Abstract
ObjectiveTo determine the cellular immune response in Bell's palsy (BP) and its prognostic value in relation to clinical and electrophysiological findings. MethodsTwenty patients with BP were subjected to: Facial nerve paralysis assessment according to House–Brackmann (H&B) grading system, bilateral facial nerve conduction study with electroneurography (ENoG) quotient calculation, blink reflex, and needle electromyography (EMG) for the affected side; one week from the onset. Before the start of medical treatment, peripheral blood mononuclear cell subsets were analyzed to reveal the percentage of total T cells (CD3+), T helper/inducer cells (CD4+), T cytotoxic (CD8+) and B cells (CD19+). Patients were followed up by H&B, ENoG and needle EMG up to 3months from the onset (end point). Fifteen age and sex matched healthy control subjects for the electrophysiological study and laboratory tests were included. ResultsThe percentages of CD3+, CD4+ & CD8+ were significantly depressed in BP patients than in control. CD19+ percentage did not show significant difference between them. On follow up, H&B revealed significant improvement. Neither electrophysiological parameters nor ENoG showed significant difference between initial and follow up assessments. Initial CD4+ percentage correlated negatively with disease duration. While Initial CD8+ percentage correlated positively with follow up compound muscle action potential (CMAP) amplitude of orbicularis oris muscle and ENoG of orbicularis oculi and nasalis muscles. Initial CD19+ percentage correlated negatively with follow up H&B and R1 & R2 responses of follow up blink reflex. Initial CD3+ percentage did not correlate with any of the follow up measures. ConclusionDecreased percentage of peripheral blood CD3+, CD4+ & CD8+ in BP patients emphasizes the role of cell mediated autoimmune pathogenesis in the acute stage of the disease. These cells have a prognostic significance for prediction of the disease duration and outcome. Analysis of T lymphocytes subsets may provide an additional parameter to differentiate patients with favorable from those with poor prognosis.
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