerve palsy jeopardizes quality of life, rendering psychological consequences such as low self-esteem, social isolation, anxiety, and depression. Among therapeutical approaches, use of Botulinum toxin type A (BoNT-A) on the nonparalyzed side has shown promising results and improvement of quality of life. Nevertheless, the correct technique is paramount, since over-injection of the muscles can result in lack of function, leading to a "paralyzed" appearance, and even worse, functional incompetence, which may cause greater distress to patients. Therefore, the objective of this article is to provide a practical guideline for botulinum toxin use in facial palsy. To this aim, adequate patient assessment, BoNT-A choice, injection plan and dosage, and injection techniques are covered.
Topics: Acetylcholine Release Inhibitors; Adult; Bell Palsy; Botulinum Toxins, Type A; Facial Muscles; Facial Paralysis; Female; Humans; Injections, Intramuscular; Quality of Life; Treatment Outcome
PubMed: 33670477
DOI: 10.3390/toxins13020159 -
IDCases 2020We report a case of a 26-year-old previously healthy male who presented with peripheral facial nerve palsy and painful vesicular eruptions over an erythematous base on...
We report a case of a 26-year-old previously healthy male who presented with peripheral facial nerve palsy and painful vesicular eruptions over an erythematous base on pinna and external auditory canal. A diagnosis of Ramsay Hunt syndrome was made. Patient improved with prednisolone, acyclovir, and physiotherapy. Sometimes it may be difficult to differentiate Ramsay Hunt syndrome from Bell's palsy, as patient may develop vesiscles after the onset of facial weakness.
PubMed: 32577399
DOI: 10.1016/j.idcr.2020.e00850 -
The New England Journal of Medicine Dec 2020Limited data suggest that higher hemoglobin thresholds for red-cell transfusions may reduce the risk of cognitive delay among extremely-low-birth-weight infants with... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Limited data suggest that higher hemoglobin thresholds for red-cell transfusions may reduce the risk of cognitive delay among extremely-low-birth-weight infants with anemia.
METHODS
We performed an open, multicenter trial in which infants with a birth weight of 1000 g or less and a gestational age between 22 weeks 0 days and 28 weeks 6 days were randomly assigned within 48 hours after delivery to receive red-cell transfusions at higher or lower hemoglobin thresholds until 36 weeks of postmenstrual age or discharge, whichever occurred first. The primary outcome was a composite of death or neurodevelopmental impairment (cognitive delay, cerebral palsy, or hearing or vision loss) at 22 to 26 months of age, corrected for prematurity.
RESULTS
A total of 1824 infants (mean birth weight, 756 g; mean gestational age, 25.9 weeks) underwent randomization. There was a between-group difference of 1.9 g per deciliter (19 g per liter) in the pretransfusion mean hemoglobin levels throughout the treatment period. Primary outcome data were available for 1692 infants (92.8%). Of 845 infants in the higher-threshold group, 423 (50.1%) died or survived with neurodevelopmental impairment, as compared with 422 of 847 infants (49.8%) in the lower-threshold group (relative risk adjusted for birth-weight stratum and center, 1.00; 95% confidence interval [CI], 0.92 to 1.10; P = 0.93). At 2 years, the higher- and lower-threshold groups had similar incidences of death (16.2% and 15.0%, respectively) and neurodevelopmental impairment (39.6% and 40.3%, respectively). At discharge from the hospital, the incidences of survival without severe complications were 28.5% and 30.9%, respectively. Serious adverse events occurred in 22.7% and 21.7%, respectively.
CONCLUSIONS
In extremely-low-birth-weight infants, a higher hemoglobin threshold for red-cell transfusion did not improve survival without neurodevelopmental impairment at 22 to 26 months of age, corrected for prematurity. (Funded by the National Heart, Lung, and Blood Institute and others; TOP ClinicalTrials.gov number, NCT01702805.).
Topics: Algorithms; Anemia; Cerebral Palsy; Cognition Disorders; Erythrocyte Transfusion; Hearing Loss; Hemoglobins; Humans; Infant, Extremely Low Birth Weight; Infant, Extremely Premature; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Neurodevelopmental Disorders; Survival Rate; Vision Disorders
PubMed: 33382931
DOI: 10.1056/NEJMoa2020248 -
Handbook of Clinical Neurology 2020Many neuromuscular disorders preexist or occur during pregnancy. In some cases, pregnancy unmasks a latent hereditary disorder. Most available information is based on... (Review)
Review
Many neuromuscular disorders preexist or occur during pregnancy. In some cases, pregnancy unmasks a latent hereditary disorder. Most available information is based on case reports or series or retrospective clinical experience or patient surveys. Of special interest are pregnancy-induced changes in disease course or severity and likelihood for baseline recovery of function postpartum. Labor and delivery present special challenges in many conditions that affect skeletal but not smooth (uterine) muscle; so labor complications must be anticipated. Anesthesia for cesarean section surgery requires special precautions in many disorders. The types of conditions reviewed are broad and include examples of autoimmune, hereditary, and compressive/mechanical processes. Disorders include carpal tunnel syndrome and other focal neuropathies, Bell palsy, myasthenia gravis, and other neuromuscular junction disorders, acute and chronic inflammatory neuropathy, hereditary and acquired muscle diseases, spinal muscular atrophy, amyotrophic lateral sclerosis, channelopathies, autonomic neuropathy, and dysautonomia. Many commonly used therapies have fetal animal but no proven human toxicity concerns, complicating treatment and risk decisions. Weaning off effective therapeutic agents or preemptive aggressive treatment or surgery prior to planned pregnancy is an option in some conditions.
Topics: Animals; Cesarean Section; Female; Humans; Muscular Diseases; Myasthenia Gravis; Neuromuscular Diseases; Pregnancy; Pregnancy Complications; Retrospective Studies
PubMed: 32768089
DOI: 10.1016/B978-0-444-64240-0.00012-X -
The Lancet. Infectious Diseases Apr 2021
Topics: Bell Palsy; COVID-19; COVID-19 Vaccines; Humans; Influenza Vaccines; SARS-CoV-2; United States; United States Food and Drug Administration
PubMed: 33639103
DOI: 10.1016/S1473-3099(21)00076-1