Depressive disorder and elevated risk of bell's palsy: a nationwide propensity score-weighting study.

BACKGROUND: Prior studies have reported a potential relationship between depressive disorder (DD), immune function, and inflammatory response. Some studies have also confirmed the correlation between immune and inflammatory responses and Bell's palsy. Considering that the pathophysiology of these two diseases has several similarities, this study investigates if DD raises the risk of developing Bell's palsy. METHODS: This nationwide propensity score-weighting cohort study utilized Taiwan National Health Insurance data. 44,198 patients with DD were identified as the DD cohort and 1,433,650 adult subjects without DD were identified as the comparison cohort. The inverse probability of treatment weighting (IPTW) strategy was used to balance the differences of covariates between two groups. The 5-year incidence of Bell's palsy was evaluated using the Cox proportional-hazard model, presenting results in terms of hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: The average age of DD patients was 48.3 ± 17.3 years, and 61.86% were female. After propensity score-weighting strategy, no significant demographic differences emerged between the DD and comparison cohort. The Cox proportional hazards model revealed a statistically significant adjusted IPTW-HR of 1.315 (95% CI: 1.168-1.481) for Bell's palsy in DD patients compared to comparison subjects. Further independent factors for Bell's palsy in this model were age (IPTW-HR: 1.012, 95% CI: 1.010-1.013, p < 0.0001), sex (IPTW-HR: 0.909, 95% CI: 0.869-0.952, p < 0.0001), hypertension (IPTW-HR: 1.268, 95% CI: 1.186-1.355, p < 0.0001), hyperlipidemia (IPTW-HR: 1.084, 95% CI: 1.001-1.173, p = 0.047), and diabetes (IPTW-HR: 1.513, 95% CI: 1.398-1.637, p < 0.0001) CONCLUSION: This Study confirmed that individuals with DD face an elevated risk of developing Bell's palsy. These findings hold significant implications for both clinicians and researchers, shedding light on the potential interplay between mental health and the risk of certain physical health outcomes.

Quality of Life in Bell's Palsy: Correlation with Sunnybrook and House-Brackmann Over Time.

OBJECTIVES: To compare patient-graded facial and social/well-being function with physician-graded facial function in Bell's palsy over time. STUDY DESIGN: A prospective follow-up study at two tertiary otorhinolaryngological centers. METHODS: A total of 96 patients, 36 women and 60 men, aged 18-77 years, were included. Facial Clinimetric Evaluation (FaCE) scale and Facial Disability Index (FDI) scores were compared with Sunnybrook and House-Brackmann scores. RESULTS: Inclusion was on mean day 7 (96 patients) and follow-up on days 53 (81 patients) and 137 (32 patients). Initially, correlations between FaCE total score, FaCE domains, FDI physical function, FDI social/well-being function and Sunnybrook and House-Brackmann scores were low to fair, except for FaCE facial movement (r = 0.55). Correlations between FaCE total score and Sunnybrook score were very good to excellent at visits 2 (r = 0.83) and 3 (r = 0.81). Women scored FaCE social and FDI social/well-being function lower than men, despite similar Sunnybrook scores. CONCLUSION: In early stages of Bell's palsy, there were low to fair correlations between FaCE/FDI (except for facial movement) and Sunnybrook score. This implies that the design of the quality of life (QoL) instruments is less suited for the acute phase. The high correlations at follow-ups suggest that the questionnaires can be used for evaluation of QoL over time. Our results indicate that women experience more facial palsy-related psychosocial dysfunction. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E612-E618, 2021.

Delayed recognition of emotional facial expressions in Bell's palsy.

We investigated the impact of acute facial palsy on the recognition of emotional facial expressions. Thirty-one patients with acute facial palsy and 30 healthy controls performed a well-established test battery with tasks both for mere face recognition (FACE) and for recognition of emotional facial expressions (EMO). Participants were tested at disease onset (t1) and about eight weeks thereafter (t2). Recognition accuracy did not differ between groups in FACE and EMO tasks at t1 and t2. By contrast, mean reaction time (RT) in the EMO task was significantly longer for patients than for controls at t1 (10.228 ± 710 ms vs 7.386 ± 283 ms; p = .001), whereas RT in the FACE task did not differ between groups. Parallel to clinical remission, patient's RTs in EMO tasks decreased but remained significantly prolonged at t2. Consistent with theories of embodied cognition, our findings show that facial palsy delays recognition of emotional facial expressions but not face recognition per se. Furthermore, normal accuracy of emotion recognition suggests efficient compensatory mechanisms that preserve this essential social function. We hypothesize that deficient sensorimotor embodiment may contribute to disturbances of non-verbal communication in patients with impaired facial motricity.

Increased risk of depression in Bell's palsy: Two longitudinal follow-up studies using a national sample cohort.

BACKGROUND: Recently, a bidirectional association between Bell's palsy and anxiety disorders has been reported. Given the common comorbidity between anxiety and depressive conditions and the typical developmental trajectory of anxiety before depression, we hypothesized that the bidirectional association between Bell's palsy and depression is also reproducible. METHODS: Using data from the Korean National Health Insurance Service-National Sample Cohort, data were collected from 3,526 Bell's palsy patients who were 1:4 matched by age, sex, income, region of residence, and past medical history with 14,104 controls. Additionally, 61,068 depression patients were matched with 244,272 control participants. A Cox proportional hazards model was used to analyze the hazard ratio (HR) of Bell's palsy for depression (study I) and depression for Bell's palsy (study II). RESULTS: In study I, the adjusted HR for depression was 1.41 (95% confidence interval [CI] = 1.20-1.66) in the Bell's palsy group (P < 0.001). In subgroup analyses, an increased risk of depression was more evident, particularly in female participants ≥ 40 years old. This association was evident in follow-up periods 6 months after the index date. In study II, the adjusted HR for Bell's palsy was 1.08 (95% CI = 0.94-1.25) in the depression group (P = 0.280). CONCLUSION: A history of Bell's palsy increased the risk of depression. Contrary to our hypotheses, depression did not increase the risk of Bell's palsy.

Bidirectional association between Bell's palsy and anxiety disorders: A nationwide population-based retrospective cohort study.

OBJECTIVE: Bell's palsy and anxiety disorders share numerous risk factors (e.g., immune response, ischemia, and psychological stress). However, there have been no studies on the bidirectional temporal association between the two illnesses. In this study, we used the Taiwan National Health Insurance Research Database (NHIRD) to test the bidirectional association between Bell's palsy and anxiety disorders. We hypothesized that patients with Bell's palsy would have an increased risk of subsequent anxiety disorders later in life and that, conversely, those with anxiety disorders would have an increased likelihood of developing Bell's palsy later in life. METHODS: We conducted two retrospective cohort studies using Taiwan's National Health Insurance Research Database (NHIRD). Study 1 included 8070 patients diagnosed with anxiety disorders and 32,280 controls without anxiety disorders who were matched with sex, age, and enrollment date to analyze the following risk of Bell's palsy among both groups. Study 2 included 4980 patients with Bell's palsy and 19,920 controls without Bell's palsy who were matched with sex, age, and enrollment date to analyze the following risk of anxiety disorders among both groups. The patient records selected for the studies were dated between January 1, 2000, and December 31, 2004. All subjects were observed until their outcomes of interest, death or December 31, 2009. RESULTS: After adjustment for age, sex, comorbidities, urbanization, and income, the hazard ratio (HR) for patients with anxiety disorders to contract Bell's palsy was 1.53 (95% CI, 1.21-1.94, P<.001), and the HR for patients with Bell's palsy to develop an anxiety disorder was 1.59 (95% CI, 1.23-2.06, P<.001). CONCLUSION: This study found a bidirectional temporal association between Bell's palsy and anxiety disorders. After one of these conditions develops, the morbidity rate for the other significantly increases. Additional studies are required to determine whether these two conditions share the same pathogenic mechanisms, and whether successfully treating one will reduce the morbidity rate for the other.

What kills everyone, gives a high for some-Recreational Snake Envenomation.

There are multiple reports of recreational snake envenomation describing psychotropic effects in absence of any adverse effects. This is in contradiction with known effects of snake venom. We report a case of a young male who subjected himself to repeated envenomation by a snake purported to be 'Indian Cobra' and experienced a 'high'. However, a direct identification of snake revealed it was a benign 'Rat snake'. We attempt to explain the reported psychological effects as a result of high expectation of rewarding experience, strong suggestion, personality traits and most importantly the dangerous nature of willfully receiving snakebites.

Needle Sensation and Personality Factors Influence Therapeutic Effect of Acupuncture for Treating Bell's Palsy: A Secondary Analysis of a Multicenter Randomized Controlled Trial.

BACKGROUND: It has not been solved what kind of needle sensation might influence outcomes of acupuncture treatment. Effects of personality factors on the therapeutic effect of acupuncture have not been investigated. This study aimed to find the effects of the traits of personality on the objective outcome when different acupuncture techniques were used in treating patients with Bell's palsy. METHODS: We performed a secondary analysis of a prospective multicenter randomized controlled trial of acupuncture for Bell's palsy. Patients were randomly assigned to the de qi and control groups, respectively. The primary outcome was facial nerve function at month 6. The intensity of each needle sensation was rated by a visual analog scale. Psychosocial factors were assessed by the pretreatment mediator questionnaire; 16 Personality Factor Questionnaire (16PF) was used for assessing personality factors and digit cancellation test for assessing attention. RESULTS: After 6 months, patients in the de qi group had better facial function (adjusted odds ratio [OR]: 4.16, 95% confidence interval [CI]: 2.23-7.78). Path analysis showed that intensity of needle sensation of fullness had direct effect on House-Brackmann (HB) score at month 6. In de qi group, the low HB score on day 1 (OR: 0.13, 95% CI: 0.03-0.45) and the low Social Boldness score (OR: 0.63, 95% CI: 0.41-0.97) in 16PF were associated with better facial function. In control group, low HB score on day 1 (OR: 0.25, 95% CI: 0.13-0.50), low Vigilance score (OR: 0.66, 95% CI: 0.50-0.88), and high Tension score (OR: 1.41, 95% CI: 1.12-1.77) in 16PF were related to better facial function. CONCLUSIONS: The needle sensation of fullness could predict better facial function and personality traits might influence outcomes of acupuncture treatment. Both of them should be considered seriously in acupuncture treatment and research.

Losing myself, finding my adaptability.

I've written this to reflect my personal experience of Bell's Palsy to inform my midwifery colleagues how this rare occurrence can impact pregnant women in their care. Pregnant women are at an increased risk of Bell's Palsy but many professionals will not encounter it due to its rarity. Collating my thoughts in this article has helped me make sense of the experience and therefore move on in many ways. I make no apologies for my relaxed style of writing, as I am knowledgeable regarding my afflictions, but an expert regarding my own perspective. Humour is vastly underrated and has carried my family through some hairy situations at times.

Efficacy of early physical therapy in severe Bell's palsy: a randomized controlled trial.

BACKGROUND: Bell's palsy (BP) is the most frequent form of peripheral palsy of the facial nerve. Prognosis for recovery is good for most patients; in the remaining cases, different grades of residual impairment persist. Physical therapy, in association with drug administration, aims to improve outcomes. OBJECTIVE: To assess the efficacy of early physical therapy in association with standard drug administration versus pharmacological therapy only, in terms of time to maximum gains and grade of recovery of function, and to examine who will most benefit from rehabilitation. METHODS: From June 2008 to May 2010, 232 individuals were evaluated. The 87 patients meeting the eligibility criteria were randomly assigned to the experimental group (prednisone and valacyclovir plus physical therapy, n = 39) or the control group (pharmacological therapy, n = 48) within 10 days of onset. Intention-to-treat analyses were done. RESULTS: The physical therapy had a significant effect on grade (P = .038) and time (P = .044) to recovery only in patients presenting with severe facial palsy (House-Brackmann [HB] grade V/VI). No significant differences were found between the study and control groups for outcome of synkinesis. CONCLUSION: Physical therapy appears to be effective only in the more severe BP (baseline HB grade V/VI), whereas less severe BP (baseline HB grade IV) results in complete spontaneous recovery, regardless of physical therapy.

Bell's palsy in Singapore: a view from the patient's perspective.

INTRODUCTION: Bell's palsy is a well-recognised disease with robust research on its possible aetiologies and epidemiology, but scant information on patients' concerns and concepts regarding the condition is available. We aimed to evaluate the ideas, concerns and expectations of patients with Bell's palsy in Singapore. METHODS: A cross-sectional study was conducted at a single tertiary-care hospital in Singapore. Participants were all patients with newly diagnosed Bell's palsy referred to the otolaryngology department either from the emergency department or by general practitioners. Participants were given a self-administered questionnaire and their facial nerve palsies were graded by the consultant doctor. RESULTS: A total of 52 patients were recruited, of which 41 were available for analysis. 78.0% of patients were concerned that they were having a stroke upon presentation of the symptoms. Other beliefs about the cause of the disease included overwork or stress (36.6%), something that the patient had eaten (9.8%) and supernatural forces (2.4%). About 50% of patients had tried some form of complementary or alternative therapy other than the steroids/medicines prescribed by their general practitioner or emergency physician. While 39.0% of patients agreed that the Internet had helped them understand more about their condition in addition to the information provided by the physician, 9.8% of them specifically disagreed with this statement. CONCLUSION: We have found that patients with Bell's palsy in Singapore are not very knowledgeable about the disease. Although the Internet is a useful resource, a physician's explanation of the disease and its natural progression remains of utmost importance.

Psychological factors are closely associated with the Bell's palsy: a case-control study.

To observe the differences in psychological status between Bell's palsy (BP) patients and healthy subjects, and to examine the relationship between psychological factors and the severity of BP, we conducted a case-control, multi-center clinical investigation. A total of 695 subjects were assigned to the case group (n=355) and the control group (n=340). House-Brackmann grading system and Facial Disability Index (FDI) were adopted to assess the BP patients; Kessler Psychological Distress Scale (K10) and 16 Personality Factor (16PF) scale were employed to evaluate the psychological distress and personality profiles of all subjects. Two independent samples t test was used to compare the differences between cases and controls, and to compare the differences among different BP patients. Pearson correlation analysis was used to examine the relationship between psychological factors and severity of facial paralysis. The results showed that psychological distress (K10) in case group (27.09±5.80) was significantly higher than that in control group (13.43±3.02) (t=-37.219, P=0.000). The scores of personality factor Warmth (A), Openness to Change (Q1), Self-Reliance (Q2) were lower in cases than in the controls (P<0.01, P<0.05, P<0.05, respectively), whereas the scores of Sensitivity (I), Vigilance (L), Apprehension (O), and Tension (Q4) were significantly higher in cases than in the controls (P<0.05, P<0.01, P<0.01, P<0.01, respectively). In addition, the psychological distress was significantly higher in female patients, severe (HB score IV-VI) patients, and subacute (onset time 72-168 h) patients compared with that in male patients, mild (HB score I-III)patients, and acute (onset time[Symbol: see text]72 h) patients (P<0.05). The scores of personality factor in female patients, severe patients, and subacute patients were also significantly different from male patients, mild patients, and acute patients (P<0.05). The result of Pearson correlation analysis showed that psychological factors (K10, personality A, F, L, N, O, Q4) were closely related to HB scores. We are led to conclude that the psychological status between BP patients and healthy people are different; psychological distress and personality factors are closely associated with severity of facial paralysis.

Compensatory expressive behavior for facial paralysis: adaptation to congenital or acquired disability.

OBJECTIVE: Although there has been little research on the adaptive behavior of people with congenital compared to acquired disability, there is reason to predict that people with congenital conditions may be better adapted because they have lived with their conditions for their entire lives (Smart, 2008). We examined whether people with congenital facial paralysis (FP), compared to people with acquired FP, compensate more for impoverished facial expression by using alternative channels of expression (i.e., voice and body). RESEARCH METHOD/DESIGN: Participants with congenital (n = 13) and acquired (n = 14) FP were videotaped while recalling emotional events. MAIN OUTCOME MEASURES: Expressive verbal behavior was measured using the Linguistic Inquiry Word Count (Pennebaker, Booth, & Francis, 2007). Nonverbal behavior and FP severity were rated by trained coders. RESULTS: People with congenital FP, compared to acquired FP, used more compensatory expressive verbal and nonverbal behavior in their language, voices, and bodies. The extent of FP severity had little effect on compensatory expressivity. CONCLUSIONS/IMPLICATIONS: This study provides the first behavioral evidence that people with congenital FP use more adaptations to express themselves than people with acquired FP. These behaviors could inform social functioning interventions for people with FP.

[Relationship between neuro-psychological factors and effect of acupuncture in treating Bell's palsy].

OBJECTIVE: To study the influence of neuro-psychological factors on the effect of acupuncture in the treatment of Bell's palsy and the overall prognosis in patients. METHODS: Fifty patients with Bell's palsy were randomized into the treatment group and the control group, and they were treated with manipulated and non-manipulated acupuncture, respectively. Scorings by subjective perceptive scale of acupuncture, Cartel personality test, and Hamilton Anxiety Scale were performed and the curative effect was assessed according House-Brackmann grading standards. RESULTS: The total effective rate of acupuncture was 78.0% (39/50), and that of manipulated acupuncture was better than that of non-manipulated acupuncture [89.2% (25/28) vs. 63.6% (14/22), P < 0.01]. Visual analogue scoring for perception of "Deqi", evaluated either by patients or by doctors, showed that the scores was higher in the treatment group than in the control group (P < 0.01). Cartel personality test (16PF) found that patients with personality factors of sociability, intellectuality, excitability, braveness, and independence were capable of getting "Deqi" more easily, there existed a significant correlation between personality factors and curative effect. By Hamilton Anxiety Scale scoring, 92.0% (46/50) of the patients were found being in an anxiety state, and the efficacy of treatment was negatively correlated with the degree of anxiety (r = -0.9491, P < 0.05). CONCLUSION: Neuro-psychological factors put great influence on the efficacy of treatment for Bell's palsy, multiple measures, such as drug-therapy, acupuncture, psychological intervention, rehabilitation therapy, etc., should be taken in combination for improving patients' prognosis.

Psychometric testing of the Gordon Facial Muscle Weakness Assessment Tool.

School nurses may be the first health professionals to assess the onset of facial paralysis/muscle weakness in school-age children. The purpose of this study was to test the psychometric properties of the Gordon Facial Muscle Weakness Assessment Tool (GFMWT) developed by Gordon. Data were collected in two phases. In Phase 1, 4 content experts independently rated each of the 22 items on the GFMWT for content relevance. The ratings were used to generate Item and Scale Content Validity Index (CVI) scores. In Phase 2, school nurses (N = 74) attending a state conference independently rated referral urgency on a set of 10 clinical scenarios using the GFMWT. The GFMWT had an item and scale CVI of 1.0. Overall, the interrater reliability was .602 (p < .001). When used by school nurses, the GFMWT was shown to be both a reliable and a valid tool to assess facial muscle weakness in school-age children.

Recuperabilidad de la parálisis facial periférica con prednisolona vs. aciclovir/prednisolona / Recoverability of peripheral facial paralysis with prednisolone vs. acyclovir/prednisolone

En la literatura no existe suficiente evidencia que soporte la asociación de un antiviral al corticoide sistémico; sin embargo, su uso es frecuente en la práctica clínica justificada por la posible etiología viral. Objetivo: Describir la frecuencia de recuperación completa de la parálisis facial periférica idiopáticaen los pacientes que reciben prednisolona o prednisolona/aciclovir.Métodos: Se realizó un estudio de cohorte histórica identificando los casos de parálisis facial periférica. Resultados: Se reportan 106 casos, 59 mujeres (55,7%) y 47 hombres (44,3%), con edad promedio 36.9 años (DE16.7). Al ingreso el 47,2% de los pacientes presentaron parálisis grado III. Recibieron prednisolona 32 pacientes (30,2%) y prednisolona-aciclovir 74 (69,8%). La recuperación completa (House Brackman I) con prednisolona se documentó en 23 (71,9%) y 52 (70,2%) pacientes tratados con prednisolona-aciclovir. El seguimiento mediano fue 39 días. En ambos grupos lafrecuencia de mejoría fue mayor en quienes ingresaron con grados II y III de parálisis. Conclusión: La tasa de mejoría reportada es superior a la descrita con el uso de placebo pero está por debajo de lo esperado para el uso de prednisolona a 3 meses. La frecuencia de recuperación completa fue similar con prednisolona y prednisolona-aciclovir.

There is not enough evidence in the literature available that supports the addition of an anti viral to the systemic corticoid. However, it is frequently used in clinical practice where it is justified by the probable viral etiology. Objective: To describe the full recovery frequency of idiopathic peripheral facial paralysis in patients to whom prednisolone or prednisolone / acyclovir is given. Methods: A historical cohort study was conducted and the cases of peripheral facial paralysis were identified. Results: 106 cases were reported, 59 women (55,7%) and 47 men (44,3%), with an average age of 36.9 years of age (DE 16.7). 47,2% of the patients showed paralysis of the III degree upon admission. 32 of the patients (30,2%) were administered prednisolone and 74 (69,8%) were given prednisolone / acyclovir. Full recovery (House Brackman I) with prednisolone was documented in 23 (71,9%) and 52(70,2%) of the patients that had been treated with prednisolone-acyclovir. The average follow – up was 39 days. Recovery frequency was higher in both groups among the patients that were admitted to the hospital with degree II and III paralysis. Conclusion: The reported recovery rate is above the one described when using placebo but it is stillbelow the expected rate when using prednisolone for 3 months. Full recovery frequency was similar with prednisolone and with prednisolone-acyclovir.

The phenomenon of the late recovered Bell's palsy: treatment options to improve facial symmetry.

BACKGROUND: Bell's palsy is an idiopathic neuropathy of cranial nerve VII, and the incidence ranges from 15 to 40 per 100,000. The majority of patients recover, but up to 16 percent of patients have significant sequelae. The phenomenon of the "late recovered" Bell's palsy has the following specific features and has not formerly been described: (1) tightening of the facial muscles, with a deepening nasolabial fold and reduced palpebral fissure; (2) blepharospasm; and (3) incomplete recovery of peripheral VIIth nerve branches, with ipsilateral forehead paralysis, reduced depressor anguli oris function, and poor excursion of the angle of the mouth on smiling. METHODS: Nonsurgical treatment involved four monthly botulinum toxin injections. Patients had injections to paralyze the ipsilateral orbicularis oculi, contralateral forehead rhytides, and depressor anguli oris and to treat blepharospasm and muscle tightness. The effectiveness of the botulinum toxin injections on facial symmetry and patient appreciation of this were assessed by measuring brow height and teeth exposure before and 3 weeks after injection. RESULTS: Twenty-three patients were followed up for a mean period of 37 months. The difference in brow height and teeth exposure after injection was less than preinjection measurements, but this did not reach statistical significance. Patient self-assessments showed improvements in their appreciation of the facial symmetry, ability to go out in public, and feelings of self-worth (visual analogue scale). Surgical treatment options include ipsilateral brow lift, division of the contralateral frontal branch, contralateral tarsorrhaphy to equalize the palpebral fissures, and bilateral upper blepharoplasty. CONCLUSIONS: The true benefit of botulinum toxin injections was more apparent during facial animation and not when the face was static. The patients greatly appreciated the improvement in facial symmetry. Various treatment options are available to improve the quality of life for patients with late recovered Bell's palsy.

Physiotherapy in patients with facial nerve paresis: description of outcomes.

PURPOSE: The purpose of this study was to describe changes and stabilities of long-term sequelae of facial paresis in outpatients receiving mime therapy, a form of physiotherapy. MATERIAL AND METHODS: Archived data of 155 patients with peripheral facial nerve paresis were analyzed. Main outcome measures were (1) impairments: facial symmetry in rest and during movements and synkineses; (2) disabilities: eating, drinking, and speaking; and (3) quality of life. RESULTS: Symmetry at rest improved significantly; the average severity of the asymmetry in all movements decreased. The number of synkineses increased for 3 out of 8 movements; however, the group average severities decreased for 6 movements; substantially fewer patients reported disabilities in eating, drinking, and speaking; and quality of life improved significantly. CONCLUSION: During a period of approximately 3 months, significant changes in many aspects of facial functioning were observed, the relative position of patients remaining stable over time. Observed changes occurred while the patients participated in a program for facial rehabilitation (mime therapy), replicating the randomized controlled trial-proven benefits of mime therapy in a more varied sample of outpatients.