Idiopathic Peripheral Facial Palsy Research Articles

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.

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.

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.

Neurological manifestation of HEV infection: still a rare disease entity?

Hepatitis E virus (HEV) infection is the most common form of viral hepatitis and is reported to cause neurological manifestation in up to 30% of diagnosed infections. We evaluated the medical reports of all patients (n = 29,994) who were discharged from the Department of Neurology of Ulm University between 01.01.2015 and 30.09.2022 to detect neurological manifestations of HEV. In addition, we retrospectively analyzed the serum samples of n = 99 patients representing different neurological diseases possibly related to HEV for anti-HEV-IgM and anti-HEV-IgG. At the time of discharge from hospital, the etiology of neurological symptoms in these patients was unclear. Overall, five cases of extrahepatic neurological manifestation of HEV (defined as anti-HEV-IgM and HEV-IgG positive) could be detected. An increase of both, anti-IgM- and anti-IgG-serum levels was significantly more common in neuralgic amyotrophy/plexus neuritis/radiculitis than in AIDP/CIDP (P = 0.01), meningitis/encephalitis (P = 0.02), idiopathic peripheral facial paralysis (P = 0.02) and tension headache (P = 0.02). In 15% (n = 15 out of 99) of retrospectively analyzed serum samples, conspicuous positive anti-HEV-IgG levels were detected. This finding was most common in AIDP/CIDP. In conclusion, results of this study indicate neurological manifestation of HEV to be a rare but still underestimated course of disease, occurring at any age and gender. Therefore, testing for HEV should be considered in patients with neurological symptoms of unknown origin, especially in those with neuralgic amyotrophy/plexus neuritis.

The clinical availability of facial nerve enhancement in temporal bone MRI for the patients of idiopathic acute peripheral facial palsy.

This study is to evaluate the duration of facial nerve enhancement in gadolinium-enhanced temporal bone MRI after the onset of acute facial palsy. Gd-enhanced MRI imagines were examined in 13 patients with idiopathic acute facial palsy within 14days after the onset. The degree of facial nerve function was measured according to the House-Brackmann (H-B) grading system at their first visit at outpatient clinic. The follow-up MRI was taken about 16.5months (7-24months) after onset of disease. The degree of facial nerve enhancement was measured with signal intensity (SI) which was quantitatively analyzed using the region-of-interest (ROI) measurements for each segment of the facial nerve. SI was statistically analyzed by comparing SI values of contralateral site and ipsilateral site using the paired t test with SPSS program. The gadolinium enhancement was statistically increased at labyrinthine segment and geniculate ganglion area of facial nerve at initial temporal bone MRI. The gadolinium enhancement was statistically decreased at all the segments of facial nerve except tympanic segment (p < 0.05) at follow-up MRI. The facial nerve enhancement in Gd-enhanced MRI images prolonged more than 21months of the onset. The newly developed pathologic lesions of acute facial palsy especially occur at the site of labyrinthine and geniculate ganglion.

Incidence of Underlying Abnormal Findings on Routine Magnetic Resonance Imaging for Bell Palsy

There is no consensus on the benefits of routine magnetic resonance imaging (MRI) of the facial nerve in patients with suspected idiopathic peripheral facial palsy (PFP) (ie, Bell palsy [BP]). To estimate the proportion of adult patients in whom MRI led to correction of an initial clinical diagnosis of BP; to determine the proportion of patients with confirmed BP who had MRI evidence of facial nerve neuritis without secondary lesions; and to identify factors associated with secondary (nonidiopathic) PFP at initial presentation and 1 month later. This retrospective multicenter cohort study analyzed the clinical and radiological data of 120 patients initially diagnosed with suspected BP from January 1, 2018, to April 30, 2022, at the emergency department of 3 tertiary referral centers in France. All patients screened for clinically suspected BP underwent an MRI of the entire facial nerve with a double-blind reading of all images. The proportion of patients in whom MRI led to a correction of the initial diagnosis of BP (any condition other than BP, including potentially life-threating conditions) and results of contrast enhancement of the facial nerve were described. Among the 120 patients initially diagnosed with suspected BP, 64 (53.3%) were men, and the mean (SD) age was 51 (18) years. Magnetic resonance imaging of the facial nerve led to a correction of the diagnosis in 8 patients (6.7%); among them, potentially life-threatening conditions that required changes in treatment were identified in 3 (37.5%). The MRI confirmed the diagnosis of BP in 112 patients (93.3%), among whom 106 (94.6%) showed evidence of facial nerve neuritis on the affected side (hypersignal on gadolinium-enhanced T1-weighted images). This was the only objective sign confirming the idiopathic nature of PFP. These preliminary results suggest the added value of the routine use of facial nerve MRI in suspected cases of BP. Multicentered international prospective studies should be organized to confirm these results.

Observed-over-Expected analysis as additional method for pharmacovigilance signal detection in large-scaled spontaneous adverse event reporting.

The large-scale COVID-19 vaccination campaigns in 2021 and 2022 led to a rapid increase in numbers of received adverse event reports in spontaneous reporting systems. As background incidences of naturally occurring medical events became increasingly relevant for causality assessment of potential associations with the vaccines, a novel approach for signal detection was warranted. This article illustrates the Observed-over-Expected (O/E) analysis as an additional method for signal detection and risk assessment in large-scaled spontaneous reporting systems. All individual case safety reports (ICSRs) concerning idiopathic peripheral facial paralysis or Bell's palsy following administration of the COVID-19 vaccines (n= 291) manufactured by Pfizer/BioNTech (Comirnaty), Moderna (Spikevax), AstraZeneca (Vaxzevria) and Janssen (JCOVDEN) received by the National Pharmacovigilance Centre Lareb until 24th March 2022 were included in the O/E analysis, within a risk window of 7 and 14 days following immunisation. Dutch background incidence rates from 2019 and exposure of the Dutch population to the vaccines were obtained from the PHARMO institute and RIVM. The data was stratified in age groups, gender and administered dose in order to differentiate between population subgroups. Bell's palsy was reported more frequently than expected in several population subgroups following administration of all four COVID-19 vaccines, including children and adolescents. Among children, a high O/E ratio was found for boys aged 5-14 years after receiving the Pfizer/BioNTech vaccine. Regarding adolescents and young adults, women aged 15-24 years receiving Pfizer/BioNTech and Moderna, and men aged 15-24 years receiving Janssen developed Bell's palsy more often than expected. Furthermore, O/E ratios were high for individuals aged 25-64, regarding females receiving Pfizer, Moderna and AstraZeneca and males receiving Janssen. As facial paralysis was not labelled as an adverse event for the Janssen vaccine, this analysis contributed to signalling the association and warranting further regulatory action. The O/E method is a useful approach for signal detection of potential adverse reactions when handling large numbers of ICSRs. Further research is needed to attest to the causality on a clinical basis.

Retrospective study of peripheral facial paralysis in a tertiary hospital over 3 years

PurposeTo identify clinical and epidemiological characteristics of patients with peripheral facial palsy (PFP) at a tertiary care hospital. MethodThis is a retrospective observational study of patients with PFP treated at a tertiary medical center. We gathered demographic data, etiology, laterality, recurrence, recovery, clinical ophthalmology, severity according to the House–Brackmann (HB) scale, electrophysiological tests, medical services attended, medical and surgical treatment. ResultsTwo hundred and eighty-three PFP were included, 135 (48%) were men and 148 (52%) were women p = 0.47). All patients had unilateral involvement. The mean age was 54 ± 20 years. The main etiology was idiopathic in 215 (76%) patients. Median recovery time was 7 weeks. Recovery was complete in 190 (67%) patients. One hundred and seventy (84%) patients with idiopathic PFP had complete recovery, versus 30 (16%) patients with non-idiopathic PFP (p < 0.01). The 84% of patients with HB grade II, recovered completely, while with HB grade VI only 17% recovered (p = 0.003). Two hundred and twenty-nine patients (81%) had lagophthalmos. The majority received ocular surface care treatment in 271 (96%) patients and of these 249 (88%) patients received oral corticosteroid therapy. Thirteen patients (5%) required ophthalmologic surgery. ConclusionsPFP affects all age ranges, without predilection for sex and unilateral. Its main cause is idiopathic. Recovery is complete in most cases, being more favorable in mild and idiopathic affections. Most only require medical treatment.

Estudio retrospectivo de parálisis facial periférica en un hospital de tercer nivel a lo largo de 3 años

PurposeTo identify clinical and epidemiological characteristics of patients with peripheral facial palsy (PFP) at a tertiary care hospital. MethodThis is a retrospective observational study of patients with PFP treated at a tertiary medical center. We gathered demographic data, etiology, laterality, recurrence, recovery, clinical ophthalmology, severity according to the House–Brackmann (HB) scale, electrophysiological tests, medical services attended, medical and surgical treatment. ResultsTwo hundred and eighty-three PFP were included, 135 (48%) were men and 148 (52%) were women (P=.47). All patients had unilateral involvement. The mean age was 54±20 years. The main etiology was idiopathic in 215 (76%) patients. Median recovery time was 7 weeks. Recovery was complete in 190 (67%) patients. One hundred and seventy (84%) patients with idiopathic PFP had complete recovery, versus 30 (16%) patients with non-idiopathic PFP (P<.01). The 84% of patients with HB grade II, recovered completely, while with HB grade VI only 17% recovered (P=.003). Two hundred and twenty-nine patients (81%) had lagophthalmos. The majority received ocular surface care treatment in 271 (96%) patients and of these 249 (88%) patients received oral corticosteroid therapy. Thirteen patients (5%) required ophthalmologic surgery. ConclusionsPFP affects all age ranges, without predilection for sex and unilateral. Its main cause is idiopathic. Recovery is complete in most cases, being more favorable in mild and idiopathic affections. Most only require medical treatment.

Bell's Palsy and Its Semantic Change over Time.

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. Extensive review of available 19th and 20th century literature mentioning "Bell's palsy" and "Bell's paralysis." 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. 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.

Efficacy of steroid treatment and identification of prognostic factors in idiopathic peripheral facial nerve palsy in children

Purpose: The aim of the study is intended to investigate the etiology and clinical features of children with idiopathic peripheral facial palsy (IPFP) and to identify probable prognostic factors. It is also intended to investigate corticosteroid therapy and compare its efficacy.&#x0D; Materials and Methods: A total of 80 patients with newly diagnosed IPFP were included in the study. Demographic, clinical features and laboratory findings including age, gender, House Brackmann Facial Nerve Grading System (HBGS) grade at admission and follow-up, and the dosage and onset of steroid treatment were reviewed. We assigned our patients to 3 groups: Group 1: Patients given 1 mg/kg oral steroid treatment (1 mg/kg/day oral prednisolone). Group 2: Patients given 2 mg/kg oral steroid treatment (2 mg/kg/day oral prednisolone), and Group 3: Patients who did not receive oral steroid treatment. &#x0D; Results: A total of 80 children (41 girls and 39 boys) with a median age of 11 years were included in the study. The complete recovery was detected in %78,8(n:63) with IPFP. Of all patients, 78.8% (n=63) showed complete recovery. Admission after more than 24 hours was found to reduce the likelihood of ER by 10 times (1/0.10), while patients with HBGS grade of 5 were found to be 33.3 times (1/0.03) less likely to achieve ER than patients with HBGS grades of 2 to 3. Finally, steroid treatment at 2 mg/kg/d increased the probability of early recovery by 8.38 times.&#x0D; Conclusion: The prognosis of IPFP in children was very good. The prognostic factors affecting the early recovery were being HBGS grade 2 or 3 on the 21th day and receiving steroid treatment in the first 24 hours and 2 mg/kg/d dose.

Idiopathic Peripheral Facial Palsy and Preclampsia: A Case Report

During pregnancy, pre-eclampsia can be associated to idiopathic peripheral facial nerve palsy. It can be explained by similar physiopathological mechanisms. Facial palsy usually appears during the third trimester of pregnancy or in the early postpartum period. The prognosis is generally good and is not affected by the pregnancy. The occurrence of peripheral facial palsy during pregnancy should alert the obstetrician to look for a possible pre-eclampsia. We report a case of a patient with pre-eclampsia who developed idiopathic peripheral facial palsy during the third semester of pregnancy. Evolution was favorable, following treatment combining anti-hypertensive medication, corticosteroid therapy and ophthalmologic care.

Is the С-reactive protein/albumin ratio a prognostic factor in children with peripheral facial paralysis?

BACKGROUND: Bells Palsy (BP), accepted as an idiopathic condition and for which inflammation is believed to have a role in the pathogenesis, is a disease characterized by acute unilateral weakness in facial muscles innervated by the facial nerve.&#x0D; AIM: This study aimed to examine the relationship between the C-reactive protein/albumin ratio (CAR) and hematological parameters including the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), mean platelet volume (MPV), and red cell distribution width (RDW) in children with BP.&#x0D; MATERIALS AND METHODS: The study included 65 children diagnosed with idiopathic peripheral facial paralysis and a control group of 49 healthy children. The patients were classified into two groups according to the House-Brackmann (HB) grade at the time of diagnosis, as mild (HB grade 23) and severe (HB grade 45). Patients evaluated as HB grade 1 with normal, healthy, and symmetrical muscle function were not included in the study. The children in the patient group were classified into three groups at the end of a six-month follow-up period as full recovery, partial recovery, and no recovery. The patient and control groups were compared according to the CAR, NLR, PLR, MPV, and RDW values. After treatment, the full recovery and no recovery groups were compared based on the CAR, NLR, PLR, MPV, and RDW values.&#x0D; RESULTS: The NLR was found to be significantly higher in the BP patient group than in the control group (p 0.001). There was also a significant difference in the NLR value between the full recovery and no recovery groups. No statistically significant difference was found between the patient and control groups or between the full recovery and no recovery groups in terms of the CAR, PLR, MPV and RDW values.&#x0D; CONCLUSIONS: NLR, an easily accessed hematological parameter, may be used as a marker of poor prognosis in pediatric patients with BP. CAR was of no prognostic value in pediatric BP patients.

Chronic Bell's Palsy Literature Review and Case Report

Bell’s palsy, or idiopathic peripheral facial nerve palsy is a neurologic condition characterized by unilateral weakness of facial muscles. The evidence-based guidelines mostly consider the acute treatment of Bell’s palsy. However, chronic cases of Bell’s palsy are not supported by strong evidence regarding treatment options, except for a weak recommendation to utilize physical therapy. This case report has presented an application of a combination of physical therapy modalities (Mirror Book Therapy, High Inten-sity Laser Therapy, and Acupuncture) within 10 weeks, to treat a patient with long-term sequelae. This combination of therapies has resulted in a significant improvement in the level of recovery measured by facial grading scales. However, further research is necessary to provide stronger evidence regarding the benefits of this treatment option.

Prevalence of herpes zoster virus reactivation in patients diagnosed with Bell's palsy.

Herpes zoster virus can cause inflammatory neuropathy of the facial nerve. However, studies evaluating the prevalence of this agent in peripheral facial palsy are heterogeneous regarding sample group selection, laboratory analysis method and variables studied. In addition, there are a lack of epidemiological data in the Brazilian population on this serological phenomenon in peripheral facial palsy. This study estimated herpes zoster reactivation prevalence in serological samples through chemiluminescence immunoassay for quantitative determination of specific antibodies directed against the virus. This cross-sectional study sought to determine the prevalence of viral reactivation by herpes zoster in subjects with idiopathic peripheral facial palsy through analysis of serological samples over a year. Forty-seven patients (32 females and 15 males) participated. Severe paralysis was more common in older patients (p = 0.017). Facial pain (p = 0.02) and vertigo (p = 0.001) were related to a worse evolution of facial palsy. The rate of serological reactivation of the virus was 12.76 per cent. The rate of serological reactivation of herpes virus in idiopathic peripheral facial palsy in our population is similar to foreign literature data, suggesting similar aetiological mechanisms in the genesis of this morbidity.

The evaluation of facial nerve canal diameter in patients with ipsilateral recurrent idiopathic peripheral facial paralysis.

This study evaluated the effects of the diameter of facial canal segments on the ipsilateral recurrence of idiopathic peripheral facial paralysis. This study enrolled 20 patients with ipsilateral recurrent idiopathic peripheral facial paralysis. Measurements were made at the meatal foramen and mid-level of the labyrinthine segment and the narrowest and widest diameters of the mastoid and tympanic segments using the curved planar reformation technique with high-resolution computed tomography. The diameters of the labyrinthine segment measured at the meatal foramen and mid-level segments and the narrowest and widest diameters of the tympanic and mastoid segments on the recurrent paralytic side were significantly smaller than the diameters of the segments on the healthy side. The narrowness of the facial canal segments may be a risk factor in recurrent idiopathic peripheral facial paralysis.

The Bicentenary of Bell's Description of the Neuroanatomical Basis of Facial Paralysis: Historical Remarks.

Charles Bell was a talented and versatile Scottish anatomist, neurophysiologist, artist, and surgeon. On July 12, 1821, he reported his studies regarding facial innervation in the essay "On the Nerves," read before the Royal Society in London. Since then, idiopathic peripheral facial paralysis has been named "Bell's palsy." He was the first author to describe the neuroanatomical basis of facial paralysis, in an essay enriched by beautifully self-made illustrations. The aim of this article is to trace the history of Bell's description of the neuroanatomy of the facial nerve, reexamining his 1821 article, in which he stated that the lower facial expression muscles were dually innervated by both the fifth and seventh cranial nerves. In 1829, he rectified this conclusion, recognizing the exclusive role of the facial nerve, which he defined as the "respiratory nerve." We offer a tribute to this polymath scientist on the bicentenary of his 1821 publication.

Interest of Rehabilitation in Idiopathic Peripheral Facial Palsy in Children: A Case Report

Interest of Rehabilitation in Idiopathic Peripheral Facial Palsy in Children: A Case Report

Assessment of Hematological Parameters and The Relationship with Paralysis Degree in Children with Idiopathic Peripheral Facial Paralysis

Assessment of Hematological Parameters and The Relationship with Paralysis Degree in Children with Idiopathic Peripheral Facial Paralysis

Facial palsy as a manifestation of early neuroborreliosis (clinical case)

Lyme borreliosis is a tick-borne transmitted infectious disease caused by the spirochete Borrelia burgdorferi sensu lato and spread by the bite of ticks of the genus Ixodes. Lyme neuroborreliosis is a clinical manifestation of Lyme borreliosis, which affects the central nervous system and peripheral nervous system in up to 15% of the affected patients. Nerve structures are affected by spirochetes both in acute and late phase of the disease. The clinical course of neuroborreliosis is highly variable. Although at least 80% of European patients present with facial nerve palsy and radiculitis, symptoms of neuroborreliosis may be quite unspecific or even mimic other neurological diseases. Idiopathic peripheral facial palsy has long been considered as the most common cause of prosopoparesis, but modern diagnosis significantly narrow the range of cases of unknown genesis. Neuroborreliosis is difficult to diagnose, especially when prosopoparesis is the only clinical manifestation, so practitioners should be mindful of possible etiology to avoid misdiagnosis. The article presents a clinical case of early neuroborreliosis in a woman of 57 years who manifested with peripheral facial palsy. The author describes in detail the course of the disease (the appearance of new symptoms on the background of standard medical therapy (poor response), the presence of additional criteria (erythema migrans, lymphocytoma (rarely), arthralgia), diagnosis (specific immunological examination of blood to Borrelia burgdorferi sensu lato). Antibiotic therapy made it possible to achieve complete recovery of facial nerve function and avoid future complications.