Treatment of idiopathic facial paralysis (Bell's Palsy) and secondary facial paralysis with extracellular vesicles: a pilot safety study.

BACKGROUND: Paralysis of the facial nerve (CN VII) is one of the most debilitating issues that any patient can encounter. Bell's palsy is the most commonly seen mononeuropathy. Although usually self-limited, symptomatology can persist for decades in persistent cases. The non-surgical alternative therapies discussed in this study are successful without reconstruction and are regenerative. OBJECTIVE AND DESIGN: We sought to determine a safe new treatment could be developed to restore facial nerve function using extracellular vesicles (EVs) in patients who have been unable to return to normal under a variety of conditions. We performed a pilot safety study of 7 patients with idiopathic and secondary facial paralysis to determine if any functional restoration was possible. Each patient had symptomology for varying periods of time, with diverse House-Brackmann scores. They were all treated with the same protocol of extracellular vesicles (EVs) over a 4-week period of time and were evaluated both before and after treatment. CASE PRESENTATIONS: All patients in this study received treatment by their private physicians prior to entering the study. A record review was completed, with independent physical examinations. House-Brackmann scores and Facial Disability Indices were obtained prior to, and after completing the study. EVs were injected into the area of the main trunk of the facial nerve on the affected side, and an intravenous drip of EVs on visits during weeks 1, 2, and 4. CONCLUSIONS: All seven patients enrolled in the study improved with this treatment protocol. After the second week of treatment, we saw a progression of independent motion of the affected eyelid, brow motion, and commissure. Although all patients began at different House-Brackman starting points, almost all ended at the same endpoint on the scale over the same period of time - four weeks. No adverse effects were encountered. Clearly, the duration of the treatment protocol needs to be longer than one month. The pathomechanism is still unknown. But it appears that the mechanism is reversible. At last, these patients can have hope. TRIAL REGISTRATION: The Institute of Regenerative and Cellular Medicine IRB approval number: IRCM-2021-304.

Homeopathic Treatment of Ramsay Hunt Syndrome: A Case Report.

INTRODUCTION: Ramsay Hunt syndrome (RHS) is an uncommon neurological complication resulting from the reactivation of latent herpes zoster virus. The condition often presents with facial paralysis, palatal ulcers, dysphagia, and altered taste sensation, leading to reduced quality of life. Standard therapeutic options for RHS have limitations, prompting the exploration of alternative treatments with improved prognostic outcomes. This case report aims to present a noteworthy clinical observation of RHS managed with individualized homeopathic treatment, emphasizing its potential therapeutic effect. CASE DESCRIPTION: A 24-year-old female patient exhibited left-sided facial weakness, along with palatal ulcers, dysphagia, and ageusia, prompting the diagnosis of RHS. Following the principles of homeopathy, a personalized therapeutic regimen was formulated, consisting tailored administration of Rhus toxicodendron, Spigelia anthelmia, and Sulfur. The House-Brackmann scale was employed to objectively assess the severity of facial palsy, while photographic documentation tracked the progression of palatal ulcers and facial paralysis. Over a carefully monitored observation period of 14 days, the patient demonstrated notable therapeutic response. There was a significant reduction in the extent of palatal ulceration and left-sided facial palsy exhibited marked improvement. Subsequent days of follow-up witnessed a consistent amelioration of the patient's condition, substantiating the effect of the individualized homeopathic treatment. CONCLUSION: This case report highlights an exceptional instance of RHS recovery within a relatively short timeframe, achieved through the administration of individualized homeopathic therapy. The favorable outcomes observed in this case underscore the potential of homeopathy as a promising intervention for RHS management. Nevertheless, further systematic investigations are imperative to comprehensively evaluate the scope and applicability of homeopathy in the treatment of RHS.Das Ramsay­Hunt­Syndrom (RHS) ist eine seltene neurologische Komplikation, die durch die Reaktivierung einer latenten Herpes­Zoster­Virusinfektion verursacht wird. Die Krankheit manifestiert sich häufig mit Gesichtslähmung, Ulcerationen am Gaumen, Dysphagie und verändertem Geschmacksempfinden und ist mit einer Einschränkung der Lebensqualität verbunden. Die Standardtherapieoptionen für RHS sind begrenzt, weshalb nach alternativen Behandlungsmöglichkeiten mit besseren prognostischen Ergebnissen gesucht wird. Im vorliegenden Fallbericht wird eine interessante klinische Beobachtung bei RHS vorgestellt, das mit individualisierter Homöopathie behandelt wurde, und deren potenzielle therapeutische Wirksamkeit wird hervorgehoben.Eine 24-jährige Patientin zeigte eine linksseitige Gesichtsschwäche in Verbindung mit Ulcerationen am Gaumen, Dysphagie und Ageusie, so dass die Diagnose RHS gestellt wurde. Gemäß den Prinzipien der Homöopathie wurde ein personalisiertes Therapieschema formuliert, das die individuell zugeschnittene Gabe von Rhus toxicodendron, Spigelia anthelmia, und Sulphur umfasste. Die objektive Bewertung des Schweregrads der Gesichtslähmung erfolgte mithilfe der House-Brackmann-Skala, wohingegen das Fortschreiten der Gaumenulcerationen und der Gesichtslähmung fotografisch dokumentiert wurde. Während eines sorgfältig überwachten Beobachtungszeitraums von 14 Tagen zeigte die Patientin ein deutliches therapeutisches Ansprechen. Das Ausmaß der Gaumenulcerationen ging signifikant zurück, und die linksseitige Gesichtslähmung besserte sich deutlich. In den folgenden Tagen besserte sich der Zustand der Patientin kontinuierlich, was die Wirkung der individualisierten homöopathischen Behandlung untermauert.Dieser Fallbericht beleuchtet einen ungewöhnlichen Fall von Genesung nach einem RHS innerhalb relativ kurzer Zeit, die durch Verabreichung einer individualisierten homöopathischen Therapie erreicht wurde. Die im vorliegenden Fall beobachteten günstigen Ergebnisse unterstreichen das Potenzial der Homöopathie als vielversprechende Intervention zur Behandlung von RHS. Allerdings sind weitere systematische Untersuchungen unabdingbar, um den Umfang und die Anwendbarkeit der Homöopathie bei der Behandlung von RHS umfassend zu beurteilen.

Effectiveness of multiwave locked system laser on the treatment of patients with idiopathic Bell's palsy: a randomized double-blind placebo controlled trial.

The objective of this study is to investigate the effect of scanning and point application of multiwave locked system (MLS) laser therapy on the recovery of patients with idiopathic Bell's palsy (IBP). A randomized double-blind placebo-controlled trial was carried out on 60 patients with subacute BP. Patients were randomly assigned into three groups of 20 patients each. Facial massage and facial exercises were applied to all patients. Group one received MLS laser as a manual scanning technique (10 J/cm2, area 50cm2, total energy 500 J). Group two received MLS laser using point application technique (10 J/point, 8 points, total 80 J). Group three received placebo laser. House-Brackmann scale (HBS) and facial disability index (FDI) were used to evaluate the facial recovery. Assessment was performed at baseline and after 3 and 6 weeks of treatment. Comparison within and between groups was performed statistically with significance level p < 0.05. Results showed significant improvement in the FDI and HBS after treatment in all groups. Both scanning and point application significantly improved the score of FDI and HBS more than placebo group. Scanning technique combined with facial massage and exercises had a more significant effect than the point application group or the placebo group in improving FDI and HBS scores after 3 and 6 weeks of treatment. The MLS laser is an effective physiotherapy method used for the treatment of patients with IBP. MLS laser in scanning or point application techniques was more effective than exercise alone with greater effect of scanning technique than point application technique.

Photobiomodulation Therapy to Treat Facial Paralysis of 8 Years: Case Report.

Background: Paralysis of the facial muscles produces functional and aesthetic disturbance that has a negative impact for the patient's quality of life. Objective: To evaluate the effects of a photobiomodulation (PBM) with low-level laser (LLL) on the treatment of a patient with 8 years of facial paralysis. Methods: PBM with two different wavelengths of LLL (660 and 808 nm), applied only on the affected side, three times a week for 8 consecutive weeks. Evaluations were performed before starting treatments, after the 12th session of treatment and after the 24th session, using the House-Brackmann scale and electroneuromyography. Results: The House-Brackmann and electroneuromyography tests showed improvements in the movement of the facial muscles when tested in the middle and at the end of the treatment with LLL. Conclusions: PBM with LLL at the wavelength of 660 and 808 nm with the parameters used in this case report was an effective and noninvasive treatment for facial paralysis in this long-standing, chronic case of 8 years.

Bell's Palsy in Children (BellPIC): protocol for a multicentre, placebo-controlled randomized trial.

BACKGROUND: Bell's palsy or acute idiopathic lower motor neurone facial paralysis is characterized by sudden onset paralysis or weakness of the muscles to one side of the face controlled by the facial nerve. While there is high level evidence in adults demonstrating an improvement in the rate of complete recovery of facial nerve function when treated with steroids compared with placebo, similar high level studies on the use of steroids in Bell's palsy in children are not available. The aim of this study is to assess the utility of steroids in Bell's palsy in children in a randomised placebo-controlled trial. METHODS/DESIGN: We are conducting a randomised, triple-blinded, placebo controlled trial of the use of prednisolone to improve recovery from Bell's palsy at 1 month. Study sites are 10 hospitals within the Australian and New Zealand PREDICT (Paediatric Research in Emergency Departments International Collaborative) research network. 540 participants will be enrolled. To be eligible patients need to be aged 6 months to < 18 years and present within 72 hours of onset of clinician diagnosed Bell's palsy to one of the participating hospital emergency departments. Patients will be excluded in case of current use of or contraindications to steroids or if there is an alternative diagnosis. Participants will receive either prednisolone 1 mg/kg/day to a maximum of 50 mg/day or taste matched placebo for 10 days. The primary outcome is complete recovery by House-Brackmann scale at 1 month. Secondary outcomes include assessment of recovery using the Sunnybrook scale, the emotional and functional wellbeing of the participants using the Pediatric Quality of Life Inventory and Child Health Utility 9D Scale, pain using Faces Pain Scale Revised or visual analogue scales, synkinesis using a synkinesis assessment questionnaire and health utilisation costs at 1, 3 and 6 months. Participants will be tracked to 12 months if not recovered earlier. Data analysis will be by intention to treat with primary outcome presented as differences in proportions and an odds ratio adjusted for site and age. DISCUSSION: This large multicenter randomised trial will allow the definitive assessment of the efficacy of prednisolone compared with placebo in the treatment of Bell's palsy in children. TRIAL REGISTRATION: The study is registered with the Australian New Zealand Clinical Trials Registry ACTRN12615000563561 (1 June 2015).

Clinical Study on Yu’s Meridian Detection and Treatment plus Acupuncture for Facial Paralysis / 上海针灸杂志

Objective To observe the clinical efficacy of Yu’s meridian detection and treatment plus acupuncture in treating facial paralysis.Method Sixty patients with facial paralysis in acute stage were randomized into a treatment group and a control group, 30 cases in each group. The treatment group was intervened by Yu’s meridian detection and treatment plus acupuncture, while the control group was by ordinary acupuncture. The House-Brackmann (H-B) scale and symptom-sign scores were observed before and after the treatment.Result The H-B scale scores were changed significantly in the two groups after the treatment (P<0.05). After the treatment, the H-B score of the treatment group was significantly different from that of the control group (P<0.05). The symptom-sign scores were significantly changed in both groups after the treatment (P<0.01). The symptom-sign score of the treatment group was significantly different from that of the control group after the treatment (P<0.05).Conclusion Yu’s meridian detection and treatment plus acupuncture is an effective method in treating facial paralysis.