Recurrent Bell's Palsy Research Articles

Prevalence of Recurrent Bell’s Palsy

Recurrent Bell’s palsy is experiencing more than 1 episode of Bell's palsy after recovering from the first one. Prevalence of Recurrent Bell's Palsy ranges from 2.6-15.2% although it is a rare occurrence. The study under observation was conducted to find out the prevalence of Recurrent Bell's Palsy in patients. Objective: To assess the prevalence of recurrent Bell's palsy. Methods: A convenience sampling method was used to perform an observational cross-sectional analytical survey based on inclusion and exclusion criteria. Data were collected by using questionnaire after informed consent and was analyzed using SPSS version 26.0. Results: It was concluded that mean age of Recurrent Bell’s palsy patients was 40.8 years. Male and female both genders were involved. Most common Bell's palsy-related predisposing factors were hypertension, Diabetes, old age, and Pregnancy respectively. More cases were reported in winter season than summers in recurrent Bell’s palsy patients. Conclusions: The prevalence of RBP is 4.2% and most commonly associated risk factors are Hypertension, Diabetes, Positive family history and pregnancy.

Recurrent Bell’s palsy; a single institutional experience

Background and objectives: Bell's palsy is the commonest disease of the facial nerve. The aim is to analyze several clinical and epidemiologic aspects of the recurrent Bell's palsy in Erbil city. Methods: This cross-sectional study was conducted at outpatient clinic from October 2019 to October 2020. Twenty-five patients, who had developed a recurrent Bell’s palsy, aged 17-70 years old, were consecutively enrolled. Neurological examination and lab tests were conducted. Results: Out of 25 patients, 15 (60%) of them were female and 10 (40%) were male. 20 (80%) of patients with recurrent Bell's palsy the subsequent episodes were on the same side, and five (20%) of the episodes were contralateral to the primary one, of these five patients, four of them were female and one was male. 12 patients had a history of hyperacusis, 10 of them reported in females and two in males with significant differences between both genders (p<0.029). A high number of facial palsy related to the side of the face affected was found on the left side 13 (52%). The facial palsy was found to be more severe in females. Recurrence of Bell's palsy was more common in the first two years from the initial episode. Conclusion: The study showed a significant recurrence of Bell's palsy more in the initial two years from the onset of the first attack. The recurrence was more likely to occur at the same side of the initial episode and it was the commonest in females and younger age groups.

Computed tomographic features of the proximal petrous facial nerve canal in recurrent Bell's palsy.

ObjectivesThe primary objective was to determine whether the narrowest dimensions of the labyrinthine facial nerve (LFN) canal on the symptomatic side in patients with unilateral recurrent Bell's palsy (BP) differ from those on the contralateral side or in asymptomatic, age‐ and gender‐matched controls on computed tomography (CT). The secondary objectives were to assess the extent of bony covering at the geniculate ganglion and to record inter‐observer reliability of the CT measurements.MethodsThe dimensions of the LFN canal at its narrowest point perpendicular to the long axis and the extent of bony covering at the geniculate ganglion were assessed by two radiologists. Statistical analysis was performed using the Wilcoxon signed‐rank and Mann‐Whitney U tests (LFN canal dimensions) and the Chi‐squared test (bony covering at the geniculate ganglion). Inter‐observer reliability was evaluated using Intra‐Class Correlation (ICC) and Cohen's kappa.ResultsThe study included 21 patients with unilateral recurrent BP and 21 asymptomatic controls. There was no significant difference in the narrowest dimensions of the ipsilateral LFN canal when compared to the contralateral side or controls (P = .43‐.94). Similarly, there was no significant difference in the extent of bony covering at the geniculate ganglion when compared to either group (P = .19‐.8). Good inter‐observer reliability was observed for LFN measurements (ICC = 0.75‐0.88) but not for the bony covering at the geniculate ganglion (Cohen's kappa = 0.53).ConclusionThe narrowest dimensions of the LFN canal and the extent of bony covering at the geniculate ganglion do not differ in unilateral recurrent BP, casting doubt over their etiological significance.Level of EvidenceLevel IV.

Epidemiological trends of Bell's palsy treated with steroids in Korea between 2008 and 2018.

Contemporary epidemiological data on Bell's palsy are crucial to clarify disease burden and improve management strategies. We aimed to examine the epidemiology of, and factors associated with, Bell's palsy treated with steroids in Korea. Using the National Health Insurance claims data from 2008 to 2018, we determined the incidence, recurrence rate, and management trends of Bell's palsy treated with steroids. We defined Bell's palsy cases based on diagnostic codes and concurrent treatment with steroids. The incidence of Bell's palsy showed an increasing trend (from 23.0 per 100 000 persons in 2008 to 30.8 per 100 000 persons in 2018). Age (60-69 y), sex (men), and month (January) were risk factors of Bell's palsy. The recurrence rate of Bell's palsy over the 11-y period was 1.5%. Male sex (hazard ratio [HR], 1.1; 95% confidence interval [CI], 1.0-1.2) and physiotherapy (HR, 0.9; 95% CI, 0.8-0.99) were independently associated with the recurrence of Bell's palsy. During the study period, the use of electrodiagnostic testing steadily increased, whereas that of physiotherapy steadily decreased, and antiviral therapy fluctuated,. The incidence and recurrence rates presented in this study are comparable with those reported in earlier studies that included patients with Bell's palsy, regardless of the use of steroids, and documented an increase in the burden of Bell's palsy. Further randomized controlled trials are required to ascertain the long-term effects of physiotherapy on recurrent Bell's palsy.

Recurrent Bell's palsy: outcomes and correlation with clinical comorbidities.

SUMMARYRecurrent Bell’s palsy (RBP) has been reported to range from 2.6 to 15.2% of primary Bell’s palsy (BP) and has been associated with systemic comorbidities such as diabetes and hypertension. A retrospective analysis of patients affected by BP and RBP were performed to define the signs and symptoms associated with recurrence and the outcomes. Clinical and subjective characteristics of 341 patients affected by facial palsy were analysed. Facial function was assessed via House-Brackmann and Sunnybrook grading system. Characteristics of the palsy and systemic comorbidities (diabetes, hypertension, herpetic infections, autoimmunity disorders, audio-vestibular symptoms) were analysed in BP and RBP patients applying Fisher exact and the Mann-Whitney U tests, while time to recovery was explored with univariate and multivariate analysis. Twenty-four patients presented two or more episodes of facial palsy, representing a recurrence rate of 7%. Associated symptoms (e.g. retroauricular pain, taste disorder, dry eye etc.) were similar between BP and RBP patients. RBP occurred at older age than primary episode (p = 0.03). Recurrence was a risk factor for delayed recovery (p = 0.02), although final facial function was similar between the two groups. In conclusion, no significant differences were found between primary BP patients and RBP patients in terms of symptoms, palsy severity and presence of comorbidities. Delayed facial nerve function recovery in RBP did not affect the final outcome. Treatment of facial nerve recurrences must be the same of the primary episode, although the presence of prodromal symptoms may alert the patient and early corticosteroid treatment may be commenced even before the onset of paresis.

Recurrent Bell's palsy.

Although recurrent facial palsy was first reported in 1871, the aetiology, definitions, classifications, pathogenesis, treatment options and prognosis have not been clearly determined. There have been no systematic reviews and meta-analyses of recurrent Bell's palsy. The purpose of this study was to evaluate the clinical manifestations of recurrent Bell's palsy through a systematic review and meta-analysis. The SCOPUS, PubMed, Cochrane Library and EBSCO databases were searched through 1 May 2018, using the search terms "recurrent Bell's palsy" and "recurrent facial palsy," for studies involving patients with recurrent Bell's palsy. Reference lists of eligible studies were also reviewed. A search of titles and abstracts in these four databases identified 222 studies; of these, 27 studies, involving 1041 patients from 13 countries, were analysed. The mean percentage of patients who experienced recurrence of Bell's palsy ranged from 0.8% to 19.4%. Five studies that included 191 patients were included in the meta-analysis. Among patients previously affected by Bell's palsy, the mean incidence of recurrent Bell's palsy was 6.5%. Sidedness of recurrent disease, relative to the side of the original disease, had no effect on patient prognosis. Of all patients with Bell's palsy, 66.0% recovered completely, with the recovery rate lower in patients with recurrent than with primary Bell's palsy.

Clinical Analysis of Recurrent Bell's Palsy in One University Hospital

Results: Recurrent BP was observed in 31 (7.9%) patients. The number of recurrence was varied from 2 to 5. The recurrent BP (9.7%) had more incidence of family history and MRI enhancement than those of single BP (2.2%, p=0.047). The single BP (63.4%) had better recovery than recurrent BP (45.2%, p=0.045). Conclusions: The recurrent BP had more incidence of family history, MRI enhancement and poor prognosis than the single BP.

Recurrent Bell's Palsy in a Nigerian patient with Human Immunodeficiency Virus (HIV) infection: Case Report

Recurrent Bell's Palsy in a Nigerian patient with Human Immunodeficiency Virus (HIV) infection: Case Report

Familial recurrent Bell′s palsy

Bell's palsy is a peripheral facial palsy of sudden onset. The etiology of Bell's palsy is unknown and hereditary components may play a role in familial recurrent Bell's palsy. We report three families in which eight patients had a total of 12 episodes of typical Bell's palsy. The pathophysiology of familial recurrent Bell's palsy is discussed.

Coxsackie B meningoencephalitis in a patient with acquired immunodeficiency syndrome and a multiple sclerosis–like illness

Both Coxsackie infection and multiple sclerosis (MS) are rare in human immunodeficiency virus (HIV) infection. We report a 35-year-old woman with known HIV infection of 12 years' duration and a clinical illness of 4 years' duration consistent with MS. The latter was characterized by optic neuritis, bilateral abducens palsies, recurrent Bell's palsy, hemiparesis, and ataxia coupled with white matter abnormalities on magnetic resonance imaging (MRI). Autopsy revealed Coxsackie B meningoencephalitis; no other infectious disease were detected and no histopathological features of MS were evident. We suggest that the relapsing-remitting neurological disease in this patient was the consequence of Coxsackie B meningoencephalitis. This is the first case report, to the best of our knowledge, of an enteroviral meningoencephalitis complicating human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS).

Recurrent Bell's palsy in children - Report of two cases.

Recurrent Bell's palsy in children - Report of two cases.

Neurophysiological evaluation of acute facial paralysis in children

Objective evaluation of facial nerve paralysis represents a unique challenge to the clinician. Electroneurography (ENoG) and the acoustic reflex (AR) have been widely used as neurophysiological tests in an assessment of facial nerve function. However, ENoG or AR alone does not suffice diagnostic and prognostic purposes of facial function evaluation in children. To further investigate the diagnostic aspects of facial nerve paralysis, the prognostic value of AR and ENoG, and the time course of the disease in pediatric population, a series of 30 children with acute facial paralysis were investigated by correlation of findings from video-taped House-Brackmann facial grading system, AR and ENoG. The results showed that AR was absent or abnormal for thresholds in 68.2% of patients with Bell's palsy and normal middle ear function. Shorter duration and higher percentage of recovery were found in the children with a normal AR than those with an abnormal AR. Three children showed an abnormal tympanogram and hearing loss associated with acute facial paralysis. These findings should alert the clinician to the presence of a specific, treatable disease in the evaluation of Bell's palsy. The percentage of electroneurographic response varied with different days after onset. ENoG showed minimal responses at weeks 1–3 after onset of Bell's palsy in most patients. The study of the time-course in the children with Bell's palsy demonstrated a functional gap in the early (< 1 week) and late clinical stage (after 6 weeks) of the disease, suggesting that ENoG predicted well only during weeks 1–4 after onset. In general, ENoG showed a good recovery in children, however, recurrent Bell's palsy becomes a concern. The need for neurophysiological follow-up for possible incomplete recovery of the facial nerve is emphasized. It is recommended that AR and ENoG should be included in the diagnostic workup when evaluating pediatric facial function.

Familial recurrent Bell's palsy in an Italian family

Familial recurrent Bell's palsy in an Italian family

特発性顔面神経麻ひ再発例の検討

The incidence and prognosis of recurrent Bell's palsy were examined in a total of 418 patients with Bell's palsy. Bell's palsy was recurrent in 6.5%, 3.1% unilateral, and 1.7% bilateral alternating. The age at the first attack in patients with three or more recurrent palsies was significantly younger than that in those with non-recurrent palsy or with two attacks. The patients with two or more attacks had a worse prognosis than did those with no recurrence or a first recurrence. The stapedial reflex was of prognostic value in patients with both non-recurrent and recurrent palsies. However, the ENoG and NET examinations were not useful in the prediction of the prognosis of recurrent facial palsy.

Recurrent lower motor neurone facial paralysis in four successive pregnancies

Recurrent lower motor neurone facial paralysis in successive pregnancies is a rare phenomenon of which there are few case reports in the literature. There have been two previous reports of recurrent Bell's palsy in two and three successive pregnancies respectively, but it is felt that these should have more appropriately been reported as recurrent lower motor neurone facial paralysis in pregnancy as, by definition, any facial paralysis that recurs should not be classified as Bell's palsy even though Bell himself commented on the association between facial paralysis and pregnancy. We report the first case of recurrent lower motor neurone facial paralysis in four successive pregnancies and review the literature.

Recurrent peripheral facial nerve palsy after dental procedures

Peripheral facial palsy is an uncommon complication of dental procedures. Most cases begin immediately after dental anesthesia and resolve within 12 hours. No report of recurrent facial palsy with dental manipulations has previously been described. We report a patient with two episodes of peripheral facial palsy, 2 years apart, developing within 24 hours of dental procedures. A third episode of contralateral facial weakness developed 3 years after the second event. This event was not related to dental manipulations. Although the exact mechanism is not known, dental manipulations may rarely result in precipitation of recurrent Bell's palsy.

Recurrent Bell's palsy in pregnancy

A case of recurrent Bell's palsy occurring in two successive pregnancies in a 37-year-old woman is presented. The causes of facial nerve paralysis of the lower motor neurone type are discussed. The rate of recurrence of Bell's palsy during pregnancy is unknown. Treatment with corticosteroids of Bell's palsy during pregnancy poses the threat of possible side effects on the fetus.

Recurrent Bell's palsy: analysis of 140 patients.

Of 1,700 patients with facial paralysis seen in a retrospective study from 1969 through 1977 and 280 patients seen prospectively from 1983 through 1986, 7.1% had recurrence of Bell's palsy. In this group, the frequency of ipsilateral recurrence was equal to that for contralateral recurrence. The mean age at onset of Bell's palsy was 33.0 years; Bell's palsy recurred a mean of 9.8 years later. Recurrent facial paralysis did not indicate a worse prognosis for recovery regardless of which side was affected. There was no statistical difference between results for male patients or female patients, nor was there a statistically significant sex predominance, except in the age group 10 to 19 years. In our results, computed tomography (CT) scan in patients with recurrent Bell's palsy detected no facial-nerve neuroma. Of 77 patients followed a mean of 33 years after the first episode (range, 2.8 to 60 years), none showed progressive facial-nerve dysfunction or any signs of tumor. We conclude that an ipsilateral recurrence of facial paralysis without documented evidence of a tumor does not warrant a transmastoid decompression of the facial nerve. The results of our analysis were verified prospectively as well as retrospectively. A new classification system is introduced for ease of computer analysis and for simplified discussion of recurrent facial paralysis.

Cellular immunity abnormalities in patients with recurrent Bell's palsy.

Recurrent Bell's palsy is a rare form of facial paralysis. To investigate the role which cellular immunity plays in the aetiology of recurrent Bell's palsy, we evaluated a series of such patients using a laboratory test specially formulated to test the cellular immune system. We measured T-lymphocyte and T-lymphocyte subsets in the peripheral blood of 10 recurrent Bell's palsy patients and in 30 healthy volunteers. T-lymphocytes and T-lymphocyte subsets were reduced significantly in the patients, but the T-helper: T-cytotoxic ratio was normal. Cellular immunity abnormalities were therefore found in the peripheral blood of patients with recurrent Bell's palsy, supporting the concept that this is an immunomediated demyelinating disease.

Recurrent Bell's palsy. Etiology, frequency, prognosis.

The etiology, frequency and prognosis of recurrent Bell's palsy were studied in patients with peripheral paresis of n.facialis of various etiology. Fourteen (11.9%) of 117 patients with Bell's palsy had a recurrent paresis of n.facialis. Nine of these were of homolateral and five contralateral type. Seven recurrent facial paralyses in idiopathic Bell's palsy (i.e. 10.4% of the patients with idiopathic facial palsy), 3 facial palsies of viral origin (i.e. 8.8% of the patients with viral facial palsy), one in association with diabetes mellitus, one during pregnancy, one combined with positive rheumatic serological tests, and one in a case of Melkersson-Rosenthal syndrome were found. The frequency and heterogenity of etiology of recurrent facial palsies suggest a predisposing factor or immune mechanisms. In eight patients there was within 6 to 8 weeks a good, in two patients a moderate and in four patients a poor recovery of function. The greater reduction of the compound action potential of the m.orbicularis oris in recurrent homolateral facial palsy in relation to patients with single manifestation point out the greater denervation and therefore the poorer prognosis of recurrent palsies. A prophylactic decompression to prevent a third attack of recurrent facial paresis is considered.