Prevalence of herpes zoster virus reactivation in patients diagnosed with Bell's palsy.

OBJECTIVE: Herpes zoster virus can cause inflammatory neuropathy of the facial nerve. However, studies evaluating the prevalence of this agent in peripheral facial palsy are heterogeneous regarding sample group selection, laboratory analysis method and variables studied. In addition, there are a lack of epidemiological data in the Brazilian population on this serological phenomenon in peripheral facial palsy. This study estimated herpes zoster reactivation prevalence in serological samples through chemiluminescence immunoassay for quantitative determination of specific antibodies directed against the virus. METHODS: This cross-sectional study sought to determine the prevalence of viral reactivation by herpes zoster in subjects with idiopathic peripheral facial palsy through analysis of serological samples over a year. RESULTS: Forty-seven patients (32 females and 15 males) participated. Severe paralysis was more common in older patients (p = 0.017). Facial pain (p = 0.02) and vertigo (p = 0.001) were related to a worse evolution of facial palsy. The rate of serological reactivation of the virus was 12.76 per cent. CONCLUSION: The rate of serological reactivation of herpes virus in idiopathic peripheral facial palsy in our population is similar to foreign literature data, suggesting similar aetiological mechanisms in the genesis of this morbidity.

Acupuntura y terapia neural para el tratamiento de la Parálisis de Bell / Acupuncture and Neural Therapy for Treating Bell's Palsy

Introducción: La efectividad de las terapias alternativas para el tratamiento de la parálisis de Bell es aún controvertida. Objetivo: Reportar la experiencia en el tratamiento de la PB mediante la administración conjunta de acupuntura y terapia neural. Métodos: Se recopiló información de 30 pacientes con parálisis de Bell, quienes recibieron una sesión semanal de acupuntura y terapia neural de manera conjunta y fueron evaluados mediante la escala House-Brackmann durante 12 semanas. Resultados: El 80 por ciento (24) de los pacientes continuaron el tratamiento hasta la semana 12 y al término de la misma ninguno alcanzó función motora normal. Apenas 6 (25 por ciento) pacientes mostraron signos de recuperación entre las semanas 6 y 12. Así, el porcentaje de pacientes con grado IV se redujo de 6 (20 por ciento) durante la evaluación inicial a 3 (12 por ciento) durante la semana 9 (p = 0,001) y el de pacientes con grado III de 12 (50 por ciento) durante la semana 9 a 9 (38 por ciento) durante la semana 12 (p = 0,663). Se evidenciaron efectos adversos en 9 (32 por ciento) pacientes, lo que incluyó hematoma en el sito de puntura y síncope, que se resolvieron sin complicaciones. Conclusiones: La administración conjunta de acupuntura y terapia neural durante al menos 6 semanas tuvo efectos modestos sobre la recuperación de pacientes con parálisis de Bell sin producir efectos adversos mayores(AU)

Introduction: The effectiveness of alternative therapies for treating Bell's palsy is still controversial. Objective: To report the experience in the treatment of Bell's palsy through joint administration of acupuncture and neural therapy. Methods: Information was collected from 30 patients with Bell's palsy, who received a weekly session of acupuncture and neural therapy jointly and were assessed using the House-Brackmann scale for 12 weeks. Results: 80 percent (24) of the patients continued treatment until week 12 and, at the end of the week, none reached normal motor function. Only 6 patients (25 percent) showed signs of recovery between weeks 6 and 12. Thus, the percentage of patients with grade IV decreased from 6 (20 percent), during the initial evaluation, to 3 (12 percent), during week 9 (p<0.001); while the percentage of patients with grade III decreased from 12 (50 percent), during week 9, to 9 (38 percent), during week 12 (p=0.663). Adverse effects were evidenced in 9 (32 percent) patients, including hematoma at the puncture site and syncope, which was solved without complications. Conclusions: Joint administration of acupuncture and neural therapy for at least six weeks had modest effects on the recovery of patients with Bell's palsy, without producing major adverse effects(AU)

Workplace cluster of Bell's palsy in Lima, Peru.

BACKGROUND: We report on a workplace cluster of Bell's palsy that occurred within a four-month period in 2011 among employees of a three-story office building in Lima, Peru and our investigation to determine the etiology and associated risk factors. FINDINGS: An outbreak investigation was conducted to identify possible common infectious or environmental exposures and included patient interviews, reviews of medical records, an epidemiologic survey, serological analysis for IgM and IgG antibodies to putative Bell's palsy-inducing pathogens, and an environmental exposure assessment of the office building. Three cases of Bell's palsy were reported among 65 at-risk employees, attack rate 4.6%. Although two patients had underlying risk factors, there was no clear association or common identifiable risk factor among all cases. Serologic analysis showed no evidence of recent infections, and air and water sample measures of all known chemical or neurotoxins were below maximum allowable concentrations for exposure. CONCLUSIONS: An infection spread among workplace employees could not be excluded as a potential cause of this cluster; however, it was unlikely a pathogen commonly associated with individual cases of Bell's palsy. Although a specific etiology was not identified among all cases, we believe this methodology will aid future outbreak investigations of Bell's palsy and a better understanding of its etiology. While environmental assessments may be useful in their ability to ascertain the cause of clusters of Bell's palsy, future investigations should prioritize focus on common infectious etiology.

The neurologist's dilemma: a comprehensive clinical review of Bell's palsy, with emphasis on current management trends.

BACKGROUND: Recent advances in Bell's palsy (BP) were reviewed to assess the current trends in its management and prognosis. MATERIAL/METHODS: We retrieved the literature on BP using the Cochrane Database of Systematic Reviews, PubMed, and Google Scholar. Key words and phrases used during the search included 'Bell's palsy', 'Bell's phenomenon', 'facial palsy', and 'idiopathic facial paralysis'. Emphasis was placed on articles and randomized controlled trails (RCTs) published within the last 5 years. RESULTS: BP is currently considered the leading disorder affecting the facial nerve. The literature is replete with theories of its etiology, but the reactivation of herpes simplex virus isoform 1 (HSV-1) and/or herpes zoster virus (HZV) from the geniculate ganglia is now the most strongly suspected cause. Despite the advancements in neuroimaging techniques, the diagnosis of BP remains one of exclusion. In addition, most patients with BP recover spontaneously within 3 weeks. CONCLUSIONS: Corticosteroids are currently the drug of choice when medical therapy is needed. Antivirals, in contrast, are not superior to placebo according to most reliable studies. At the time of publication, there is no consensus as to the benefit of acupuncture or surgical decompression of the facial nerve. Long-term therapeutic agents and adjuvant medications for BP are necessary due to recurrence and intractable cases. In the future, large RCTs will be required to determine whether BP is associated with an increased risk of stroke.

Bell's palsy. A prospective, longitudinal, descriptive, and observational analysis of prognosis factors for recovery in Mexican patients.

OBJECTIVE: To determine the prognosis factors in Mexican patients with Bell's palsy. DESIGN: We designed a prospective, longitudinal, descriptive, and observational analysis. Two hundred and fifty one patients diagnosed with Bell's palsy at the National Institute of Rehabilitation were included. We studied the sociodemographic characteristics, seasonal occurrence, sidedness, symptoms, and therapeutic options to determine the prognostic factors for their recovery. RESULTS: Thirty-nine percent of patients had a complete recovery and 41.5% had an incomplete recovery. Marital status, gender, etiology, symptoms, sidedness, House-Brackmann grade, and treatments did not represent significant prognostic factors for recovery. Age > 40 years (OR = 2.4, IC 95% 1.3-4.3, p = 0.002) and lack of physical therapy (OR = 6.4, IC 95% 1.4-29.6, p = 0.006) were significant prognostic factors for incomplete recovery. Familial palsy resulted to be a protective prognostic factor against an incomplete recovery (OR = 0.54, IC 95% 0.28-1.01, p = 0.039). This protection factor was only significant in female patients (OR = 0.41, p = 0.22) but not in male patients (OR = 1.0, p = 0.61). CONCLUSIONS: The proportion of cases with incomplete recovery was high. The age > 40 years and lack of physical therapy were the only significant prognostic factors for an incomplete recovery.

Estudio epidemiológico de la parálisis de Bell o parálisis facial idiopática, realizado en el servicio de fisiatría del Hospital Clínico Universitario de la Universidad Central de Venezuela, noviembre 2003, marzo 2004: resultados preliminares / An epidemiological study of Bell´s palsy or idiopathic facial palsy, performed at the University Clinical Hospital, Central University of Venezuela, November 2003, March 2004: preliminary results

Se realizó un estudio descriptivo de prevalencia en pacientes diagnosticados con Parálisis de Bell ó Parálisis Facial Idiopática según la Clasificación Internacional de Enfermedades Aplicadas a la Odontología y Estomatología (CIE-AO 1985) que Acudieron al Servicio de neurología sección de Rehabilitación del Hospital Clínico Universitario de Caracas. Periodo noviembre 2003 - Marzo 2004. Estos datos fueron analizados de acuerdo a la clasificación clínica de la parálisis según (House y Brackmann)1.Se estudiaron 79 pacientes relacionándolos con la edad, sexo, lado anatómico afectado, tiempo de evolución, antecedentes personales, hábitos tabáquicos, alcohólicos, usos de drogas y presencia ó no de dolor. De la totalidad el 37,97 por ciento de los pacientes se ubicaron en el grado 4 según la clasificación clínica de la parálisis según House y Brackmann, la cuarta década de la vida fue la más frecuentemente afectada, con 20 pacientes (25.3 por ciento). Es más frecuente en mujeres (64,56 por ciento), el 53,16 por ciento tenía el lado izquierdo afectado, 29 por ciento de los pacientes presentaron dolor auricular previo a la parálisis.

The goal of this research is to present preliminary results on the prevalence of patients with diagnosis of Bell's paralysis (idiopathic facial paralysis),in accordance with the international classification of diseases applied to Dentistry and Stomatology (CIE - AO,1985),whom were consulted in the Service of Physiatry of the University Hospital between November 2003 and March 2004.The data were analized according to the Clinical Classification of the Paralysis (House and Brackmann),age,gender,anatomical side most frequently affected,evolution time,individual antecedents,habits,and presence or abscense of pain.37.97% was regarded as grade IV facial paralysis (House and Brackmann Clinical Classification).Seventynine patients were studied and is more frequent in the fourth decade of life { 20 (25.3%) patients}.It is seen more often in females (64,55%),with 53,16%affected in the left side of the face.Twentynine per cent of the patients had auricular pain before the presentation of the lesion.

Lifetime prevalence of Bell's palsy in rural Bolivia: a door-to-door survey.

We carried out a door-to-door survey in rural areas of the Cordillera Province, Bolivia, to determine the prevalence of the most common neurological diseases in a sample of about 10,000 inhabitants. A team of non-doctor health workers administered a standard screening instrument for neurological diseases, a slightly modified version of the World Health Organization protocol. All subjects found positive at the screening phase underwent a complete neurological examination. On screening, we found 1,130 positive subjects, of whom 909 were aged 15 years and above. After the neurological examination, we found 52 cases who had experienced Bell's palsy during their life in the population aged 15 years and above. The lifetime prevalence on November 1, 1994 was 11.1/1,000 (95% confidence interval 7.8-14.5) for the population aged 15 years and above. The prevalence was higher in women than in men (13.7 and 8.7/1,000, respectively) and increased with age, reaching a peak in the group aged 65 years or more (31.7/1,000). Only 3 cases (5.8%) had received medical therapy.

[Idiopathic facial paralysis (Bell's palsy): a study of 180 patients]. / Paralisia facial periférica idiopática de Bell: a propósito de 180 pacientes.

The objective of this study was to analyze some clinical and epidemiologic aspects, as well as the follow up of 180 patients with Bell's palsy. In the study population there was a predominance of female (66.7%). Two peaks of incidence in the age distribution were identified: third-fourth and sixth decades of life. In the group of 180 patients there were 198 events of facial paralysis, 17 recurrences and in one patient the paralysis was bilateral at the onset. In 15 patients (8.3%) there were recurrences of the facial paralysis, in 12 cases (70.6%) the recurrences were ipsilateral. The left side of the face was involved in 55.6% of the cases. In eight patients the paralysis occurred during pregnancy (n=5) or puerperium (n=3). As associated conditions we found: arterial hypertension (11.7%), diabetes mellitus (11.1%), pregnancy or puerperium (4.4%; 6.7% in the women), and neurocysticercosis (1.1%). In 72.8% of the cases no association with such conditions was found. In 22.8% of the patients some kind of sequelae were identified: hemifacial spasm (12.8%), partial recovery of the motor deficit (10.6%), syndrome of the crocodile tears (3.3%), sincinetic contraction (2.8%), and the Marcus Gunn inverse phenomenon (1.1%). In conclusion, this study shows that the idiopathic facial paralysis may lead to important sequelae in more than 20% of the patients.

Paralisia facial periférica idiopática de Bell: a propósito de 180 pacientes / Idiopathic facial paralysis (Bell´s palsy): a study of 180 patients

O objetivo deste estudo foi analisar aspectos clínicos, epidemiológicos e evolutivos da paralisia facial periférica idiopática em 180 pacientes. Houve ligeiro predomínio do sexo feminino (66,7 por cento). Quanto à faixa etária mais acometida, foram observados dois picos de incidência um nas terceira e quarta décadas, e o outro na sexta década de vida. Nos 180 pacientes houve 198 episódios de paralisia facial periférica, sendo 17 recorrências e em um paciente a paralisia foi de instalaçäo inicial bilateral. Em 15 pacientes (8,3 por cento) houve recidiva da paralisia facial, em dois casos a paralisia se repetindo por mais duas vezes. Em 12 casos (70,6 por cento) a recidiva ocorreu no mesmo lado da paralisia anterior. O lado esquerdo da face estava envolvido em 55,6 por cento dos casos. Em oito pacientes a paralisia aconteceu na gestaçäo (n=5) ou no pós-parto (n=3). Quatro das pacientes grávidas apresentaram paralisia de Bell no terceiro trimestre. Uma paciente com 18 anos de idade desenvolveu paralisia facial do lado direito no sétimo mês da gravidez, havendo recidiva da paralisia no mesmo lado aos 23 anos de idade, no 15º dia pós-parto. Como condicöes associadas encontramos hipertensäo arterial sistêmica (11,7 por cento), diabete mélito (11,1 por cento), gravidez ou pós-parto imediato (4,4 por cento; 6,7 por cento nas mulheres) e neurocisticercose (1,1 por cento). Em 72,8 por cento dos casos näo encontramos associaçäo com outras afecçöes. Em 22,8 por cento dos pacientes observou-se uma das seguintes sequelas: espasmo hemifacial (12,8 por cento), recuperaçäo parcial do déficit motor (10,6 por cento), síndrome das lágrimas do crocodilo (3,3 por cento), contraçöes sincinéticas (2,8 por cento), lacrimejamento (1,1 por cento) e fenômeno de Marcus Gunn invertido (1,1 por cento). Concluíndo, no estudo foi demonstrado que a paralisia facial periférica idiopática pode provocar sequelas importantes, cosméticas ou funcionais, em mais de 20 por cento dos pacientes

Parálisis de Bell (parálisis facial idiopática) / Bellïs paralysis (idiophatic facial paralysis)

La parálisis de Bell, es una enfermedad benigna de la porción infratemporal del nervio facial que consiste en la pérdida temporal de la función contráctil de la musculatura mímica de la cara, de causa desconocida, pero puede ser secundaria a un traumatismo, compresión o tumor. Este es un proceso autolimitante que no amenaza la vida del paciente y generalmente desaparece en un plazo de 1 a 3 semanas. Su rango de incidencia es de 23 por cada 100.000 personas por año. No tiene diferencia por sexo, en los últimos estudios hay una incidencia entre los 20 y 35 años de edad, siendo más frecuente en pacientes diabéticos e hipertensos que en la población normal. Se presenta indiferentemente en cualquiera de los dos lados de la cara y sólo el 1 por ciento en ambos lados simultáneamente. Se caracteriza por presentar el fenómeno de Bell (Figura 1)(signo de parálisis facial periférica que se manifiesta por el movimiento ocular hacia arriba y afuera del globo ocular, cuando el enfermo intenta cerrar el párpado), dolor facial o retroarticular, diagusia, hiperacusia y disminución del lagrimeo