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[Clinical and electrophysiological study of isaxonine in peripheral facial paralysis (author's transl)].

In a double-blind survey carried out versus a placebo, the action of isaxonine was examined with 42 patients suffering from peripheral facial paralysis, most often a frigore. The statistical analysis of the clinical and electrophysiological results shows a significantly higher improvement for the isaxonine group, both in quality and speed of recovery of the nervus facialis functions. Clinical and biological tolerance posed no particular problem.

Double-Blind Method↗

Reproducibility of normal facial motor nerve conduction studies and their relevance in the electrophysiological assessment of peripheral facial paralysis.

To determine the intra-examiner intertrial reproducibility of normal facial motor nerve conduction studies (FNCS) and their relevance in electrophysiological assessments of peripheral facial paralysis, 52 patients with acute unilateral Bell's palsy were examined on two separate occasions 1 months apart. Three electroneurographic methods were assessed. On the unaffected side of the face, FNCS are reliable when performed by a single examiner over time. Nevertheless, compound muscle action potential (CMAP) baseline-to-peak and peak-to-peak amplitude showed a rather high intertrial variability. Reproducibility of the assessed surface electrode recording procedures was similar. Regarding the affected side, in patients with mild axonotmesis of the facial nerve variations of electroneurographic parameters 1 months apart fell within the range of normal intertrial variability. In patients with severe or moderate axonotmesis, the distal latency and the M wave amplitude variations showed significant intertrial variations. Reproducibility of FNCS appears to be similar to that found in limb motor nerves. Normal variability curtails the sensitivity of FNCS in detecting mild facial nerve axonotmesis, although this technique remains useful in severe cases.

Action Potentials↗

[Evaluation of electroneurography as a prognostic method in the development of peripheral facial paralysis].

Electroneurography (EnoG) is a prognostic test used in the assessment of the peripheral facial nerve paralysis. We believe that when performed in standard conditions and together with the clinical evolutive parameters, it is very useful to reveal the critical time for a more radical treatment. We studied 44 patients; 13 patients had greater than 90% neural degeneration on EnoG. 5 of them underwent facial nerve surgical decompression due to a poor clinical outcome and up to three of these patients had a normal facial function after this.

Adolescent↗

[Ability of the tissues to assimilate glucose and the pyruvate and lactate levels after intravenous glucose load in patients with peripheral facial paralysis].

In 60 control subjects and 48 patients with peripheral facial nerve palsy carbohydrate metabolism was tested performing a rapid intravenous glucose tolerance test with 0.5 g glucose per 1 kg of actual body weight and with determination of concentrations of glucose, pyruvate and lactate at rest in fasting state and after intravenous glucose load. Glucose was determined in capillary blood by the orthotoluidine method, pyruvate and lactate in venous blood by the enzymatic method. In the group of patients with facial nerve palsy a significantly lower number of subjects had a normal ability of glucose assimilation by tissues and a significantly higher frequency of pathological results of glucose tolerance test with a high prevalence of fasting hyperglycaemia. In patients with abnormal glucose tolerance test the fasting pyruvate concentration was high. After an intravenous glucose load the concentration of pyruvate in the 120th minute of the test was significantly increased (p less than 0.05) in patients with facial nerve palsy independently of the degree of glucose tolerance impairment. In patients with pathological result of the glucose tolerance test disturbances were observed also in lactate concentration. The production of lactate was decreased in the initial phase and then it was increased in the time up to 120 minutes. No direct correlation was observed between the disturbances of pyruvate concentration and the preserved ability of glucose assimilation by the peripheral tissues.

Adult↗

[Association of peripheral facial paralysis in patients with human immunodeficiency virus infection].

INTRODUCTION: Neurological disorders are common in patients infected with the human immunodeficiency virus (HIV). The objective of this study is to show the possible association of peripheral facial paralysis (PFP) in persons who test positive for HIV, which because of the characteristics of outpatient management is important in basic medical attention. PATIENTS AND METHODS: The scope of our study included all patients observed in 1998 and the first six months of 1999 who had PFP, and in whom detailed clinical history, physical examination by a neurologist, laboratory tests and HIV serological tests were done. RESULTS: We found that 89.1% of the patients with PFP were seropositive. The facial paralysis showed similar characteristics to Bell s palsy, with complete recovery after four weeks in 66.6% of this group of patients. The seronegative patients also recovered completely but took longer to do so. In two cases the PFP was associated with obvious features of AIDS. CONCLUSIONS: In the literature reviewed we have not found such a large group of patients with PFP associated with HIV+. However, it is obvious that there is an increase in facial paralysis which is in proportion to the increase in HIV+ persons. The results of our study suggest to us that HIV should be tested for in patients with PFP.

Adolescent↗

Evaluation of greater petrosal nerve function in patients with acute peripheral facial paralysis: comparison of soft palate electrogustometry and Schirmer's tear test.

We tested sensory and secretomotor function of the greater petrosal nerve (GPN) by means of electrogustometry (EGM) of the soft palate and Schirmer's tear test in 115 patients (59 males, 56 females) with acute peripheral facial paralysis. Facial paralysis was caused by Bell's palsy in 78 cases, Ramsay Hunt syndrome in 27 cases and zoster sine herpetic lesions in 10. All patients had dysfunction of the stapedial nerve. An electrogustometer was used to test taste (GPN sensory function), and elevation of the threshold by > 6 dB on the affected side was considered abnormal. Schirmer's test was used to evaluate lacrimal (GPN secretomotor) function, which was considered abnormal when tear secretion on the affected side was < 50% of secretion on the non-affected side. Of the 78 patients with Bell's palsy, 28.2% had altered taste on the soft palate (sensory dysfunction) and 10.3% had lacrimal dysfunction, indicating that EGM of the soft palate is more sensitive than Schirmer's test for identifying dysfunction of the GPN in patients with facial paralysis due to Bell's palsy. Of the total of 115 patients, 32 (28%) had taste dysfunction and 9 (28.1%) of these 32 patients also had lacrimal dysfunction. This finding indicates that facial paralysis has different effects on the sensory and secretory nerve fibers of the GPN. The results of Schirmer's test were more closely related to the severity of, and prognosis for, facial paralysis than the results of EGM.

Acute Disease↗

[Recurrent peripheral facial paralysis. Our case load from 1995].

Of 117 cases of peripheral facial palsy seen in our emergency room in 1995, 10 (8.5%) were relapses. Seven were males and 3, females. Mean age at the first appearance was 23.6 years. The mean interval between the first facial palsy and the first recurrence was 10.1 years, and between the first and second recurrence, 4.6 years. Five of the 10 patients (50%) had a second recurrence. Two of the 10 patients (20%) had a family history of facial palsy. Only 1 (10%) was diabetic. Seven of 10 patients achieved a complete functional recovery and 3 had sequelae. Computed tomography was normal in every patient. In our series, a family history of facial palsy and low ENoG results were related with a poorer prognosis. ENoG scan was used as a prognostic and follow-up factor.

Adolescent↗

[Peripheral facial paralysis as the first symptom of unknown metastatic primary tumor].

The spread of metastases to the brain and the leptomeninges is usually a terminal event in patients with known malignancies. We report on two patients, in whom the diagnosis of a diffusely metastasizing carcinoma was considerably delayed by the initial symptom of a peripheral facial nerve paralysis. The clinical, neuroradiologic and cerebrospinal fluid findings are discussed. A malignant neoplasm with diffuse or focal metastasis to the leptomeninges is a rare cause of peripheral facial paralysis of unclear genesis. The necessity of a lumbar puncture plus magnetic resonance imaging of the brain to enable an early diagnosis is emphasized.

Adenocarcinoma, Mucinous↗

Problems with eating and drinking in patients with unilateral peripheral facial paralysis.

Patients with facial paralysis not only suffer from asymmetry of the face, but also from problems with eating and drinking. To demonstrate that these patients have many problems with activities such as eating and drinking, we examined 17 outpatients with a unilateral peripheral facial paralysis for the presence of problems in these functions. To collect data, all patients completed a questionnaire concerning the problems they had directly following onset of the paralysis and at the moment of this study. In addition, they were examined to determine the severity of the paralysis, the problems with eating and drinking, their experiences regarding impairments and disabilities, and the compensatory behavior. The result of the study is a portrayal of problems and conscious or unconscious compensations. Furthermore, we concluded that the Sunnybrook Facial Grading System score does not predict the number of problems in eating and drinking, the number of compensations, and the emotional impact. Significant correlations are found only between various scores on Visual Analog Scales and the number of compensatory actions. Patients differ in how they experience the extensive problems due to the facial paralysis and in the extent to which they are successful in adaptation. Consulting a speech therapist for treatment of functional problems is a meaningful adjunct to regular therapy. The treatment of deglutition disorders can be best based upon the detailed information of the questionnaire and the examination of eating, drinking, and compensatory behavior.

Adaptation, Physiological↗

[Iatrogenic peripheral facial paralysis].

The Authors have made a research on the peripheric palsy of the facial nerve caused by surgical operations and anesthetic methods; they emphasize the importance of the prevention of the esthetic and functional damage that results from the injury. This prevention not always is possible in relation to the anatomic conditions and to the anomalies of the course of the nerve.

Anesthesia, Dental↗

[High-resolution computed tomography of peripheral facial paralysis].

High resolution computer tomographic examinations of the petrous bones were performed on 19 patients with confirmed peripheral facial nerve paralysis. High resolution CT provides accurate information regarding the extent, and usually regarding the type, of pathological process; this can be accurately localised with a view to possible surgical treatment. The examination also differentiates this from idiopathic paresis, which showed no radiological changes. Destruction of the petrous bone, without facial nerve symptoms, makes early suitable treatment mandatory.

Facial Paralysis↗

[Contralateral reinnervation in peripheral facial paralysis].

Neurological and EMG studies were performed on 17 patients with peripheral facial palsy in order to investigate the possibility of reinnervation of the palsied mimic muscles close to the middle facial line by outgrown fibres from the contralateral intact facial nerve. The patients were aged between 10 and 77 years (middle age 38 years) with duration of the facial palsy from 2 month to 30 years. In eight patients there were data about double reinnervation - both by the ipsilateral lesioned nerve and by the contralateral intact facial nerve. In contrast to the statement of other authors that the age of the patients and the duration of the disease, its severity or the way of occurrence of facial palsy--acute or chronic, are of importance to the development of contralateral reinnervation, our data do not suggest such a role for these factors.

Adolescent↗

Peripheral facial paralysis (PFP) and HIV infection in Togo.

OBJECTIVES: The purpose of this study was to determine the seroprevalence of HIV in a group of 150 patients with PFP and to study the semiological and evolutive aspect of PFP in patients with or without HIV. MATERIAL AND METHODS: This semilongitudinal study was conducted during 6 years (1990-1995) at the Lomé teaching hospital. Patients consulting for PFP had the HIV test and regular controls. RESULTS: The HIV seroprevalence was 52%. The average age was 31.4+/-8.81 years There was no difference on clinical features between patients with or without HIV infection. Cerebrospinal fluid was normal in patients without HIV infection, but it showed pleiocytosis in patients with HIV infection (87.88%). Of the HIV carriers 14% presented a recurrence. A total of 26.32% of the patients screened in 1990 developed AIDS when followed up. CONCLUSION: Peripheral facial paralysis is frequently associated to HIV infection. An HIV test must be proposed to all patients with PFP in Africa.

AIDS Dementia Complex↗

[Peripheral facial paralysis in Petropolis].

The author presents 83 cases of "a frigore" peripheral facial palsy, occurred in the mountain city of Petropolis which has characteristics such as a tropical climate without any traces of a dry season and an average temperature of 50 degrees F to 73.5 degrees F. The author relates them with virus infections which appear within a year period. Fifty six patients belong to his clinic and have a follow up, while other 25 patients proceed from another clinics and from them he only has reports on sex, age, side of palsy and the beginning of illness. He shows that the largest number of cases occurred along the months of May, August, September and October. Season distribution for southern hemisphere is analysed. He also considers etiology, incidence, prevalence, treatment and results on patients studied.

Adolescent↗

Change in gene expression in facial nerve nuclei and the effect of superoxide dismutase in a rat model of ischemic facial paralysis.

Peripheral nerve injury induces changes in gene expressions of a variety of neuroactive substances in cell somata, which may have roles in the adaptive response to the injury, neuronal survival, growth and regeneration. In this study, we designed a rat model of ischemic peripheral facial paralysis with a selective embolization technique, and observed mRNA expression of calcitonin gene-related peptide (CGRP), c-jun, and growth associated protein (GAP)-43 in facial nerve nuclei using in situ hybridization histochemistry. The rats were demonstrated to have a transient facial paralysis consistently, and thus this method was regarded as a model of minor peripheral nerve injury. The mRNA of CGRP, c-jun and GAP-43 showed a distinct pattern of induction and time course of increase after the ischemic nerve injury. The results suggest that the small injury to the peripheral nerve was able to induce changes in mRNA expression in the cell body of motoneurons. We also investigated the protective effect of superoxide dismutase (SOD), which is a free radical-scavenging enzyme involved in cellular antioxidant defenses. The SOD treatment clearly alleviated the behavioral impairment and decreased the CGRP mRNA expression at 3rd day after injury. These data suggest that a free radical generated by the ischemia may be partially responsible for ischemic nerve damage and the change in gene expression in motoneurons.

Animals↗

[Isolated peripheral facial paralysis and HIV infection: 7 cases].

Human immunodeficiency virus infection frequently involves the peripheral or central nervous system. Seven cases of isolated peripheral facial palsy that occurred at various stages of the disease are reported. The palsy was the first manifestation of the disease in 5 patients, and revealed it in 3 of them. The palsy involved the right side in 6 cases (complete N = 2; incomplete N = 4); it was bilateral in one (complete on both sides). Abnormalities of the cerebrospinal fluid were present in all patients but differed depending on the stage of the retroviral infection. Electroneuromyography defined the type of the palsy, principally due to axonotmesis in 4 patients (including the bilateral one) and principally to neurapraxia in 3 patients. The outcome was good in most cases. The physiopathology remains undetermined.

Adult↗

Necrotizing otitis externa, otitis media, peripheral facial paralysis, and brain abscess in a thalassemic child after allogeneic BMT.

Severe infection is one of the major complications in the early and late post-bone marrow transplantation period. The authors report a thalassemic child who developed necrotizing otitis externa and otitis media, a very rare complication after bone marrow transplantation, and then peripheral facial nerve paralysis and brain abscess in the early period of bone marrow transplantation despite antibacterial and antifungal prophylaxis. Necrotizing otitis media is characterized by necrosis and sloughing of considerable areas in the middle ear and adjacent tissues and is an unusual disorder because of today's antibiotics. Granulocytopenia and background ear tissue exposed to previous repeated otitis media attacks may be the predisposing factors in this case. The authors conclude that the children with previous histories of recurrent otitis media should be prepared and monitored very carefully during bone marrow transplantation because of the risk of necrotizing otitis media, especially in the granulocytopenic period.

Anti-Bacterial Agents↗