Idiopathic Facial Paralysis Research Articles

Compare the Effectiveness of Mime Therapy on Facial Synkinesis in Idiopathic and Traumatic Lower Motor Neuron Facial Palsy

Background: The seventh cranial nerve has a core function of regulating emotional displays and speech. Facial paralysis, characterized by the loss of voluntary motor control on one or both sides, is commonly attributed to Bell’s palsy which accounts for 50-75% of cases and trauma responsible for 10-23% of cases. Various rehabilitation methods, including Mime Therapy, are employed to enhance facial muscle function. Objective: This study aims to compare Mime Therapy's impact to reduce the synkinesis of a face in individuals with idiopathic and traumatic lower motor neuron facial nerve palsy. Study Design: Experimental, Comparative Study Study Setting: Physiotherapy OPD, Neurology ward, and ENT ward of Himalayan Hospital, Dehradun Participant: This study involved 30 patients, with 20 in Group A (Idiopathic) and 10 in Group B (Traumatic), all of whom had House-Brackmann Scores of 3-5. The patient’s ages ranged from 20 to 70. Outcome Measure: Two outcome measures were used: House Brackmann Score and Sunnybrook Facial Grading System. Result: A noticeable difference in both outcome measures was observed. In the House Brackmann Score for group A (p-value <0.001) and B (p-value=0.016), In Sunnybrook Facial Grading System for group A (p-value<0.001) and B (p-value=0.002). However, when comparing the post-intervention results of both groups, no distinct variation was found in the outcome variables (p-value>0.05). Conclusion: The study provides evidence demonstrating that Mime Therapy has been successful in effectively reducing Facial Synkinesis in patients with both idiopathic and traumatic LMN Facial Palsy. The results indicate a significant improvement in the condition, suggesting that Mime therapy can be an efficacious treatment approach for this type of facial paralysis. KEYWORDS: Mime Therapy, Facial Synkinesis, Idiopathic LMN Facial palsy, Traumatic LMN facial palsy, Bell’s palsy.

Bell's palsy and COVID-19: A cohort study with historical rate comparison

IntroductionDuring the SARS-CoV-2 pandemic, immune-mediated neurological events have been described in patients vaccinated against the virus or who have overcome the disease. Among these events is Idiopathic peripheral facial palsy or Bell’s palsy. ObjectivesTo study the incidence of Bell's Palsy in the ENT emergency department of a tertiary hospital in Catalonia during the SARS-CoV-2 pandemic. MethodsRetrospective historical cohort comparison study of patients diagnosed with Bell's palsy between January 2018 and December 2021. Crude incidence rates were calculated as the total number of events divided by person time at risk per 100.000 person-years. Observed (2020, 2021) and historical (2018, 2019) rates were compared using standardized incidence rates with corresponding 95% confidence intervals. ResultsOf the total number of ENT emergency department visits from 2018 to 2021 (22.658), there were 247 cases of Bell's palsy. The incidence rate of Bell's palsy in the pre-pandemic group was 12,2 and 10,9 per 100.000 person-years for 2018 and 2019, respectively. The 2020 standardized incidence rate of Bell's palsy was 0,70 [95% CI 0,49–1,01] and 1,25 [95% CI 0,93–1,67] for 2021. No significant differences were evident between the two groups. ConclusionIn our cohort, no association was found between vaccination or COVID-19 infection and the development of Bell's Palsy.

Chemodenervation is Associated With Reduced Mental Health Disorders in Patients With Synkinesis.

To compare the prevalence of mental health disorders in individuals with facial synkinesis, facial paralysis alone, and the general population. Retrospective cohort. Eighty-two health care organizations across the United States. The TriNetX Research Network was queried from 2011 to 2021 for patients with facial paralysis without synkinesis, facial paralysis and documented synkinesis, and controls, matched for age, sex, race, and ethnicity. Cases included infectious, iatrogenic, or idiopathic facial paralysis. Patients with pre-existing depression or anxiety were excluded. Two-year rates of newly diagnosed depression, anxiety, and mental health prescriptions were compared. Among 127,573 patients with facial paralysis, 92.5% (n = 117,976) had facial paralysis alone, and 7.5% (n = 9597) also had documented synkinesis. Compared to controls, patients with facial paralysis alone had increased risks of new depression (8.9% vs 7.3%, P < .001) and anxiety (10.1% vs 9.6%, P < .001), with higher mental health medication rates (16.6% vs 13.1%, P < .001). Patients with documented synkinesis, in comparison to controls, had the highest risks of depression (19.8% vs 8.6%, P < .001), anxiety (20.5% vs 10.5%, P < .001), and prescriptions (28.1% vs 15.8%, P < .001). The 27.8% (n = 2669) of synkinetic patients treated with chemodenervation had lower rates of depression (8.5% vs 23.5%, P < .001), anxiety (9.0% vs 23.8%, P < .001), and prescriptions (21.6% vs 30.0%, P < .001) compared to synkinetic patients who were not. Facial paralysis, particularly synkinesis, is linked to increased mental health disorders. Integrating mental health screening and treatment into a comprehensive approach is crucial. Chemodenervation is associated with decreased mental health disorders in synkinesis, highlighting its therapeutic potential.

Clinical and electrophysiological prognostic factors in predicting poor outcomes in patients with idiopathic facial nerve paralysis

ObjectiveThis study was designed to verify whether one or more clinical and neurophysiological parameters could predict a poor prognosis in idiopathic facial paralysis. MethodsSeventy-three outpatients with unilateral idiopathic facial nerve paralysis who visited our hospital within 7 days of onset. All patients received treatment according to a standard therapy protocol and ocular care. Patients’ baseline characteristics were assessed before initiating treatment, including demographic characteristics, facial nerve function assessment and previous medical history. House-Brackmann (H-B) grading system was performed at baseline and six months after the onset. Electroneurography (ENoG) and blink reflex tests were conducted 7–10 days after the onset of paralysis. Sunnybrook Facial Grading System (SFGS) was conducted at baseline, days 7–10 post-onset when the electrophysiological tests were performed, and one month after the onset. ResultsAccording to the H-B grade at 6 months following the onset, 58 patients (79.5 %) had a good prognosis, while 15 patients (20.5 %) had a poor prognosis. The CMAP amplitudes in three facial muscles (frontalis, orbicularis oculi, and orbicularis oris) were decreased, and ENoG values were increased in the poor prognosis group compared with the good prognosis group (all p < 0.01). The results of the blink reflex study showed that the group with a poor prognosis had a longer R1 latency compared to the group with a good prognosis. Additionally, the group with a poor prognosis exhibited a higher rate of R1 absence on the affected side (both p < 0.01). The findings of conditional logistic regression indicated that the absence of R1 on the affected side, frontalis ENoG, orbicularis oculi ENoG, and orbicularis oris ENoG were predictive factors of a poor prognosis for facial nerve palsy. The receiver operating characteristic (ROC) curves showed that the SFGS at 1 month after onset of 55 is considered a critical cutoff value for poor prognosis, with a sensitivity of 86.7 % and specificity of 91.4 %. ConclusionElectroneurography (ENoG) and blink reflex tests acquired within 7–10 days after the onset of paralysis are significant and highly valuable for predicting the prognosis of idiopathic facial nerve paralysis. Higher ENoG values of the muscles innervated by the facial nerve and the absence of R1 on the affected side of the blink reflex are predictive factors for a poor prognosis. The SFGS is a clinical tool that plays an important role in evaluating the prognosis of idiopathic facial paralysis, particularly one month after onset.

Recurrent Facial Palsy in an Adolescent - Case Report

Introduction: Recurrent facial nerve paralysis is an unusual occurrence. Main Symptoms: Recurrent facial palsy, oro-facial swelling, and a fissured tongue. Main Diagnosis: Lower Motor Neuron Palsy. No definitive therapy is available, and frequent recurrences are common. Conclusion: Idiopathic recurrent Lower Motor Neuron facial palsy with atypical presentations can be indicative of Melkerson-Rosenthal syndrome.

Summary of Japanese clinical practice guidelines for Bell's palsy (idiopathic facial palsy) - 2023 update edited by the Japan Society of Facial Nerve Research

ObjectiveThe “Summary of Japanese clinical practice guidelines for Bell's palsy (idiopathic facial palsy) - 2023 update edited by the Japan Society of Facial Nerve Research” aims to review the latest evidence regarding the treatment of Bell's palsy and to provide appropriate recommendations. MethodRegarding the treatment of Bell's palsy, a guideline panel identified key clinical questions using an analytic PICO framework. The panel produced recommendations following the standards for trustworthy guidelines and the GRADE approach. The panel considered the balance of benefits, harm, and preferences when making recommendations. ResultsThe panel identified nine key clinical questions: systemic (high/standard dose) corticosteroids, intratympanic corticosteroids, systemic antivirals, decompression surgery, acupuncture, physical therapy, botulinum toxin, and reanimation surgery. ConclusionThese guidelines strongly recommend systemic standard-dose corticosteroids for the clinical management of Bell's palsy. Other treatments are weakly recommended due to insufficient evidence. The absolute risk reduction of each treatment differed according to the disease severity. Therefore, physicians and patients should decide on treatment based on the disease severity.

Ultrasonography as diagnostic and prognostic tool and Therapeutic role of repetitive peripheral magnetic stimulation in acute idiopathic facial nerve palsy.

Repetitive Peripheral Magnetic Stimulation [rPMS] is a non-invasive tool that has a potential therapeutic role in many musculoskeletal disorders. We aimed to demonstrate the therapeutic efficacy of high frequency [rPMS] in acute Idiopathic Facial Nerve Palsy [IFP]. And to study the role of neuromuscular ultrasonography in acute idiopathic facial palsy. Forty patients, aged above 18 years, diagnosed with unilateral acute [within 7 days of onset] idiopathic facial palsy were enrolled and randomly divided into intervention group [20 patients] and control group. Both groups underwent clinical examination, assessment of facial nerve disability by House-Brackmann grading [HBG] score and Facial Disability Index [FDI] score, ultrasonography of facial nerve of both normal and affected sides at baseline and after 6 weeks, medical treatment and routine rehabilitation therapy. The intervention group were subjected to 10 sessions of high frequency r PMS [5/week for 2 successive weeks] on the affected side. Both [HBG] and [FDI] showed more significant improvement in the intervention group in comparison to the control group after 6 weeks follow up. Ultrasonographic measures of facial nerve in the affected side were significantly larger than non-affected side at baseline. However, those measures significantly decreased after 6 weeks follow up. Surprisingly, the intervention group showed more significant decrease in facial nerve dimeter at proximal portion [without sheath] in comparison to control group. high frequency r PMS have an adjuvant role in treatment of acute idiopathic facial palsy. Also, ultrasonography has beneficial role in evaluation and prognosis of [IFP].

PREVALENCE, MANAGEMENT, AND OUTCOME OF BELLS PALSY : A COMPREHENSIVE SYSTEMATIC REVIEW

Background: Bell’s palsy, also called idiopathic facial paralysis, is defined as an acute-onset, isolated, unilateral, lower motor neurone facial weakness. The reported annual incidence varies in different parts of the world with estimates varying between 11 and 40 per 100 000 people. The aim: The aim of this study to show about prevalence, management, and outcome of bell’s palsy. Methods: By the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. This search approach, publications that came out between 2014 and 2024 were taken into account. Several different online reference sources, like Pubmed, SagePub, and Sciencedirect were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: Eight publications were found to be directly related to our ongoing systematic examination after a rigorous three-level screening approach. Subsequently, a comprehensive analysis of the complete text was conducted, and additional scrutiny was given to these articles. Conclusion: Bell's palsy is a common but still controversial disease, with unknown etiology until now. Modern literature showed that up to 80 percent of the patients will recover without treatment.

Establishment of Facial Nerve Injury Rat Model for Idiopathic Facial Paralysis Research.

Idiopathic facial paralysis is the most common type of facial nerve injury, accounting for approximately 70% of peripheral facial paralysis cases. This disease can not only lead to a change in facial expression but also greatly impact the psychology of patients. In severe cases, it can affect the normal work and life of patients. Therefore, the research on facial nerve injury repair has important clinical significance. In order to study the mechanism of this disease, it is necessary to carry out relevant animal experiments, among which the most important task is to establish an animal model with the same pathogenesis as human disease. The compression of the facial nerve within the petrous bone, especially the nerve trunk at the junction of the distal end of the internal auditory canal and the labyrinthine segment, is the pathogenesis of idiopathic facial paralysis. In order to simulate this common disease, a compression injury model of the main extracranial segment of the facial nerve was established in this study. The neurological damage was evaluated by behavioral, neuroelectrophysiological, and histological examination. Finally, 50 g constant force and 90 s clamp injury were selected as the injury parameters to construct a stable idiopathic facial paralysis model.

Uncommon Bilateral Idiopathic Facial Nerve Palsy (Bell's Palsy) in an Infant: An Atypical Age and Clinical Challenges Explored: A Case Report.

Our case study explores Bell's palsy, a rare lower motor neuron facial nerve paralysis, particularly rare in newborns. While often idiopathic, it can stem from congenital or developmental factors. Unilateral facial paralysis is more prevalent, with Bell's palsy accounting for more than 50%, while bilateral facial paralysis is exceptionally rare. We present a distinctive case of idiopathic Bell palsy in a 3.5-month-old infant, initially affecting the right side and spontaneously resolved within 30 days, followed by involvement on the left side a month later. Despite comprehensive evaluations and treatment, persistent facial weakness was observed on the left side. The patient initially responded well but faced ongoing challenges during the second attack. Our findings underscore the need for further research to improve the understanding and management of these cases.

EVALUATION OF RECOVERY BY STAPES REFLEX IN PATIENTS WITH PERIPHERAL FACIAL PARALYSIS

Objective: The aim of this study was to investigate the acoustic reflex in different frequencies at the time of diagnosis, during the treatment and follow-up of patients with idiopathic peripheral facial nerve palsy and compare these results with House-Brackmann clinical scoring to determine the prognostic value of acoustic reflex in these patients. Material and Methods: Thirty-three adult patients with idiopathic peripheral facial palsy (aged 18-77 years, 16 male, 17 female) were included in the study. All the patients were clinically graded with House-Brackmann clinical scoring and acoustic reflex test was performed at the time of diagnosis, 1st, 2nd, 3rd, 4th weeks, 2nd and 3rd month. Ipsilateral acoustic reflex thresholds were measured from both ears with impedance audiometry using a 226 Hz probe tone. Results: Significant relation was observed between the presence of sequel and initial grade and absence of acoustic reflex at 0.5, 1, 2 kHz at time of diagnosis. In addition, after the 1st week, a significant relation was also detected at 4 kHz frequency during all the follow-up period. The risk of sequelae would increase more than 3 times as the initial grade value increased. Conclusion: The present study revealed the relation between the sequel and initial high grade, the absence of acoustic reflex at 0.5, 1, 2 kHz at time of diagnosis in addition with high age. Statistics does not support the same relation at 4 kHz frequency at time of diagnosis. However, statistic reveals that only the initial grade can best predict the risk of sequel, in addition, the risk of sequel increases more than 3 times as the initial grade value increase.

Hemogram Parameters of Children with Bell’s Palsy at the Time of Admission and Their Findings in the Follow-up

Objective: The exact cause of idiopathic facial paralysis (Bell’s palsy) is not clear. The objective of our study was to investigate the relationship between certain hemogram parameters and the clinical prognosis in pediatric patients with facial paralysis. Material and Methods: The files of patients with Bell’s palsy under the age of 18 who applied to our hospital were evaluated retrospectively. Leukocyte, neutrophil, lymphocyte, platelet count, red cell distribution width, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and monocyte to lymphocyte ratio were compared between patients with Bell’s palsy and the control group. Information about their last health status recorded. Results: A total of seventeen children with Bell’s palsy and 17 control groups were included in the study. There were 7 boys (41.20%) and 10 girls (58.70%) in each group, the mean age was 11.80±4.40 (minimum 3.0-maximum 17.9) years. While the median neutrophil-lymphocyte ratio was 1.25 (0.41-7.63) in patients with Bell’s palsy and 1.40 (0.42-2.52) in the control group, the median mean platelet volume level was 9.30 fL (8.20-12.30) in patients with Bell’s palsy and 9.95 fL (9.30-11.70) in the control group, and the median red cell distribution width level was 12.75 % (11.50-26.30) in patients with Bell’s palsy and 12.70% (12.10-26.30) in the control group. None of them were statistically significant. There were six patients with Bell’s palsy with low mean platelet volume levels and no patients with low mean platelet volume levels in the control group (p=0.007). There was a positive correlation between the neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and monocyte-lymphocyte ratio and the recovery time of patients with Bell’s palsy. Conclusion: Bell’s palsy may show a better prognosis in girls. High neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and monocyte-lymphocyte ratio may be indicators of delayed recovery, inflammation, and microvascular ischemia in Bell’s palsy.

Bell's palsy in a seven-month-old twin infant: a case report

Idiopathic peripheral facial paralysis is a rare condition in the pediatric population under one year of age, characterized by paralysis of the structures innervated by the facial nerve. This report describes the first infant in Brazil to be diagnosed with this clinical condition. A 7-months-old twin infant presented with altered left oromotor control and a discrete incomplete closure of the left eyelid when blinking, although with normal tear production. Her primitive reflexes were present and the spontaneous movements of the four limbs were normal. An investigation for infectious etiology and a magnetic resonance imaging of the brain were performed and did not show any alterations. Thus, the diagnosis of Bell's palsy was assumed, and oral prednisone was prescribed for five days. The patient evolved with total resolution of the facial paralysis during the first two weeks after discharge. Most cases of peripheral facial paralysis in children are idiopathic, while the others are associated with infectious and/or traumatic etiologies. There are still no consistent data proving the benefit of the use of corticoid alone or in combination with antiviral drugs for the treatment of children under one year of age.

A Retrospective Review of Seasonal Patterns of Idiopathic Facial Nerve Paralysis in a Tertiary Care Center.

Background The objective of this retrospective study was to investigate the seasonal patterns of idiopathic facial nerve paralysis, specifically Bell's palsy, in Riyadh, Saudi Arabia. The study aimed to determine if there is a correlation between cold weather and the incidence of Bell's palsy, as well as to examine the relationship between age, gender, comorbidities, and the development of the disease. Methodology Data were collected from King Abdulaziz Medical City in Riyadh, Saudi Arabia, between 2016 and 2021. Electronic medical records of adult patients diagnosed with idiopathic facial paralysis were reviewed. Patients with facial paralysis caused by known illnesses were excluded. Demographic information, clinical characteristics, and the course of the disease were analyzed using SPSS version 25 (IBM Corp., Armonk, NY, USA). Results The study included 136 Bell's palsy patients, with a mean age of 39.9 years. Males represented 58.1% (79) of the sample, and the right side of the face was more commonly affected in 71 (52.2%) patients. The majority of patients had House-Brackmann grade III (51, 37.5%). The monthly distribution showed a higher number of Bell's palsy cases during the winter months, particularly December, October, and November, but the seasonal distribution did not yield a statistically significant difference in incidence. Conclusions While this study observed a higher incidence of Bell's palsy during the winter months, it did not establish a statistically significant correlation between cold temperatures and the onset of Bell's palsy in Riyadh, Saudi Arabia. Furthermore, the study found that Bell's palsy predominantly affects middle-aged males, and comorbidities did not appear to be significant risk factors for the development of the disease. This research lays the groundwork for future investigations into the relationship between weather and the pathogenesis of Bell's palsy in the region.

Predictive Value of the Neutrophil-to-Lymphocyte Ratio and C-Reactive Protein in Patients with Idiopathic Facial Nerve Palsy.

This study aims to investigate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) in patients with idiopathic facial nerve palsy. The clinical data of patients with idiopathic facial nerve palsy were retrospectively analyzed. After three months of follow-up, patients were divided into good prognosis and poor prognosis, and the correlation between NLR, CRP and idiopathic facial nerve palsy was analyzed. Negative correlation of NLR with Portmann score in idiopathic facial nerve palsy (r=-0.788, P<0.05); In contrast to the group with poor prognosis, patients in good prognosis group had low levels of body mass index (BMI), NLR, and C-reactive protein (CRP), and high Portmann score (P<0.05); Multivariate logistic regression analysis showed Portmann score (OR=1.268, 95% CI (1.005-1.616)), NLR (OR=0.262, 95% CI (0.128-0.533)) and CRP levels (OR=0.949, 95% CI (0.895-0.989)) were risk factors of poor prognosis for patients with idiopathic facial nerve palsy. The area under the receiver operator characteristic (ROC) curve of NLR and CRP levels in predicting poor facial nerve function was 0.764 and 0.697, the specificity was 85.5% and 75.0%, and the sensitivity was 74. 0% and 76.0%, respectively. The ROC curve of the combined diagnosis was 0.829, the specificity was 80.7%, and the sensitivity was 82.0%. Elevated NLR and CRP are associated with a poor prognosis of idiopathic facial nerve palsy and can serve as an indicator for clinical prognosis, and can be widely used in clinical.

Task force of the Brazilian Society of Otology — evaluation and management of peripheral facial palsy

ObjectiveTo review key evidence-based recommendations for the diagnosis and treatment of peripheral facial palsy in children and adults. MethodsTask force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on peripheral facial palsy were eligible for inclusion. The American College of Physicians’ guideline grading system and the American Thyroid Association’s guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. ResultsThe topics were divided into 2 main parts: (1) Evaluation and diagnosis of facial palsy: electrophysiologic tests, idiopathic facial palsy, Ramsay Hunt syndrome, traumatic peripheral facial palsy, recurrent peripheral facial palsy, facial nerve tumors, and peripheral facial palsy in children; and (2) Rehabilitation procedures: surgical decompression of the facial nerve, facial nerve grafting, surgical treatment of long-term peripheral facial palsy, and non-surgical rehabilitation of the facial nerve. ConclusionsPeripheral facial palsy is a condition of diverse etiology. Treatment should be individualized according to the cause of facial nerve dysfunction, but the literature presents better evidence-based recommendations for systemic corticosteroid therapy.

Contrast-enhanced MRI findings of patients with acute Bell palsy within 7 days of symptom onset: A retrospective study.

The brain magnetic resonance imaging (MRI) findings seen in patients with Bell palsy are abnormal contrast enhancement of affected facial nerves. Previous studies were conducted on a few patients, mainly those who had experienced palsy for several weeks. This study investigated the diagnostic usefulness of MRI by examining MRI findings of acute Bell palsy (within 7 days of symptom onset) in a large cohort. Among the patients with Bell palsy (idiopathic unilateral facial palsy) who visited the hospital, 123 patients who underwent contrast-enhanced MRI of the internal auditory canal within 7 days of symptom onset were reviewed retrospectively. MRI examination results were investigated along with the patient's clinical symptoms and electrodiagnostic test results. Based on the MRI results, the frequency of abnormal contrast enhancement and contrast-enhanced areas were investigated. Of the 123 patients, 13 (11%) had normal brain MRI results, and 110 (89%) had abnormal findings. The frequency of abnormal contrast enhancement was not significantly associated with test timing (P = .56). Of the 110 patients with abnormal findings, 65 (59%) showed contrast enhancement in the labyrinthine segment and 36 (33%) in both the labyrinthine segment and geniculate ganglion. Most patients with Bell palsy who are in the acute phase showed abnormal contrast enhancement in their facial nerves, and similar findings were even observed in the examination conducted on the day of symptom onset. Brain MRI helps in the diagnosis of acute Bell palsy.

Evaluation of Predictors of Recovery after Idiopathic Facial Palsy

Evaluation of Predictors of Recovery after Idiopathic Facial Palsy

A new gene for autosomal dominant facial palsy/migraine identified in a family by whole exome sequencing.

Facial palsy manifests as unilateral or bilateral weakness and inability to move some of the facial muscles. The aetiology may be different including idiopathic, trauma, infections or brain tumours or it can be associated with chronic neurological diseases. For instance, in recurrent migraine, an increased risk of idiopathic facial palsy (often unilateral) has been observed. Migraine is a neurovascular disorder characterized by mild to severe intensity of headaches, often associated with neuro-ophthalmological symptoms. A family is reported where five members were affected by facial palsy associated with other clinical features including migraine, diplopia, facial swelling, eye conjunctivitis following a vertical transmission. Whole exome sequencing was performed in three members (two affected and one healthy) in order to identify potential variants causative of their phenotype. A missense variant c.304G>A was found leading to the p.(Ala102Thr) substitution in the TRPM8 gene, previously related to migraine by genome wide association studies. This variant was classified as deleterious by several predictor tools, and the mutant residue was predicted to alter the protein structure in terms of flexibility and interactions with the surrounding residues. These findings suggest that TRPM8 could be a new causative gene further linking migraine and recurrent facial palsy.

Treatment of idiopathic facial paralysis (Bell’s Palsy) and secondary facial paralysis with extracellular vesicles: a pilot safety study

BackgroundParalysis of the facial nerve (CN VII) is one of the most debilitating issues that any patient can encounter. Bell’s palsy is the most commonly seen mononeuropathy. Although usually self-limited, symptomatology can persist for decades in persistent cases. The non-surgical alternative therapies discussed in this study are successful without reconstruction and are regenerative.Objective and designWe sought to determine a safe new treatment could be developed to restore facial nerve function using extracellular vesicles (EVs) in patients who have been unable to return to normal under a variety of conditions. We performed a pilot safety study of 7 patients with idiopathic and secondary facial paralysis to determine if any functional restoration was possible. Each patient had symptomology for varying periods of time, with diverse House-Brackmann scores. They were all treated with the same protocol of extracellular vesicles (EVs) over a 4-week period of time and were evaluated both before and after treatment.Case presentationsAll patients in this study received treatment by their private physicians prior to entering the study. A record review was completed, with independent physical examinations. House-Brackmann scores and Facial Disability Indices were obtained prior to, and after completing the study. EVs were injected into the area of the main trunk of the facial nerve on the affected side, and an intravenous drip of EVs on visits during weeks 1, 2, and 4.ConclusionsAll seven patients enrolled in the study improved with this treatment protocol. After the second week of treatment, we saw a progression of independent motion of the affected eyelid, brow motion, and commissure. Although all patients began at different House-Brackman starting points, almost all ended at the same endpoint on the scale over the same period of time – four weeks. No adverse effects were encountered.Clearly, the duration of the treatment protocol needs to be longer than one month. The pathomechanism is still unknown. But it appears that the mechanism is reversible. At last, these patients can have hope.Trial registrationThe Institute of Regenerative and Cellular Medicine IRB approval number: IRCM-2021–304.