Progress in treatment of facial neuritis by acupuncture combined with medicine from the perspective of modern medicine: A review.

Facial neuritis is a common clinical disease with high incidence, also known as Bell palsy or idiopathic facial nerve paralysis, which is an acute onset of peripheral facial neuropathy. In modern medicine, there have been obstacles to the effective treatment of facial neuritis. At present, the clinical use of Western medicine treatment is also a summary of clinical experience, the reason is that the cause of facial neuritis is unknown. Facial neuritis belongs to the category of "facial paralysis" in traditional Chinese medicine. For thousands of years, Chinese medicine has accumulated a lot of relevant treatment experience in the process of diagnosis and treatment. At the same time, traditional Chinese medicine, acupuncture and the combination of acupuncture and medicine play an important role in the treatment of facial neuritis. This article discusses the treatment of facial neuritis with acupuncture combined with Chinese medicine, based on the research progress of modern medicine. In this review, we provide an overview of the effectiveness of acupuncture and medication combinations and facial neuritis with current studies investigating acupuncture and medication combinations in the treatment of facial neuritis.

Deletion of CD38 and supplementation of NAD+ attenuate axon degeneration in a mouse facial nerve axotomy model.

Following facial nerve axotomy, nerve function is not fully restored even after reconstruction. This may be attributed to axon degeneration/neuronal death and sustained neuroinflammation. CD38 is an enzyme that catalyses the hydrolysis of nicotinamide adenine dinucleotide (NAD+) and is a candidate molecule for regulating neurodegeneration and neuroinflammation. In this study, we analyzed the effect of CD38 deletion and NAD+ supplementation on neuronal death and glial activation in the facial nucleus in the brain stem, and on axon degeneration and immune cell infiltration in the distal portion of the facial nerve after axotomy in mice. Compared with wild-type mice, CD38 knockout (KO) mice showed reduced microglial activation in the facial nucleus, whereas the levels of neuronal death were not significantly different. In contrast, the axon degeneration and demyelination were delayed, and macrophage accumulation was reduced in the facial nerve of CD38 KO mice after axotomy. Supplementation of NAD+ with nicotinamide riboside slowed the axon degeneration and demyelination, although it did not alter the level of macrophage infiltration after axotomy. These results suggest that CD38 deletion and supplementation of NAD+ may protect transected axon cell-autonomously after facial nerve axotomy.

[Clinical observation of interventional opportunity for acupuncture treatment of acute facial neuritis].

OBJECTIVE: To observe the effect of different acupuncture intervention time on the improvement of the symptoms of acute facial neuritis and the length of recovery time, and to find the best interventional opportunity for acute facial neuritis. METHODS: A total of 120 patients with acute facial neuritis (all unilateral onset) were randomly divided into 4 groups, namely group A, group B, group C and group D, 30 cases in each group. Acupuncture performed within 3 days after onset in the group A; oral mecobalamin dispersible tablets and multivitamin B tablets were received within 3 days after onset, and acupuncture was started from the 4th day in the group B; oral mecobalamin dispersible tablets and multivitamin B tablets were given within 5 days after onset, and acupuncture was administered from the 6th day in the group C; oral mecobalamin dispersible tablets and multivitamin B tablets were given within 7 days after onset, and acupuncture was applied from the 8th day in the group D. Penetration needling was the main acupuncture treatment, with infrared radiation on the cheeks, once a day, 6 days a week and 3 weeks were given. After treatment, the symptom scores (Portmann scores) of the 7th, 14th and 28th day after onset were compared. The time of improvement and the clinical effect of each group were compared. RESULTS: On the 7th, 14th and 28th day after onset, the Portmann scores of the 4 groups were higher than those before treatment (all P<0.05). On the 7th, 14th and 28th day after onset, the Portmann scores in the group A were higher than those in the other 3 groups (all P<0.05). There was significant difference between both pairs of group B, group C and group D (all P<0.05). The total effective rate in the group A was 96.7% (29/30), which was higher than 93.3% (28/30), 86.7% (26/30) and 83.3% (25/30) in the other 3 groups (all P<0.05). The difference between the 4 groups in the beginning of improvement, significant improvement time and clinical recovery time was statistically significant (all P<0.05), and the group A was optimal. CONCLUSION: Early intervention of acupuncture with acute facial neuritis can appropriately slow the progression of facial nerve injury, improve the therapeutic effect, and shorten the clinical recovery time.

Peripheral Nerve Field Stimulation (PNFS) as a Treatment Option for Intractable Radiation-Induced Facial Neuropathic Pain in a Survivor of Laryngeal Cancer: A Case Report.

BACKGROUND: Treatment-related chronic neuropathic pain represents a major and increasing cause of discomfort in cancer survivors. Unfortunately, in approximately 10%-15% of cases, pain is scarcely relieved by opioids and common painkillers. Thus, alternative measures to manage pain have recently been adopted in these patients. CASE DESCRIPTION: We report the case of a laryngeal cancer survivor who developed an intractable bilateral mandibular radiation-induced neuropathic pain syndrome. His pain was refractory to any pharmacological treatment, whereas the implant of bilateral subcutaneous facial electrodes led to the complete resolution of pain. CONCLUSIONS: To the best of our knowledge, this is the first report in literature describing peripheral nerve field stimulation as a treatment option for intractable cancer treatment-related chronic neuropathic pain. Peripheral nerve field stimulation appears to be a safe and effective procedure.

Facial nerve stimulation associated with cochlear implant use following temporal bone fractures.

OBJECTIVE: To describe the incidence and management of patients with facial nerve stimulation (FNS) associated with cochlear implant (CI) use in the setting of a prior temporal bone fracture. PATIENTS: One adult CI recipient is reported who experienced implant associated FNS with a history of a temporal bone fracture. Additionally, a literature search was performed to identify similar patients from previous descriptions of CI related FNS. MAIN OUTCOME MEASURES: Presence of FNS after implantation and ability to modify implant programming to avoid FNS. RESULTS: The patient in the present report experienced FNS for middle and basal electrodes during intraoperative neural response telemetry (NRT) in the absence of any surgical exposure or manipulation of the facial nerve. FNS was absent during device activation, but it recurred during follow-up programming sessions. However, additional programming has prevented further FNS during regular implant use. Four other patients with FNS after temporal bone fracture were identified from the literature, and the present case represents the one of two cases in which reprogramming allowed for implant use without FNS. CONCLUSIONS: CI associated FNS is uncommon in patients with a history of a temporal bone fracture, but it is likely that fracture lines provide a lower impedance pathway to the adjacent facial nerve and thus reduce the threshold for FNS. The present report suggests that, in the setting of a prior temporal bone fracture, NRT is not always a reliable predictor of FNS during implant use, and programming changes can help to mitigate FNS when it occurs.

[A further discussion on acupuncture treatment plan of facial neuritis in Evidence-based Guidelines of Clinical Practice in Acupuncture and Moxibustion].

The treatment plan of facial neuritis in Evidence-based Guidelines of Clinical Practice in Acupuncture and Moxibustion (2011 edition) is discussed, and case information of facial neuritis during the recent five years in department of acupuncture and moxibustion, PLA General Hospital, is retrospectively analyzed. In accordance with anatomy of the facial nerve to form the acupuncture prescription, the detailed diagnosis and treatment method for facial neuritis are introduced. The advantages of the diagnosis and treatment method for facial neuritis are summarized, hoping to establish a more comprehensive, standardized and unified treatment plan.

[Clinical research on facial neuritis treated with Chen's needling therapy].

OBJECTIVE: To evaluate the effect of Chen's needling therapy on facial neuritis. METHODS: Eighty-four patients of facial neuritis were randomized into a Chen's needling therapy group and a conventional needling group, 42 cases in each one. In the Chen's needling therapy group, the few acupoints were selected (5 acupoints). Chen's flying insertion of needle and the reinforcing and reducing techniques were applied. In the conventional needling group, the acupoint selection and needling method were used routinely. The treatment of 1 month was 1 session in the two groups. According to the symptom and physical sign quantification scale, the effect was assessed at multiple time points respectively (in 2 weeks of treatment, 1 session of treatment and 1 month after 1 session of treatment). Simultaneously, House-Brackmann scale and EMG were adopted to determine the function of facial nerve. RESULTS: After treatment, the results of symptoms and physical sign quantification scale and facial nerve EMG were different significantly as compared with those before treatment in the patients of the two groups (all P < 0.05). But the differences were not significant between the two groups (all P > 0.05). CONCLUSION: Chen's needling therapy achieves the same effect on facial neuritis as compared with the conventional acupuncture therapy, and additionally it is specialized at flying insertion of needle technique and selection of few acupoints.

Effectiveness of acupuncture in treatment of facial spasm: a meta-analysis.

CONTEXT: Facial spasm is one of the common facial diseases, especially in the aged. It is mostly characterized by initially progressive, involuntary, irregular, recurrent, clonic, or tonic movements of muscles innervated by the facial nerve on one side. Acupuncture is a low-risk treatment with purported claims of effectiveness for facial spasm. OBJECTIVE: To assess the efficacy of acupuncture in facial spasm comprehensively. DESIGN: The research team conducted a systematic review and meta-analysis of all randomized clinical trials (RCTs) that examined the effectiveness of acupuncture for facial spasm. OUTCOME MEASURE(S): The research team categorized results from each of the reviewed studies in two ways: (1) the number of participants who showed a positive response to therapy (total effectiveness rate) and (2) the number of participants who made a full recovery (clinical cure rate). RESULTS: The research team reviewed a total of 13 studies involving 1262 participants with facial spasm. Researchers in China had conducted all studies, and most studies were poor in methodological quality. All studies reported that acupuncture was superior to other treatments, including carbamazepine, mecobalamin, and massage, and the meta-analysis on these low-quality studies yielded similar results. CONCLUSION: Present trials evaluating the efficacy of acupuncture in treatment of facial spasm are mostly poor in methodological quality. These studies showed that acupuncture was superior to other treatments for facial spasm; however, in its meta-analysis, the research team could not draw an affirmative conclusion as to the benefits of acupuncture due to the poor methodological quality and localized population of the included trials. The field needs large international, well-conducted RCTs.

[Overview of researches on the underlying mechanism of that "Hegu (LI 4) is indicated for orofacial disorders"].

It has been well documented in Chinese acupuncture medicine that "Hegu (LI 4) is indicated for orofacial problems". In the present paper, the authors analyze their correlation from the learning of modern medicine and results of recent experimental studies instead of traditional meridian theory of acupuncturology. The afferent nerve fibers from the LI 4 region and the orofacial part ascend to the spinal cord, nucleus of solitary tract, reticular formation, thalamus and the cerebral cortex, respectively, and overlap in the thalamus, cerebral cortex, etc. Under the circumstances, the interaction and functional integration of the afferent signals from LI 4 acupoint and the orofacial region may occur in the central nervous system. In addition, many relevant neuroactive substances (for example, serotonin, substance P, enkephalin, y-aminobutyric acid, glycine, calcitonin gene-related peptide, etc.) released from the sensory and motor neurons in the corresponding cerebral regions may constitute part of the substantial basis of that "Hegu (LI 4) is indicated for many orofacial disorders".

Management of neuropathic orofacial pain.

Current management of painful trigeminal neuropathies relies on pharmacological (topical and systemic), surgical, and complementary modalities. There is, however, a lack of quality research relating to the effectiveness of these modalities. In this review we analyze the available data that relates to the therapy of trigeminal neuralgia, postherpetic neuralgia, and posttraumatic neuropathies and provide clinical guidelines. The review focuses on medical management, as well as surgical and other interventions for painful neuropathies.

Bilateral facial nerve palsy in the course of neuroborreliosis in children-dynamics, laboratory tests and treatment.

PURPOSE: Presentation of four patients with bilateral peripheral facial nerve palsy as a clinical manifestation of neuroborreliosis in children--diagnostic, treatment and prognosis. MATERIAL AND METHODS: In 2002-2004 in The Chair and Department of Developmental Neurology, 24 children from the Wielkopolska region were admitted with diagnosis of borreliosis. Among all the children with borreliosis, confirmed by serologic examination, 4 (16.7%) demonstrated bilateral peripheral facial palsy (PFP). We investigated the presence of IgM class and IgG class specific antibodies in the sera and cerebrospinal fluid (CSF) of 4 patients with bilateral PFP. (Detected by immunoenzymatic methods--ELISA.) RESULTS: Before the occurrence of PFP all the children manifested unspecified systemic symptoms such as headaches, muscle and articulation pains, weakness and in two cases a mood depression. At first all patients demonstrated elevated IgM antibodies and proper levels of IgG antibodies. Control tests administered within 2-14 months later reduction of antibodies was indicated. Two patients demonstrated significant pleocytosis in CSF test, (without the meningeal symptoms). All children were treated with physiotherapeutic procedures and were administered antibiotic intravenously. CONCLUSIONS: PFP is one of the most frequent neurological symptoms of borreliosis in children. In case of acute PFP and especially the bilateral form of PFP, neuroborreliosis is the most probable diagnosis. All children reported PFP at one side first and after several weeks the paresis of the facial nerve on the opposite side usually appeared. The clinical state of children started to improve after the introduction of physiotherapy and this process usually lasted several months.

[Aspects of diagnosis and treatment of the facial nerve neuropathy]. / Nekotorye aspekty diagnostiki i lecheniia nevropatii litsevogo nerva.

As many as 86 patients with neuropathy of the facial nerve complicated by development of postneuritic muscular contractures were examined. Based on the clinical-and-neurophysiological investigation, findings from rheoencephalography, electroencephalography, echoencephaloscopy, electrodiagnosis of the facial nerve, clinical variants of the facial nerve function return to normal were defined together with causes of development of muscular contractures. Efficiency is shown of use of acupuncture and magnetotherapy combined in treatment of the above trouble.

[The combination of reflexotherapy and homeopathy in treating patients with facial nerve neuropathy]. / Poiedannia refleksoterapiï ta homeopatiï pry likuvanni khvorykh z nevropatiieiu lytsevoho nerva.

Used in a multiple-modality treatment of 103 patients presenting with facial nerve neuropathy were infrared laser puncture and homeopathy. The former treatments were administered with the aid of the apparatus [symbol: see text] 001 at wave-length 890 nm, average power 15 mW/cm2. Homeopathy therapy was with those drug preparations meant to deal with constitutional and symptomatic problems. As many as 103 patients with facial nerve neuropathy derived apparent benefit from treatment, which fact was confirmed by electrophysiological findings as was by those from acupuncture diagnosis techniques.

[A differentiated approach to laser puncture in facial neuritis by using the methods of acupuncture diagnosis]. / Dyferentsial'nyi pidkhid do lazeropuntury pry nevryti lytsevoho nerva z vykorystanniam metodiv akupunkturnoï diahnostyky.

Overall 87 patients with neuritis of the facial nerve were studied by making use of methods of acupuncture diagnosis as recommended by Nakatani and Akabane. The parameters under investigation included the level of physiologic corridor, left-right asymmetry, the Yang and the Yin meridians sum ratio, maximum deviation from the physiological corridor in certain meridians. The results obtained permitted the identification of three groups of patients depending on the duration of their illness. This permitted the differentiated approach to the use of laser puncture in these patients securing good results of treatment which were confirmed by both the positive dynamics of acupuncture methods of investigation and data supplied by the electrophysiological techniques (EMG, EEG). With the purpose of performing laser puncture, the infrared laser puncture apparatus Biomed-001 (wavelength 0.89, average laser emissive power 20 mw) was employed.

Facial neuromuscular retraining for oral synkinesis.

The purpose of this paper is to describe the outcome of facial neuromuscular retraining for brow to oral and ocular to oral synkinesis in individuals with facial nerve disorders. Fourteen patients with unilateral facial nerve disorders and oral synkinesis who were enrolled in physical therapy for retraining were studied. Synkinesis was measured with quantitative video facial position analysis prior to the initiation of physical therapy and at regular intervals during retraining. Retraining included surface electromyographic biofeedback-assisted specific strategies for facial muscle reeducation and a home exercise program of specific facial movements. Twelve of 13 patients with brow to oral synkinesis and 12 of 14 patients with ocular to oral synkinesis reduced their synkinesis with retraining. Patients with a 1-year on greater duration of a facial neuromuscular disorder (excluding patients with unusually marked changes) demonstrated a significant decrease in brow to oral synkinesis and in ocular to oral synkinesis; there was a mean percentage decline in abnormal movement of 60.5 percent (SD = 26.48) and 30.1 percent (SD = 62.57), respectively. We conclude that brow to oral and ocular to oral synkineses associated with partial recovery from facial paralysis were reduced with facial neuromuscular retraining for individuals with facial nerve disorders.

[Electrostimulation in the treatment of a facial nerve lesion]. / Elektrostimuliatsiia v lechenii porazheniia litsevogo nerva.

The author developed and introduced in the clinic a method of electric stimulation with sinusoidal modulated currents (using the "Amplipulse" device) in 114 patients with facial nerve lesions. A differentiated approach to electric stimulation is recommended in normal and reduced electric excitability of mimic muscles.

[Hyperbaric oxygenation in the treatment of facial neuritis]. / Giperbaricheskaia oksigenatsiia pri lechenii nevrita litsevogo nerva.

The effectiveness of hyperbaric oxygenation (HBO) in a multiple modality therapy versus the conventional treatment of patients with facial neuritis was investigated. HBO was used in the treatment of 42 patients. Twenty-nine patients with a similar picture of the diseases treated by conventional methods without the use of HBO constituted the control group. The inclusion of hyperbaric oxygenation in to the multiple modality treatment of patients with facial neuritis increased the efficacy of therapy and reduced the period needed for the restoration of the function of the damaged nerve.