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Medicina (Kaunas, Lithuania) Mar 2021Non-motor symptoms in the form of increased sensitivity are often associated with the onset of idiopathic Bell's palsy (IBP). The aims were to determine whether the...
Non-motor symptoms in the form of increased sensitivity are often associated with the onset of idiopathic Bell's palsy (IBP). The aims were to determine whether the pain threshold in the retroauricular regions (RAR) in IBP patients and the time of its occurrence is related to IBP severity. The study was conducted among 220 respondents (142 IBP patients, 78 healthy subjects (HS)). The degree of IBP was graded using the House-Brackmann and Sunnybrook Grading Scales (II-mild dysfunction, VI-total paralysis), whereas the pain thresholds were measured using the digital pressure algometer. We found no difference in the degree of the pain threshold between the right and left RAR in the HS group. IBP patients belonging to groups II, III, IV, and V had lower pain thresholds in both RARs than HS and IBP patients belonging to group VI. There was no difference in the degree of pain threshold in RAR between the affected and unaffected side in IBP patients. The incidence of retroauricular pain that precedes paralysis and ceases after its occurrence in groups II and III of IBP patients is noticeably lower and the incidence of retroauricular pain that occurred only after the onset of paralysis is more frequent. Also, we found that the incidence of retroauricular pain that precedes paralysis and ceases after its occurrence in groups V and VI of IBP patients was more frequent. The degree of pain threshold lowering in RAR (bilaterally) is inversely related to the severity of IBP. We suggest that the occurrence of retroauricular pain before the onset of facial weakness is associated with higher severity of IBP while the occurrence after the onset is associated with lower severity of IBP.
Topics: Bell Palsy; Facial Paralysis; Humans; Incidence; Pain Threshold
PubMed: 33805591
DOI: 10.3390/medicina57030263 -
European Journal of Neurology Aug 2022With the progression of coronavirus infectious disease 2019 (COVID-19), various neurological manifestations have been noticed in infected patients, and Bell's Palsy (BP)... (Review)
Review
BACKGROUND AND PURPOSE
With the progression of coronavirus infectious disease 2019 (COVID-19), various neurological manifestations have been noticed in infected patients, and Bell's Palsy (BP) is one of the peripheral neuropathies among those. BP has been associated with various other viral agents. Its evidence in patients with COVID-19 signifies the possibility of association between BP and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This research was undertaken to evaluate the number of published cases of BP as the only major neurological manifestation in patients with COVID-19 from March 2020 to December 2021 and to investigate the association of SARS-CoV-2 and BP.
METHODS
A systematic review of the published English literature was performed using an electronic search in the PubMed/Medline, Scopus, Research Gate, Research Square, and Google Scholar databases, using keywords such as "COVID-19" OR/AND "SARS-CoV-2" OR/AND "Bell's palsy" OR/AND "facial nerve palsy" OR/AND "neurological" OR/AND "manifestation".
RESULTS
The search strategy revealed 32 relevant publications with a total of 46 patients. BP was the initial manifestation in 37% of cases, and in 63% of cases it developed after COVID-19 symptoms; 71.7% of cases showed complete recovery, and 21.7% showed only partial relief from BP.
CONCLUSIONS
Although the number of documented cases in this research is low, evidence of BP as the only major neurological manifestation in patients with COVID-19 signifies an important clinical finding and the possibility of another viral etiology of BP. More evidence is needed to establish the exact correlation between these two entities.
Topics: Bell Palsy; COVID-19; Communicable Diseases; Facial Paralysis; Humans; Peripheral Nervous System Diseases; SARS-CoV-2
PubMed: 35478425
DOI: 10.1111/ene.15371 -
La Revue de Medecine Interne Jan 2019Idiopathic peripheral facial palsy, also named Bell's palsy, is the most common cause of peripheral facial palsy in adults. Although it is considered as a benign...
Idiopathic peripheral facial palsy, also named Bell's palsy, is the most common cause of peripheral facial palsy in adults. Although it is considered as a benign condition, its social and psychological impact can be dramatic, especially in the case of incomplete recovery. The main pathophysiological hypothesis is the reactivation of HSV 1 virus in the geniculate ganglia, leading to nerve edema and its compression through the petrosal bone. Patients experience an acute (less than 24 hours) motor deficit involving ipsilateral muscles of the upper and lower face and reaching its peak within the first three days. Frequently, symptoms are preceded or accompanied by retro-auricular pain and/or ipsilateral face numbness. Diagnosis is usually clinical but one should look for negative signs to eliminate central facial palsy or peripheral facial palsy secondary to infectious, neoplastic or autoimmune diseases. About 75% of the patients will experience spontaneous full recovery, this rate can be improved with oral corticotherapy when introduced within the first 72 hours. To date, no benefit has been demonstrated by adding an antiviral treatment. Hemifacial spasms (involuntary muscles contractions of the hemiface) or syncinesia (involuntary muscles contractions elicited by voluntary ones, due to aberrant reinnervation) may complicate the disease's course. Electroneuromyography can be useful at different stages: it can first reveal the early conduction bloc, then estimate the axonal loss, then bring evidence of the reinnervation process and, lastly, help for the diagnosis of complications.
Topics: Antiviral Agents; Bell Palsy; Electrodiagnosis; Facial Nerve; Glucocorticoids; Humans
PubMed: 29610004
DOI: 10.1016/j.revmed.2018.03.011 -
Clinical Evidence Jun 2002
Comparative Study Review
Topics: Adrenal Cortex Hormones; Adult; Antiviral Agents; Bell Palsy; Child; Decompression, Surgical; Facial Nerve; Humans; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 12230732
DOI: No ID Found -
Otology & Neurotology : Official... Jan 2023From 1821 to 1829, Sir Charles Bell presented cases of facial paralysis from infection, trauma, and unknown causes. As such, "Bell's palsy" initially referred to facial...
BACKGROUND
From 1821 to 1829, Sir Charles Bell presented cases of facial paralysis from infection, trauma, and unknown causes. As such, "Bell's palsy" initially referred to facial palsy of any etiology. Today, the term is reserved for idiopathic peripheral facial palsy. The objectives of this analysis were to establish when the eponym came to vogue and delineate the semantic shift from its original definition to its current one.
METHODS
Extensive review of available 19th and 20th century literature mentioning "Bell's palsy" and "Bell's paralysis."
RESULTS
Historical accounts have eponymously attached Bell's name to facial paralysis as early as the 1840s-Bell's palsy was first used to describe cases of facial palsy of any cause. In 1886, Gowers characterized Bell's palsy as a "neuritis usually within the Fallopian Canal," distinguishing it as a separate etiology. Over the next decades, the definition narrowed to peripheral facial paralysis from cold exposure or unknown causes. By the 1940s, its natural history was well described-an acute, unilateral, idiopathic, and usually self-limited peripheral facial palsy.
CONCLUSION
The semantic change of a word over time can tell us a remarkable story of its history and origins. Absence of a discrete lesion, lack of proven treatment, and good prognosis without intervention distinguished Bell's palsy from other causes of facial paralysis. Over time, the definition has narrowed from a facial palsy of any cause to an idiopathic peripheral facial palsy. Recent evidence supporting Bell's palsy as a viral mononeuritis may have driven its recent semantic change toward this specific etiology.
Topics: Humans; Facial Paralysis; Bell Palsy
PubMed: 36344494
DOI: 10.1097/MAO.0000000000003742 -
JPMA. the Journal of the Pakistan... Mar 1999
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Cleveland Clinic Journal of Medicine Jul 2015Bell palsy is a common neurologic disorder characterized by acute facial mononeuropathy of unclear cause presenting with unilateral facial weakness. Careful examination... (Review)
Review
Bell palsy is a common neurologic disorder characterized by acute facial mononeuropathy of unclear cause presenting with unilateral facial weakness. Careful examination and a detailed history are important in making an accurate diagnosis. Early recognition is essential, as treatment with corticosteroids within 72 hours of onset has been shown to hasten recovery. Fortunately, most patients recover spontaneously within 3 weeks, even if untreated.
Topics: Bell Palsy; Humans
PubMed: 26185941
DOI: 10.3949/ccjm.82a.14101 -
American Journal of Physical Medicine &... Mar 2015The aim of this study was to determine the efficacy of electrical stimulation when added to conventional physical therapy with regard to clinical and neurophysiologic... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
The aim of this study was to determine the efficacy of electrical stimulation when added to conventional physical therapy with regard to clinical and neurophysiologic changes in patients with Bell palsy.
DESIGN
This was a randomized controlled trial. Sixty patients diagnosed with Bell palsy (39 right sided, 21 left sided) were included in the study. Patients were randomly divided into two therapy groups. Group 1 received physical therapy applying hot pack, facial expression exercises, and massage to the facial muscles, whereas group 2 received electrical stimulation treatment in addition to the physical therapy, 5 days per week for a period of 3 wks. Patients were evaluated clinically and electrophysiologically before treatment (at the fourth week of the palsy) and again 3 mos later. Outcome measures included the House-Brackmann scale and Facial Disability Index scores, as well as facial nerve latencies and amplitudes of compound muscle action potentials derived from the frontalis and orbicularis oris muscles.
RESULTS
Twenty-nine men (48.3%) and 31 women (51.7%) with Bell palsy were included in the study. In group 1, 16 (57.1%) patients had no axonal degeneration and 12 (42.9%) had axonal degeneration, compared with 17 (53.1%) and 15 (46.9%) patients in group 2, respectively. The baseline House-Brackmann and Facial Disability Index scores were similar between the groups. At 3 mos after onset, the Facial Disability Index scores were improved similarly in both groups. The classification of patients according to House-Brackmann scale revealed greater improvement in group 2 than in group 1. The mean motor nerve latencies and compound muscle action potential amplitudes of both facial muscles were statistically shorter in group 2, whereas only the mean motor latency of the frontalis muscle decreased in group 1.
CONCLUSIONS
The addition of 3 wks of daily electrical stimulation shortly after facial palsy onset (4 wks), improved functional facial movements and electrophysiologic outcome measures at the 3-mo follow-up in patients with Bell palsy. Further research focused on determining the most effective dosage and length of intervention with electrical stimulation is warranted.
Topics: Adolescent; Adult; Aged; Bell Palsy; Combined Modality Therapy; Electric Stimulation Therapy; Female; Humans; Male; Middle Aged; Physical Therapy Modalities; Prospective Studies; Recovery of Function; Young Adult
PubMed: 25171666
DOI: 10.1097/PHM.0000000000000171 -
Seminars in Pediatric Neurology Dec 2003Bell's palsy is a self-limiting idiopathic rapid onset facial palsy that is non-life-threatening and has a generally favorable prognosis. Facial paralysis can be caused... (Review)
Review
Bell's palsy is a self-limiting idiopathic rapid onset facial palsy that is non-life-threatening and has a generally favorable prognosis. Facial paralysis can be caused by numerous conditions, all of which should be excluded before a diagnosis of Bell's palsy is reached. The etiopathogenesis of Bell's palsy is uncertain; acute immune demyelination triggered by a viral infection may be responsible. Controversy exists regarding treatment options. This article reviews the differential diagnosis and diagnostic and therapeutic options and discusses the controversies related to the various treatment modalities (steroids, acyclovir, and surgery). A simple practical approach to diagnosing and treating children with Bell's palsy is suggested.
Topics: Bell Palsy; Child; Child, Preschool; Dementia, Vascular; Diagnosis, Differential; Facial Nerve; Humans; Infections; Inflammation; Prognosis
PubMed: 14992461
DOI: 10.1016/s1071-9091(03)00077-9 -
Audiology & Neuro-otology 2022The prognosis of Bell's palsy, idiopathic facial nerve palsy (FNP), is usually predicted by electroneuronography in subacute phase. However, it would be ideal to... (Review)
Review
INTRODUCTION
The prognosis of Bell's palsy, idiopathic facial nerve palsy (FNP), is usually predicted by electroneuronography in subacute phase. However, it would be ideal to establish a reliable and objective examination applicable in acute phase to predict the prognosis of FNP. Immune-nutritional status (INS) calculated from peripheral blood examination is recently reported as the prognostic factor in various disease. However, the validity of INS as the prognostic factor in Bell's palsy is not well known. Thus, we conducted a retrospective study to investigate the usefulness of INS as prognostic predictors of Bell's palsy.
METHODS
We reviewed the medical records of 79 patients with Bell's palsy and divided into two groups as "complete recovery" and "incomplete recovery" groups. Clinical features such as severity of FNP and INS, including neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), prognostic nutritional index (PNI), and controlling nutrition status (CONUT) score, were assessed.
RESULTS
In univariate analysis, statistically significant differences were observed in clinical score of facial movement, NLR, LMR, PNI, and CONUT score at the initial examination between the two groups (p < 0.05). Furthermore, in multivariate analysis, statistically significant differences were also observed in facial movement score and PNI at the initial examination (p < 0.05).
CONCLUSION
Immune and nutritional condition play important roles in the pathogenesis of Bell's palsy, suggesting that INS would be one of the useful prognostic factors in Bell's palsy.
Topics: Bell Palsy; Facial Paralysis; Humans; Nutritional Status; Prognosis; Retrospective Studies
PubMed: 35512660
DOI: 10.1159/000524355