Primary unclassified sarcoma of the parotid gland: a case of diagnostic and therapeutic challenge.

Malignant salivary gland sarcomas represent a clinically and histologically diagnostic challenge. Primary unclassified sarcomas of the parotid gland consist a rare salivary gland tumor. We report an unusual case of such a tumor, which occurred in the right parotid gland of a 54-year-old male and presented as an asymptomatic painless mass. The pathologoanatomical examination revealed a rhabdoid large-cell unclassified sarcoma. The patient was treated with superficial parotidectomy and adjuvant radiotherapy. No recurrence was noted in a 10-year follow-up period. Due to the rare occurrence of primary unclassified sarcomas, there is no evidence-based treatment of choice. An optimal approach is best planned in a multidisciplinary setting, taking into consideration the resectability of the tumor, individual patient characteristics, presence of local or distant metastatic activity, local infiltrative behavior and tumor stage. A close follow-up of the patient is strongly recommended.

Efficacy of Probiotics in Prevention of Migraine Attacks in Children: A Randomized Clinical Trial Study.

Objectives: Migraine is a chronic and joint disease in children. The results of previous studies on the effectiveness of probiotics in preventing migraine attacks in children have been controversial. This study aims to investigate the effect of probiotics on migraine prophylaxis in children. Materials & Methods: In this clinical trial study, 41 children aged 5 to 15 with migraine enrolled the study in two control and intervention groups. Children in the intervention group (18 children) received propranolol at a dose of 1 mg per kilogram of body weight daily in two divided doses along with a 250 mg Yomogi capsule daily for three months, and children in the control group (23 children), received propranolol along with placebo for three months. The study compared the frequency and duration of headache days, PedMIDAS criteria, and parental satisfaction between the two groups before treatment, as well as one month and three months post-treatment. Results: The number of headache days in both groups decreased over time, but in the intervention group, this decrease was more than the control group was statistically significant (P=0.045). The average PedMIDAS scale after treatment in the intervention group was 3.9 ± 3.8; in the control group, it was 8.4 ± 8.2, which was statistically significant (P=0.047). Parents' satisfaction with the treatment was statistically significantly higher in the intervention group (94.4%) than in the control group (54.5%) (P=0.011). No significant drug complications were seen in any of the two groups. Conclusion: In children with migraine, adding probiotics to migraine treatment reduces the intensity and number of days of children's headaches and increases the Parents' satisfaction with the treatment.

Comparing Prophylactic Effect of Levetiracetam, Sodium Valproate, and Propranolol in Pediatric Migraine: A Randomized Clinical Trial.

Objectives: Epidemiologic studies point to an increased prevalence of migraine in children in recent decades. Migraine treatment involves acute and prophylactic therapy. Recently, such anti-epileptic drugs as Levetiracetam have been used to treat adult migraines. The present study aimed to compare the efficacy of Levetiracetam, Sodium Valproate, and Propranolol in preventing migraine headaches in children. Materials & Methods: In this clinical trial, children with migraine were randomly divided into three groups. Each group consisted of 13 children. Two groups were treated with Propranolol and Sodium Valproate, respectively. Another group (the case) was treated with Levetiracetam. The patients were assessed based on headache score, PedMIDAS, and headache frequency before and three months after the intervention. Finally, the data was analyzed using descriptive and analytical statistical methods. Results: Levetiracetam significantly reduced the headache severity (P=0.026), frequency (P=0.024), and PedMIDAS score (P=0.001) in children with migraine. However, no significant difference was found between the three groups. The percentage of patients who experienced pain relief was detected as 69.24%, 92.31%, and 30.76% in the Propranolol, Sodium Valproate, and Levetiracetam groups, respectively. Conclusion: This study concluded that Levetiracetam can be used as a migraine prophylaxis drug in children.

The First Report of Iranian Registry of Patients with Spinal Muscular Atrophy.

BACKGROUND: Insufficient amounts of survival motor neuron protein is leading to one of the most disabling neuromuscular diseases, spinal muscular atrophy (SMA). Before the current study, the detailed characteristics of Iranian patients with SMA had not been determined. OBJECTIVE: To describe the key demographic, clinical, and genetic characteristics of patients with SMA registered in the Iranian Registry of SMA (IRSMA). METHODS: IRSMA has been established since 2018, and the demographic, clinical, and genetic characteristics of patients with SMA were recorded according to the methods of treat neuromuscular disease (TREAT-NMD) project. RESULTS: By October 1, 2022, 781 patients with 5q SMA were registered. Of them, 164 patients died, the majority of them had SMA type 1 and died during the first 20 months of life. The median survival of patients with type 1 SMA was 23 months. The consanguinity rate in 617 alive patients was 52.4%, while merely 24.8% of them had a positive family history. The most common type of SMA in live patients was type 3. Morbidities were defined as having scoliosis (44.1%), wheelchair dependency (36.8%), tube feeding (8.1%), and requiring mechanical ventilation (9.9%). Most of the registered patients had a homozygous deletion of SMN1, while the frequency of patients with higher copy numbers of SMN2, was less in more severe types of the disease. Earlier onset of the disease was significantly seen in patients with lower copy numbers of SMN2. The neuronal apoptosis inhibitory protein (NAIP) gene deletion was associated with a higher incidence of more severe types of SMA, higher dependency on ventilators, tube feeding, and earlier onset of the disease. CONCLUSIONS: The IRSMA is the first established Iranian nationwide registry of patients with SMA. Using this registry, decision-makers, researchers, and practitioners can precisely understand the epidemiology, characteristics, and genetics of patients with SMA in Iran.

Administration in Efficacy of Melatonin Reducing Headaches in Children With Migraines and Sleep Disorders: A Randomized Clinical Trial Study.

Objectives: Migraine headache after tension headache is the most common primary headache in children, and sleep disorders can aggravate the symptoms. Melatonin has been proposed in some studies for prophylaxis of migraine headaches. This study aimed to evaluate melatonin's effect on migraine symptoms in children with migraine headaches and sleep disorders. Materials & Methods: In this randomized clinical trial study, all 30 children aged 5 to 15 years with migraine headaches and sleep disorders were referred to the Pediatric Neurology Clinic and enrolled. Patients were randomly divided into two equal groups; the intervention group was treated with melatonin (3 mg daily) and propranolol (1 mg/kg daily), and the control group was treated with propranolol alone (1 mg/kg daily). The severity of the migraine headaches was assessed with PEDMIDAS and a five-point Likert scale. The children's sleep habits questionnaire (CSHQ) assessed children's sleep disorders. The ANOVA and linear regression methods were used to analyze and compare the findings between the groups. Results: Out of 30 children participating in the study, 9 were girls, and 21 were boys. The number of daily headaches one month (P = 0.02) and four months (P = 0.03) after treatment was significantly lower in the melatonin group compared to the control group. Regarding sleep quality, there was no significant difference between the two groups. Conclusion: Melatonin and propranolol could better alleviate migraine headaches than propranolol alone in children.

Effectiveness of prophylaxis treatment in the acute febrile stage of febrile seizure in children under five years old.

OBJECTIVES: In children suffering from febrile seizure, the likelihood of recurrence seems to be high in the early hours following the first episodes in the absence of proper interventions. The present study was aimed at assessing and comparing the outcomes of different preventive interventions in the acute stage after febrile seizure in children. MATERIALS & METHODS: This randomized clinical trial study was performed between September 2015 and September 2016. We enrolled patients aged between 6 and 60 months suffered from febrile seizure and referred to the Pediatric Emergency Department at Besat Hospital in Hamadan. The eligible patients were randomly assigned to the following four receive one of the following groups: group 1 (not receiving any anti-seizure drugs), group 2 (receiving a single dose of phenobarbital) on admission, group 3 (receiving a single dose of phenobarbital on admission continued until the fever is resolved), and group 4 (receiving diazepam until the disappearance of fever). RESULTS: The study population consisted of 248 children. The recurrence rate of seizure in the acute stage was 4.84%. Also, the impact of diazepam and phenobarbital (either as a single dose or as continuous) on the prevention of febrile seizure recurrence in the acute stage has been established. None of the patients had febrile status epilepticus. CONCLUSION: Controlling seizures without prescribing anti-seizure drugs increases the risk for the recurrence of febrile seizure in the acute stage. Different drug regimens for controlling seizure, including diazepam and phenobarbital (as stat or maintenance), may play a similar role in preventing the occurrence of febrile seizure.

Evaluation of the Levetiracetam treatment on reduction of epileptic discharges in electroencephalogram in children with epilepsy.

OBJECTIVES: Epilepsy is a relatively common disease in childhood. In some patients, the electroencephalogram (EEG) is abnormal despite the clinical control of seizures. Studies have identified the adverse effects of epileptic discharges on cognition, learning, behavior, and seizure recurrence in children. This study investigated the Levetiracetam effect on epileptic discharges in the interictal phase of EEG in epileptic children. MATERIALS & METHODS: This clinical trial was conducted on 54 epileptic children aged 2 to 15 years, whose clinical seizures were controlled by sodium valproate in the last six months but still had epileptic discharges in EEG. The participants were divided into two groups: an intervention group (21 people), for which Levetiracetam was added to sodium valproate, and a control group (33 people), for which treatment with sodium valproate alone was continued. The patients were then followed for one year. RESULTS: The percent normalization of epileptic discharges in the intervention and control groups was 66.7% and 57.1% (P = 0.500), respectively. Also, the mean time for the normalization of epileptic discharges in the intervention and control groups was 12.60±8.25 and 20.57±12.67 months (P = 0.042), respectively. CONCLUSION: In children with controlled seizures whose EEG was still abnormal, sodium valproate therapy alone and combined with Levetiracetam effectively reduced the severity of epileptic discharges. However, the addition of Levetiracetam to sodium valproate normalized EEG more rapidly.

Comparison of the Effect of High and Low Doses of Adrenocorticotropic Hormone (ACTH) in the Management of Infantile Spasms.

OBJECTIVES: Infantile spasms can have irrecoverable adverse effects on a child's brain. Adrenocorticotropic hormone (ACTH) is the most common first-line medication for the treatment of infantile spasms. However, the suitable dose and duration of treatment continue to be debated among specialists. Since high doses of ACTH, which are commonly used, can produce more side effects, lower doses are preferred. The aim of this study was to determine the effect and extent of complications caused by high and low doses of ACTH in children with infantile spasms. MATERIALS & METHODS: This clinical trial was performed on 32 infants with infantile spasms, aged 1.5-18 months. The subjects were divided into high- and low-dose ACTH groups. Treatment continued for two months. The therapeutic effects and complications were then compared over 18 months. RESULTS: The results indicated no significant difference between the groups in terms of the short-term prognosis of convulsions, final prognosis of patients with spasm relapse, EEG changes after treatment, and post-treatment development of hypertension. On the other hand, there was a significant difference in the frequency distribution of restlessness intensity and becoming Cushingoid, which were more frequent in the high-dose group. CONCLUSION: The results indicated that high- and low-dose ACTH are equally effective in controlling spasms, yet the low dose causes fewer side effects.

The Relationship Between Severity of Epilepsy and Sleep Disorder in Epileptic Children.

OBJECTIVE: Sleep disturbances are one of the most common behavioral problems in childhood. Sleep problems have an even greater prevalence in children with epilepsy and are one of the most common comorbid conditions in childhood epilepsy. MATERIALS & METHODS: This descriptive-correlation study with the general goal of determining the effects of epilepsy on sleep habits of epileptic children was conducted in Hamadan, western Iran, in 2014. Sampling was done using convenience sampling techniques. Data were collected using the Early Childhood Epilepsy Severity Scale (E-Chess) and Children's Sleep Habits Questionnaire (CSHQ) and analyzed using SPSS and descriptive and inferential statistics. RESULTS: The mean score of sleep habits was 55/08±6/71. Bedtime resistance (12/14±2/93), parasomnias (11/02±1/84) and sleep anxiety (8/29±2/46) were the most frequent sleep disorders in the studied sample. Based on Pearson's r, there were significant positive bidirectional relationships between bedtime resistance (rs =0.129, P<0.019), parasomnias (rs =0.298, P<0.005), sleep-disordered breathing (rs =0.295, P<0.005), CSHQ total score (rs =0.144, P<0.022) on the one hand, and children's epilepsy severity on the other. CONCLUSION: Sleep problems should not be overlooked, and a comprehensive review of the sleep habits of this group of patients should be conducted.

Thymic alterations in mice deficient for the SNARE protein VAMP8/endobrevin.

SNARE (soluble-N-ethylmaleimide-sensitive factor attachment receptor) proteins mediate the recognition and fusion of transport vesicles in eukaryotic cells. The SNARE protein VAMP8 (also called endobrevin) is involved in the fusion of late endosomes and in some pathways of regulated exocytosis. In a subset of mice deficient for the SNARE protein VAMP8, a severe alteration of the thymus and in T lymphocyte development was observed and characterized. The size of the thymus and the number of thymocytes were dramatically reduced compared with those in heterozygous littermates. Further, the compartmentalization into cortex and medulla and the organization of the thymus epithelium were disturbed. The numbers of all thymocyte subpopulations were reduced, with the CD4 and CD8 double-positive thymocytes being most severely affected. The proportion of proliferating thymocytes was reduced, and the staining of apoptotic cells in situ and ex vivo indicated an increased number of apoptotic cells. Isolated thymocytes of Vamp8 (-/-) mice were more susceptible to various apoptotic stimuli including glucocorticoids, FAS receptor, and CD3/CD28-mediated signaling in vitro, even before an increased number of apoptotic cells was detectable in situ. However, bone marrow of phenotypically affected Vamp8 (-/-) mice was readily able to repopulate immunodeficient hosts suggesting that the SNARE protein VAMP8 has a specific function in the thymic stroma affecting the proliferation and apoptosis of T lymphocytes during maturation in the thymus.

Immunohistochemical staining of plastic (methyl-methacrylate)-embedded bone marrow biopsies applying the biotin-free tyramide signal amplification system.

Immunohistochemistry of trephine bone marrow biopsies plays a prominent role in diagnostic assessment of a broad spectrum of non-neoplastic and neoplastic hematologic and metastatic diseases. We tested the quality of immunohistochemical stainings in sections of methyl-methacrylate-embedded core biopsies prepared according to the so-called Hannover-method of cold polymerization using the novel biotin-free tyramide signal amplification system in comparison to the alkaline phosphatase-conjugated "EnVision" method. Examining a large panel of immunohistochemical markers, the amplification system proved to be a highly sensitive technique substantially superior to the EnVision-AP method in reliably detecting the antigenic determinants of the target cells and referred to the intensity of immunoprecipitations.

Comparison of Effectiveness of Topiramate and Diazepam in Preventing Risk of Recurrent Febrile Seizure in Children under Age of 2 Years.

OBJECTIVE: Febrile seizures are the most common type of convulsions. Medicinal prophylaxis is sometimes used for children at high risk of recurrent febrile seizure. In certain circumstances, conventional drugs such as diazepam and phenobarbital cannot be used and the need for alternative medicines is felt. This study compared the effectiveness of topiramate and diazepam in preventing the risk of recurrent febrile seizure in children under 2 yr old. MATERIALS AND METHODS: This randomized controlled trial, in Besat Hospital in Hamedan, Iran from 22 Nov 2013 to 22 Nov 2015 (Registered code: IRCT Number: IRCT2015010120527N1), included 54 patients, at risk of recurrent febrile seizure, inhibited from taking phenobarbital. Samples were randomly divided into two groups. The first group received diazepam treatment during fever episodes and the second group received daily dose of topiramate. A one-year follow-up of recurrent febrile seizure and its complications was also conducted. RESULTS: Thirty-four patients (17 patients in each group) completed the one-year course of the trial. Recurrent febrile seizure was not observed in the course of preventive treatment. The prevalence of minor complications was 29.4% in the diazepam group and 48.5% in the topiramate group. No major complication was observed in among the subjects. CONCLUSION: Topiramate can be recommended for preventing recurrent febrile seizure when the use of frontline medicines is not possible.

Comparison of the Quality of Sleep and Intensity of Headache between Migraine, Tension Headache, and Healthy Children.

OBJECTIVES: Headache and sleep problems are commonly reported in children, and both can adversely impact the child's life. We aimed to compare the sleep quality and intensity of headache between school-age children with migraine as well as tension headache and healthy children. MATERIALS & METHODS: In this cross-sectional study, 198 children 6-12 yr old in three groups were enrolled from Aug 2015 to Mar 2016. Migraine and tension headache groups from the Outpatient Clinic of Imam Khomeini of Hamadan, western Iran and healthy group from elementary schools were randomly selected (66 children in each group). Data were collected using demographic questionnaire, Child Sleep Habits Questionnaire (CSHQ), Numeric Scale of Pain Intensity and Wong-Baker Faces Pain Rating Scale. The data were analyzed using SPSS by descriptive statistic and multivariate ANOVA, one way ANOVA, Chi-square, Kruskal-Wallis and linear regression tests. RESULTS: Approximately, 45.5% of children with migraine and 37.9% of them with tension headache had experienced severe headache. Only a significant relationship was seen between mean scores of headache intensity and sleep quality in migraine group (P<0.05). There was a significant difference in mean scores of sleep quality among three groups (P<0.001). CONCLUSION: The children with migraine experienced more unsuitable sleep in duration of severe headache. Highlighting the co-morbidity between intensity of headache and sleep problem of children with migraine and tension headache is important to improve treatment strategies and to know the impact of headache on their normal life.

Comparison of the Effect of Phenobarbital versus Sodium Valproate in Management of Children with Status Epilepticus.

OBJECTIVES: Acute prolonged seizure is the most common neurological emergency in children. This research was conducted to compare the effect of intravenous phenobarbital and Sodium valproate in control of seizure in children with status epilepticus, referred to emergency ward from Mar to Nov 2013. MATERIALS & METHODS: In this randomized clinical trial, registered with the code number IRCT2015051722300N1, 80 children aged 6 months to 10 years with prolonged seizure and with no response to one dose of diazepam (0.2 mg/kg) administered through IV injection during the five min were selected. Children were randomly divided into two groups, intervention, and control through permutation blocks. In intervention group, intravenous Sodium valproate (20 mg/kg) and in control group, intravenous phenobarbital (20 mg/kg) were prescribed. Data such as age, gender, history of previous seizure, seizure type, and recovery time after receiving drug was recorded in the form. Data analysis was done through descriptive statistics, Chi-square and Independent t- test. RESULTS: Two groups were the same in terms of age and gender and had no statistically significant difference, but they were different in terms of seizure type. In valproate group, 18 patients (45%) and in phenobarbital group, 32 patients (80%) had positive response to the treatment and the chi-square test showed the significant difference. CONCLUSION: With regards to this point that in phenobarbital group, patients had more rapid response to drug in comparison with patients in Sodium valproate group, phenobarbital is a suitable and effective drug for controlling of seizure in children.

Chronic Myelogenous Leukemia Presenting with Facial Nerve Palsy in an Infant.

When a child presents with cranial nerve palsy and a bulging fontanel, a pediatric neurologist is often consulted to determine the cause of increased intracranial pressure. This report describes an infant with chronic myelogenous leukemia (CML) referred to Ali-bin-Abitaleb Hospital, Zahedan, eastern Iran in 2013 who presented with seventh cranial nerve palsy and bulging fontanel. Chromosomal analysis and peripheral blood smear confirmed the diagnosis of CML.

Deletion of the SNARE vti1b in mice results in the loss of a single SNARE partner, syntaxin 8.

SNARE proteins participate in recognition and fusion of membranes. A SNARE complex consisting of vti1b, syntaxin 8, syntaxin 7, and endobrevin/VAMP-8 which is required for fusion of late endosomes in vitro has been identified recently. Here, we generated mice deficient in vti1b to study the function of this protein in vivo. vti1b-deficient mice had reduced amounts of syntaxin 8 due to degradation of the syntaxin 8 protein, while the amounts of syntaxin 7 and endobrevin did not change. These data indicate that vti1b is specifically required for the stability of a single SNARE partner. vti1b-deficient mice were viable and fertile. Most vti1b-deficient mice were indistinguishable from wild-type mice and did not display defects in transport to the lysosome. However, 20% of the vti1b-deficient mice were smaller. Lysosomal degradation of an endocytosed protein was slightly delayed in hepatocytes derived from these mice. Multivesicular bodies and autophagic vacuoles accumulated in hepatocytes of some smaller vti1b-deficient mice. This suggests that other SNAREs can compensate for the reduction in syntaxin 8 and for the loss of vti1b in most mice even though vti1b shows only 30% amino acid identity with its closest relative.

Sialoblastoma of the parotid gland in a 13-year-old girl with multiple recurrences and long-term follow-up.

BACKGROUND: Sialoblastoma is an extremely rare congenital salivary gland tumor of epithelial origin. It is usually localized in the parotid or submandibular gland and presents primarily at birth or in early childhood. METHODS: We report a case of a 13-year-old girl with a sialoblastoma of the parotid gland presenting as an asymptomatic painless mass. RESULTS: The patient showed multiple recurrences and, based on the histopathological finding of facial nerve infiltration, was treated surgically with total parotidectomy and facial nerve reconstruction. CONCLUSION: Because of the rare occurrence of sialoblastoma, there is no evidence-based treatment of choice. The treatment should be individualized, taking into consideration the patient's age, the high locoregional recurrence rate, the local aggressive characteristics, and the potential metastatic activity of this rare tumor. A close follow-up of the patient is strongly recommended.

Omega 3 in Childhood Migraines: a Double Blind Randomized Clinical Trial.

OBJECTIVE: The effect of using omega-3 to prevent migraine attacks has been raised in recent studies. The majority of these studies have been conducted in adults. Conversely, other studies have yet to confirm the effect of omega-3. The main purpose of this study was to assess the effects of omega-3 in the prevention of migraine attacks in children. MATERIALS & METHODS: In this study, children aged 5-15 years with a diagnosis of migraine were randomly assigned to case and control groups. The case group was treated with sodium valproate and 1 g of omega-3; the control group was treated with sodium valproate and a placebo for 2 months. The severity of attacks was evaluated before and after the treatment using PedMIDAS and parental satisfaction (CGI) using a 7-point Likert scale. RESULTS: In this study, 12 cases and 13 controls were enrolled. The average number of headache attacks per month decreased significantly in both groups after starting the treatment but there was no significant difference between the two groups. The severity of attacks decreased significantly in both groups after starting the treatment but it was not significant between them. Examination of the CGI average showed the average was 6.08 (SD = 0.52) in the case group and 6.07 (SD = 0.65) in the control group. CONCLUSION: The present study indicated that omega-3 with a dose of 1 mg per day has no effect in reducing the severity and frequency of migraine attacks in children. Sodium valproate was effective in reducing the frequency and severity of attacks.

Metal-on-metal bearings and hypersensitivity in patients with artificial hip joints. A clinical and histomorphological study.

BACKGROUND: Some patients who have a total hip replacement with a second-generation metal-on-metal articulation have persistent or early recurrence of preoperative symptoms. Characteristic histological changes in the periprosthetic tissues suggested the development of an immunological response. Therefore, in order to determine the relevance of these symptoms, we performed a study of the clinical data and periprosthetic tissues associated with endoprostheses with a metal-on metal articulation that had been retrieved at revision. METHODS: Periprosthetic tissues as well as the clinical data on the patients were obtained from the first nineteen consecutive revisions performed at the treating hospitals. At the time of the revision, fourteen patients had the metal-on-metal articulation exchanged for either an alumina-ceramic or a metal-on-polyethylene articulation. Five patients received another second-generation metal-on-metal total joint replacement. Five-micrometer sections were prepared from the tissue samples, were stained with routine and immunohistochemical methods, and were examined histologically. Histological specimens from three groups of patients, two of which were treated with non-metal-on-metal implants, served as controls. RESULTS: The majority of patients had persistence of their preoperative pain or early recurrence of the pain after the original total hip replacement, and often a pronounced hip joint effusion had developed after the original replacement. Radiographic follow-up showed the development of radiolucent lines in five hips and of osteolysis in another seven hips. At the revision surgery, both the cup and the stem were found to be well fixed in nine patients. The characteristic histological features were diffuse and perivascular infiltrates of T and B lymphocytes and plasma cells, high endothelial venules, massive fibrin exudation, accumulation of macrophages with droplike inclusions, and infiltrates of eosinophilic granulocytes and necrosis. Only a few metal particles were detected. Immunohistochemical analysis demonstrated that the cellular reaction was still active. The patients who received another second-generation metal-on-metal articulation at the time of the revision had no decrease in symptoms. In the control group of tissues obtained at revisions of endoprostheses without cobalt, chromium, or nickel articulations, there were no similar signs of immune reactions. CONCLUSIONS: These histological findings support the possibility of a lymphocyte-dominated immunological response. Although the prevalence of this reaction is low, the persistence or early reappearance of symptoms, including a marked joint effusion and the development of osteolysis, after primary implantation may suggest the possibility of such a reaction.

Comparison of the Efficacy of Combination Therapy of Prednisolone - Acyclovir with Prednisolone Alone in Bell's Palsy.

OBJECTIVE: Bell's palsy is a rapid onset, usually, unilateral paralysis of the facial nerve that causes significant changes in an individual's life such as a decline in personal, social, and educational performance. This study compared efficacy of combined prednisolone and acyclovir therapy with prednisolone alone. MATERIALS & METHODS: This study is a randomized controlled trial conducted on 43 Children (2-18 years old) with Bell's palsy. The first group of 23 patients was treated with prednisolone and the remaining patients were treated with a combination of prednisolone and acyclovir. The required data were extracted, using an informational form based on the House-Brackmann Scale, which grades facial nerve paralysis. The data were analyzed with Mann-Whitney test using SPSS version 16. RESULTS: The mean age of the first and second group were 8.65 ± 5.07 and 8.35 ± 4.92 years, respectively, (p=0.84). Sixty one percent and 39% of patients in the first group, and 45% and 55% of patients in the second group were male and female, respectively. No significant differences exist between the groups in terms of age and gender. The rate of complete recovery was 65.2% in group I and 90% in the group II (p=0.04). CONCLUSION: The results of this study showed that the combined prednisolone and acyclovir therapy of patients with Bell's palsy is far more effective than treatment with prednisolone alone. Actually, age and gender had no impact on the rate of recovery.