Treatment of Peripheral Facial Paralysis After COVID-19 Infection With Traditional Chinese Medicine Therapies: A Case Report.

Peripheral facial paralysis, characterized by facial expression and motor dysfunction of facial muscle groups, stems from lower motor neuron lesions of the facial nerve and can arise from various medical conditions such as viral infections, trauma, tumors, and autoimmune disorders, among others. It affects individuals across all age groups, from pediatric to geriatric populations. While many cases have no discernible cause, some are associated with infectious or non-infectious factors. Typically, most patients experience gradual recovery within one to three months following appropriate treatment in the acute phase, which may include inflammation control, antiviral therapy, reduction of neuroedema, and nerve nourishment. Although relatively rare, there have been few reports of peripheral facial paralysis following COVID-19 infection. Here, we present a case possibly linked to COVID-19: a 23-year-old male who reported numbness, facial asymmetry, and ear pain on the right side of his face persisting for five days after contracting COVID-19. Upon physical examination, peripheral facial paralysis of House-Brackmann grade IV was observed, prompting the initiation of traditional Chinese medicine (TCM) treatment. On the 10th day of treatment, acupoint catgut embedding was introduced as an adjunct therapy. Following four weeks of combined treatment, the patient's peripheral facial paralysis improved to grade I, and treatment was subsequently discontinued. TCM therapies, including acupuncture, electroacupuncture, plum blossom needle, moxibustion, acupoint catgut embedding, Chinese herbal medicine, etc., are safe and promising complementary treatments for the acute management of peripheral facial paralysis. However, additional large-scale, randomized controlled studies are needed to determine whether these interventions have a significant additive or synergistic effect on achieving full recovery in patients with peripheral facial paralysis.

Acupuncture and Traditional Chinese Medicine in the Treatment of Peripheral Facial Palsy Caused by Wisdom Tooth Extraction: A Case Report.

BACKGROUND: Peripheral facial palsy is characterized by acute peripheral facial nerve paralysis. While most cases have no identifiable cause, some are linked to infectious or noninfectious factors. The potential connection between herpes simplex virus-1 and peripheral facial palsy has been studied since the 1970s, with a small number of cases reported following tooth extraction. Patients who have treatment delayed for over a year and still exhibit no signs of recovery have a bleak prognosis. In this case, factors contributing to facial paralysis in this patient are facial nerve injury as a result of wisdom teeth extraction, improper nursing, and delayed treatment. CASE PRESENTATION: A 23-year-old female presented with numbness and stiffness on the right side of the outer skin around the lips. These symptoms persisted for about 4 years after the extraction of the right lower wisdom tooth. Physical examination revealed House-Brackmann grade II peripheral facial paralysis. Acupuncture and traditional Chinese medicine treatments were initiated with an aim to facilitate nerve repair and neurofacilitation in the affected area. Following a 4-week course of treatment, the patient experienced a decrease in numbness and stiffness in the area, and treatment was discontinued. CONCLUSION: The combination of acupuncture and traditional Chinese medicine is a safe and promising supplementary therapy for peripheral facial palsy caused by wisdom tooth extraction. Nevertheless, it is imperative to conduct larger scale and randomized controlled studies to determine whether these complementary interventions have a significant additive or synergistic effect toward achieving complete recovery in the patients.Die periphere Fazialisparese ist durch eine akute periphere Gesichtsnervenlähmung gekennzeichnet. Meist ist keine erkennbare Ursache feststellbar, doch besteht bei einigen Fällen ein Zusammenhang mit infektiösen oder nicht-infektiösen Faktoren. Ein möglicher Zusammenhang zwischen dem Herpes-simplex-Virus-1 (HSV-1) und der peripheren Fazialisparese wird seit den 1970er Jahren untersucht, und es wurde über eine kleine Zahl von Fällen nach einer Zahnextraktion berichtet. Patienten, bei denen die Behandlung erst nach einjähriger Verzögerung oder noch später beginnt und die keine Anzeichen für eine Besserung zeigen, haben eine ungünstige Prognose. In diesem Fall sind die Faktoren, die zur Gesichtslähmung des Patienten beitragen, eine Verletzung des Nervus facialis infolge der Weisheitszahnextraktion, unsachgemäße Pflege und ein verzögerter Behandlungsbeginn.Eine 23-jährige Frau stellte sich mit Taubheitsgefühl und Steifigkeit auf der rechten Seite im Bereich der äußeren Haut um die Lippen herum vor. Die Symptome bestanden seit der Extraktion des rechten unteren Weisheitszahns etwa 4 Jahre zuvor. Die körperliche Untersuchung ergab eine periphere Fazialisparese Grad II nach House-Brackmann. Es wurde eine Behandlung mit Akupunktur und traditioneller chinesischer Medizin begonnen, um die Nervenreparatur und die Neurofazilitation im betroffenen Bereich zu fördern. Nach vierwöchiger Behandlung kam es bei der Patientin zu einer Abnahme des Taubheitsgefühls und der Steifigkeit im betroffenen Bereich und die Behandlung wurde beendet.Die Kombination von Akupunktur und traditioneller chinesischer Medizin ist eine sichere und erfolgversprechende ergänzende Therapie für die periphere Fazialisparese nach Weisheitszahnextraktion. Allerdings müssen unbedingt größere und randomisierte kontrollierte Studien durchgeführt werden, um festzustellen, ob diese komplementärmedizinischen Methoden in Hinblick auf das Ziel einer vollständiger Genesung der Patienten einen signifikanten additiven oder synergistischen Effekt haben.

Cerebral abnormalities in HIV-infected individuals with neurocognitive impairment revealed by fMRI.

Although the combination antiretroviral treatment (cART) has considerably lowered the risk of HIV associated dementia (HAD), the incidence of neurocognitive impairments (NCI) has not decreased likely due to the insidious and slow progressive nature of HIV infection. Recent studies showed that the resting-state functional magnetic resonance imaging (rs-fMRI) is a prominent technique in helping the non-invasive analysis of neucognitive impairment. Our study is to explore the neuroimaging characteristics among people living with HIV (PLWH) with or without NCI in terms of cerebral regional and neural network by rs-fMRI, based on the hypothesis that HIV patients with and without NCI have independent brain imaging characteristics. 33 PLWH with NCI and 33 PLWH without NCI, recruited from the Cohort of HIV-infected associated Chronic Diseases and Health Outcomes, Shanghai, China (CHCDO) which was established in 2018, were categorized into the HIV-NCI and HIV-control groups, respectively, based on Mini-Mental State Examination (MMSE) results. The two groups were matched in terms of sex, education and age. Resting-state fMRI data were collected from all participants to analyze the fraction amplitude of low-frequency fluctuation (fALFF) and functional connectivity (FC) to assess regional and neural network alterations in the brain. Correlations between fALFF/FC values in specific brain regions and clinical characteristics were also examined. The results showed increased fALFF values in the bilateral calcarine gyrus, bilateral superior occipital gyrus, left middle occipital gyrus, and left cuneus in the HIV-NCI group compared to the HIV-control group. Additionally, increased FC values were observed between the right superior occipital gyrus and right olfactory cortex, bilateral gyrus rectus, and right orbital part of the middle frontal gyrus in the HIV-NCI group. Conversely, decreased FC values were found between the left hippocampus and bilateral medial prefrontal gyrus, as well as bilateral superior frontal gyrus. The study concluded that abnormal spontaneous activity in PLWH with NCI primarily occurred in the occipital cortex, while defects in brain networks were mostly associated with the prefrontal cortex. The observed changes in fALFF and FC in specific brain regions provide visual evidence to enhance our understanding of the central mechanisms underlying the development of cognitive impairment in HIV patients.

Exploration of the effects of Yang's pricking-cupping therapy on eczema-induced pruritus based on rs-fMRI. / 基于rs-fMRI探讨杨氏絮刺火罐对湿疹瘙痒的影响.

OBJECTIVES: To explore the clinical effect of Yang's pricking-cupping therapy and its central mechanism in treatment of eczema-induced pruritus using resting-state functional magnetic resonance imaging (rs-fMRI). METHODS: Fifty patients with eczema-induced pruritus were enrolled in the observation group, and 50 healthy subjects were enrolled in the control group. No any intervention was delivered in the control group. Yang's pricking-cupping therapy was operated at Dazhui (GV 14) and bilateral Quchi (LI 11), Xuehai (SP 10) and Sanyinjiao (SP 6), once a week, lasting 6 weeks in the observation group. The scores of the 12-item pruritus severity scale (12-PSS), the eczema area and severity index (EASI), the dermatology life quality index (DLQI), the Pittsburgh sleep quality index (PSQI), and the self-rating anxiety scale (SAS) were compared before and after treatment in the observation group. The rs-fMRI scanning was conducted and the regional homogeneity (ReHo) analysis performed in all of the participants before and after treatment in the observation group, as well as at the time of subject enrollment in the control group. The correlation was analyzed between ReHo values in the different areas of the brain and the scores of the above scales. RESULTS: Compared with those before treatment, the scores of 12-PSS, EASI, DLQI, PSQI, and SAS were reduced after treatment in the observation group (P<0.01, P<0.05). ReHo values were increased in the right caudate nucleus, the right middle temporal gyrus, the right orbitofrontal gyrus, the right thalamus and the left angular gyrus before treatment in the observation group when compared with those in the control group (P<0.001); and ReHo values in the above areas of the brain were decreased after treatment when compared with those before treatment in the observation group (P<0.001). In comparison with the control group, ReHo values were reduced in the left middle temporal gyrus, the left superior parietal lobule and the left supplementary motor area in the observation group before treatment (P<0.001); while when compared with those before treatment, ReHo values in the above areas of the brain were elevated after treatment in the observation group (P<0.001). Before treatment, ReHo value in the left supplementary motor area was positively correlated with 12-PSS score (r=0.432, P=0.004), and the value in the right orbitofrontal gyrus was negatively correlated with PSQI score (r=-0.318, P=0.04) in the observation group. After treatment, ReHo value in the left superior parietal lobule was positively correlated with 12-PSS score (r=0.384, P=0.012) in the observation group. CONCLUSIONS: The abnormal cerebral functional activities are exhibited in multiple areas of the brain involved in stimulus response, emotional regulation, behavior control and attention in the patients with eczema-induced pruritus. Yang's pricking-cupping therapy can effectively relieve the pruritus symptoms and skin lesions of the patients, which may be related to reversing the abnormal cerebral functional activities induced by pruritus.