Intravascular hypercoagulability in patients with recent Bell's palsy

Role of Biomarkers as Prognostic Factors in Acute Peripheral Facial Palsy

Acute peripheral facial palsy (APFP), including Bell's palsy and Ramsay Hunt syndrome, is a disease that affects daily life through facial motor dysfunction, causing psychological problems. Various tests to evaluate prognosis have been studied; however, there are no validated predictive biomarkers to guide clinical decision making. Therefore, specific biomarkers that respond to treatment are required to understand prognostic outcomes. In this review, we discuss existing literature regarding the role of APFP biomarkers in prognosis and recovery. We searched the PubMed, EMBASE, and Cochrane Library databases for relevant papers. Our screening identified relevant studies and biomarkers correlating with the identification of predictive biomarkers. Only studies published between January 2000 and October 2021 were included. Our search identified 5835 abstracts, of which 35 were selected. All biomarker samples were obtained from blood and were used in the evaluation of disease severity and prognosis associated with recovery. These biomarkers have been effective prognostic or predictive factors under various conditions. Finally, we classified them into five categories. There is no consensus in the literature on the correlation between outcomes and prognostic factors for APFP. Furthermore, the correlation between hematologic laboratory values and APFP prognosis remains unclear. However, it is important to identify new methods for improving the accuracy of facial paralysis prognosis prediction. Therefore, we systematically evaluated prognostic and potentially predictive APFP biomarkers. Unfortunately, a predictive biomarker validating APFP prognosis remains unknown. More prospective studies are required to reveal and identify promising biomarkers providing accurate prognosis.

Status of Lactate Dehydrogenase, Neutrophil-lymphocyte Ratio, Mean Platelet Volume, and Platelet-lymphocyte Ratio in Bell's Palsy

Objective: The inflammatory and vascular disorders have been proposed in the pathogenesis of Bell’s palsy (BP). Several studies investigated the role of inflammation and ischemia in BP using white blood cell (WBC) count and its subtypes. Here, we aimed to investigate lactate dehydrogenase (LDH), neutrophil-lymphocyte ratio (NLR), mean platelet volume (MPV), and platelet-lymphocyte ratio (PLR) in BP.

Methods: The study was conducted on 76 patients with BP and 60 healthy controls. The comparison of LDH, NLR, MPV, and PLR was made between groups. The relationships between LDH, NLR, MPV, and PLR were also investigated.

Results: The mean LDH concentrations and NLR were significantly high in BP group than in control group (p < 0.01, p < 0.05, respectively). There was no significant difference between groups in MPV and PLR (p = 0.195, p = 0.263, respectively).

Conclusion: Our results support the diagnostic value of high LDH concentrations in BP patients. Further studies are needed to investigate the relationship between LDH and the severity and prognosis of BP.

Thiol/disulphide homeostasis in Bell's palsy as a novel pathogenetic marker

OBJECTIVES

The aim of this study was to investigate the relationship between Bell's palsy and a novel oxidative stress parameter, thiol/disulphide homeostasis.

DESIGN

A prospective study evaluating oxidative stress in Bell's palsy.

SETTING

This research took place in the department of Otorhinolaryngology, Ataturk Training and Research Hospital.

PARTICIPANTS

Totally, 77 patients with Bell's palsy and 38 healthy controls were included in this study.

MAIN OUTCOME MEASURES

The blood levels of total and native thiol and disulphide activity were assessed, and their levels were compared in the patients and controls.

RESULTS

There were statistically significant differences between the patients and controls regarding thiol/disulphide parameters. The mean native thiol and total thiol were significantly lower and disulphide levels were higher in the Bell's palsy than controls. On binary logistic regression analysis, the created model showed 45.3% variation. The cut-off value was 18.95 for disulphides.

CONCLUSION

Native and total thiol levels were low in the Bell's palsy. This metabolic disturbance may have a role in the pathogenesis of Bell's palsy.

Elevated neutrophil-to-lymphocyte ratio in Bell's palsy and its correlation with facial nerve enhancement on MRI

OBJECTIVE

The aim of this study was to investigate the role of inflammation and atherothrombosis in Bell's palsy (BP) by using neutrophil-to-lymphocyte ratio (NLR) and mean platelet volume (MPV), respectively, and to study their relations with the facial nerve enhancement on temporal gadolinium-enhanced magnetic resonance imaging (TGd-MRI).

STUDY DESIGN

Case control study.

SETTING

Tertiary health institution.

SUBJECTS AND METHODS

This study was performed on 65 patients who were diagnosed with BP and a control group of 35 healthy individuals. The BP patients were also divided into 2 groups, those with facial nerve enhancement on TGd-MRI and those without enhancement. The NLR and MPV of each group were compared.

RESULTS

The NLRs of the BP patients were significantly higher than control group (P = .001). The NLRs of patients with facial nerve enhancement on TGd-MRI were significantly higher than patients without enhancement (P = .001). There was a positive and significant correlation between NLR and House-Brackmann (HB) grade of the patients (r = 0.641; P < .05). MPV did not show any significant correlation with any of the parameters studied (P > .05).

CONCLUSION

NLR can be used as a new and important marker in BP since it is high in BP patients and significantly correlated with HB grade and facial nerve enhancement on TGd-MR. On the other hand, MPV does not have such correlations. These results offer evidence to support an inflammatory theory rather than microvascular response theory in the etiopatogenesis of BP.