RESUMEN
Bell's palsy (BP) is a rapid-onset neurological disorder causing unilateral facial paralysis, affecting approximately 40,000 people annually in the United States. Suggested treatments for BP include corticosteroids, facial therapy, and osteopathic manipulative treatment (OMT) in order to improve symptoms; however, some people with BP have spontaneous resolution. A 52-year-old female with left-sided facial paralysis and drooping for the past four months due to BP presented to the osteopathic treatment center. For the first three weeks after developing BP, the patient had soreness when attempting to move her facial features, but on later treatments, she only experienced weakness on the left side of her face. The patient's facial sensation was intact bilaterally, but she was unable to move her left eyebrow, eyelid, cheek, and lip. OMT focused on the intraoral musculature, the cervical spine, and cranial treatment utilizing osteopathic techniques such as osteopathic cranial manipulative medicine (OCMM), direct myofascial release, soft tissue, balanced ligamentous tension, and muscle energy. Utilizing the Facial Disability Index (FDI) questionnaire and the Sunnybrook facial grading system (SFGS), an improvement in facial paralysis was seen due to both OMT and physical therapy (PT) treatments. It is difficult to discern which treatments helped the patient the most (OMT, PT, or at-home exercises); however, the patient's improvement was notable. This case study demonstrates that OMT, PT, and at-home exercises may positively contribute toward the improvement of BP symptoms by addressing cranial and muscular somatic dysfunctions of the head and neck. The treatment, which included techniques such as muscle energy and intraoral myofascial release, resulted in significant improvements in facial function and grading scores. One limitation of the study is that, however unlikely, chronic BP may resolve spontaneously, which may have contributed to the patient's progress. While OMT, PT, and at-home exercises contributed to the patient's recovery, further research is needed to substantiate the effectiveness of OMT, PT, and at-home exercises in treating BP.
RESUMEN
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex, multi-symptom illness characterized by debilitating fatigue and post-exertional malaise (PEM). Numerous studies have reported sex differences at the epidemiological, cellular, and molecular levels between male and female ME/CFS patients. To gain further insight into these sex-dependent changes, we evaluated differential gene expression by RNA-sequencing (RNA-Seq) in 33 ME/CFS patients (20 female, 13 male) and 34 matched healthy controls (20 female and 14 male) before, during, and after an exercise challenge intended to provoke PEM. Our findings revealed that pathways related to immune-cell signaling (including IL-12) and natural killer cell cytotoxicity were activated as a result of exertion in the male ME/CFS cohort, while female ME/CFS patients did not show significant enough changes in gene expression to meet the criteria for the differential expression. Functional analysis during recovery from an exercise challenge showed that male ME/CFS patients had distinct changes in the regulation of specific cytokine signals (including IL-1ß). Meanwhile, female ME/CFS patients had significant alterations in gene networks related to cell stress, response to herpes viruses, and NF-κß signaling. The functional pathways and differentially expressed genes highlighted in this pilot project provide insight into the sex-specific pathophysiology of ME/CFS.