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Li KY, Chou MC, Chang R, Yip HT, Hung YM, Wei JCC. The Potential Role of Human Papillomavirus Infection in Bell's Palsy: A Hypothesis-Generating Study Based on a Nationwide Cohort. Front Med (Lausanne) 2021; 8:616873. [PMID: 34540856 PMCID: PMC8447863 DOI: 10.3389/fmed.2021.616873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Our purpose was to investigate whether people with a previous human papillomavirus (HPV) infection were associated with an increased risk of Bell's palsy (BP). Methods: By using Taiwan population-based data, patients aged > 18 years with HPV infection (n = 22,260) from 2000 to 2012 were enrolled and compared with control subjects who had never been diagnosed with an HPV infection at a 1:4 ratio matched by sex, age, index date, and co-morbidities (n = 89,040). The index date was the first date of HPV diagnosis. All the patients were tracked until the occurrence of BP. Cox proportional hazards regression was applied to estimate the hazard ratios (HRs) for the development of BP in both groups. Results: The HPV group had 1.25 [95% confidence interval (CI) = 1.03–1.51] times higher risk of BP compared with the non-HPV group after adjusting for sex, age, and co-morbidities. The association of HPV and BP was significant in the sensitivity analyses. In the subgroup analysis, the impact of HPV infection on the risk of BP was more pronounced in the elderly > 50 years [adjusted hazard ratio (aHR) =1.86; 95% CI = 1.37–2.52], hypertension (aHR = 1.65; 95% CI = 1.17–2.31), and chronic obstructive pulmonary disease (aHR = 2.14, 95% CI 1.333.43) subgroups. Conclusions: Patients with HPV infection have a higher risk of subsequent BP compared with non-HPV patients. More rigorous studies are needed to confirm if and how specific HPV genotypes are associated with BP and the possible role of vaccines in disease prevention.
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Affiliation(s)
- Kuan-Ying Li
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Chia Chou
- Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan.,Department of Recreation and Sports Management, Tajen University, Pingtung, Taiwan.,Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Pingtung, Taiwan.,Graduate Institute of Bioresources, National Pingtung University of Science and Technology, Pingtung, Taiwan
| | - Renin Chang
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Hei-Tung Yip
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan.,Institute of Public Health (Biostatistics), National Yangming University, Taipei, Taiwan
| | - Yao-Min Hung
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan.,College of Health and Nursing, Meiho University, Pingung, Taiwan.,National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
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Incidence and characteristics of Lyme neuroborreliosis in adult patients with facial palsy in an endemic area in the Netherlands. Epidemiol Infect 2019; 147:e160. [PMID: 31063093 PMCID: PMC6518488 DOI: 10.1017/s0950268819000438] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Making a distinction between facial palsy due to Lyme neuroborreliosis (LNB) and idiopathic facial palsy (IFP) is of importance to ensure timely and adequate treatment. The study objective was to assess incidence and patient characteristics of facial palsy due to LNB. Hospital records were reviewed of adult patients with facial palsy visiting the departments of neurology and/or otorhinolaryngology of Gelre hospitals between June 2007 and December 2017. Gelre hospitals are located in an area endemic for Lyme borreliosis. Patients with LNB had pleocytosis and intrathecal antibody production or pleocytosis with positive IgG serology. Patients with IFP had negative serology. Clinical characteristics were compared between patients with LNB and patients with IFP. Five hundred and fifty-nine patients presented with facial palsy, 4.7% (26) had LNB and 39.4% (220) IFP. The incidence of facial palsy due to LNB was 0.9/100 000 inhabitants/year. Over 70% of patients with facial palsy due to LNB did not report a recent tick bite and/or erythema migrans (EM). Patients with facial palsy due to LNB presented more often in July to September (69.2% vs. 21.9%, P < 0.001), and had more often headache (42.3% vs. 15.5%, P < 0.01). To reduce the risk of underdiagnosing LNB in an endemic area, we recommend testing for LNB in patients with facial palsy in summer months especially when presenting with headache, irrespective of a recent tick bite and/or EM.
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Abstract
OBJECTIVES The effectiveness of antiviral agents for the treatment of Bell's palsy is uncertain. We evaluated whether a steroid with an antiviral agent (S + A group) provided better recovery outcomes than a steroid alone (S group) in patients with Bell's palsy. SUBJECTS AND DESIGN A total of 1342 patients diagnosed with Bell's palsy who visited the Kyung Hee Medical Center in Seoul, Korea, from 2002 to 2012 were included in this study. Patients in the S + A group were treated with prednisolone and antiviral agents (n = 569) and those in the S group with prednisolone alone (n = 773). Outcomes were measured using the House-Brackmann (HB) scale according to age, initial disease severity, electroneurography (ENoG) findings and underlying comorbidities. RESULTS The rate of recovery (HB grades I and II) with initially severe Bell's palsy (HB grades V and VI) was higher in the S + A than in the S group (P = 0.001). However, the rates of recovery were similar with initially moderate palsy (HB grades II-IV) (P = 0.502). In patients classified according to age and ENoG-determined severity of palsy, the overall recovery rate was higher in the S + A than in the S group, but the differences were not statistically significant (P > 0.05 for both). The recovery rate without diabetes mellitus (DM) and hypertension (HTN) was higher in the S + A group than in the S group (P = 0.031). But in the patients with HTN and DM, the difference in recovery rates between the S + A and S groups was not statistically significant (P = 0.805). CONCLUSIONS Treatment with a steroid plus antiviral agent resulted in significantly higher recovery rates than steroid therapy alone in patients with initially severe Bell's palsy and without either HTN or DM, and a nonsignificant trend towards higher recovery rates in all patients with Bell's palsy in this study. Antiviral agents may therefore help in the treatment of Bell's palsy.
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Affiliation(s)
- H M Kang
- Department of Otorhinolaryngology, School of Medicine, Kyung Hee University, Seoul, Korea
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Riga M, Kefalidis G, Chatzimoschou A, Tripsianis G, Kartali S, Gouveris H, Katotomichelakis M, Danielides V. Increased seroprevalence of Toxoplasma gondii in a population of patients with Bell's palsy: a sceptical interpretation of the results regarding the pathogenesis of facial nerve palsy. Eur Arch Otorhinolaryngol 2011; 268:1087-92. [PMID: 21305313 DOI: 10.1007/s00405-011-1499-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Accepted: 01/19/2011] [Indexed: 11/25/2022]
Abstract
Facial nerve oedema and anatomical predisposition to compression within the fallopian tube seem to be the only generally accepted facts in the pathophysiology of Bell's palsy. Several infectious causes have been suggested as possible triggers of this oedema. Most of the suggested pathogens have been associated with facial nerve lesions during latent infections, reinfections or endogenous reactivations. The aim of this study was to investigate the seroprevalence of three such pathogens Toxoplasma gondii, Epstein-Barr virus (EBV) and cytomegalovirus (CMV) in a population of patients with facial nerve palsy. Fifty-six patients with Bell's palsy were included in the study. A group of 25 individuals with similar age and gender distribution was used as control. Seropositivity for T. gondii, EBV viral capsid antigen (VCA) and CMV-specific IgM and IgG antibodies was investigated 2-5 days after the onset of the palsy. Comparisons for both IgM and IgG antibodies against T. gondii attributed significantly higher seroprevalence in the patients' group than in the control group (p = 0.024 and 0.013, respectively). The respective examinations for EBV and CMV attributed no significant results. The roles of EBV and CMV in the pathogenesis of Bell's palsy were not confirmed by this study. However, a significantly higher seroprevalence of IgM- and IgG-specific T. gondii antibodies was detected in patients with Bell's palsy when compared to healthy controls. The possibility that facial nerve palsy might be a late complication of acquired toxoplasmosis may need to be addressed in further studies.
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Affiliation(s)
- Maria Riga
- ENT Department, University Hospital of Alexandroupolis, Demokritos University of Thrace, 35 Leoforos Makris, Nea Chili, 68100 Alexandroupolis, Greece.
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5
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Quintas E, Silva A, Sarmento A. Bilateral facial palsy in a young patient after meningococcal meningitis, associated to herpetic infection. ARQUIVOS DE NEURO-PSIQUIATRIA 2009; 67:712-4. [PMID: 19722059 DOI: 10.1590/s0004-282x2009000400030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Edna Quintas
- Department of Infectious Diseases, Medical School, University of Porto, Portugal.
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Nigrovic LE, Thompson AD, Fine AM, Kimia A. Clinical predictors of Lyme disease among children with a peripheral facial palsy at an emergency department in a Lyme disease-endemic area. Pediatrics 2008; 122:e1080-5. [PMID: 18931349 DOI: 10.1542/peds.2008-1273] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Although Lyme disease can cause peripheral facial palsy in Lyme disease-endemic areas, diagnostic predictors in children have not been described. OBJECTIVE Our goal was to determine clinical predictors of Lyme disease as the etiology of peripheral facial palsy in children presenting to an emergency department in a Lyme disease-endemic area. METHODS We reviewed all available electronic medical charts of children <or=20 years old with peripheral facial palsy who were evaluated in the emergency department of a tertiary care pediatric center from 1995 to 2007. We used the Centers for Disease Control Lyme disease definition: presence of erythema migrans lesion or serologic evidence of infection with Borrelia burgdorferi. We performed binary logistic regression with bootstrapping validation to determine independent clinical predictors of Lyme disease. RESULTS We identified 313 patients with peripheral facial palsy evaluated for Lyme disease. The mean age was 10.7 years, and 52% were male. Of these, 106 (34%) had Lyme disease facial palsy. After adjusting for year of study, the following were independently associated with Lyme disease facial palsy: onset of symptoms during peak Lyme disease season (June to October), absence of previous herpetic lesions, presence of fever, and history of headache. In the subset of patients without meningitis, both onset of symptoms during Lyme disease season and presence of headache remained significant independent predictors. CONCLUSIONS Lyme disease is a frequent cause of facial palsy in children living in an endemic region. Serologic testing and empiric antibiotics should be strongly considered, especially when children present during peak Lyme disease season or with a headache.
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Affiliation(s)
- Lise E Nigrovic
- Division of Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts 02115, USA.
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Kanerva M, Mannonen L, Piiparinen H, Peltomaa M, Vaheri A, Pitkäranta A. Search for Herpesviruses in cerebrospinal fluid of facial palsy patients by PCR. Acta Otolaryngol 2007; 127:775-9. [PMID: 17573575 DOI: 10.1080/00016480601011444] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
CONCLUSIONS Herpes simplex virus 1 (HSV-1) and varicella-zoster virus (VZV) DNA were not detected in the cerebrospinal fluid (CSF) of patients with acute idiopathic peripheral facial palsy (Bell's palsy). Our results indicate either the absence of these viruses or the presence of technical shortcomings. The role of human herpesvirus 6 (HHV-6) in this disorder and the significance of a positive HHV-6 DNA finding in the central nervous system need further investigation. OBJECTIVE Our goal was to determine whether DNA of HSV-1, VZV, or HHV-6 can be found by polymerase chain reaction (PCR) in the CSF of peripheral facial palsy patients. MATERIALS AND METHODS We used PCR to detect the presence of HSV-1, VZV, and HHV-6 DNA in CSF. This was a retrospective case control study with 33 peripheral facial palsy patients (34 CSF samples) in the study group (26 with Bell's palsy, 5 with simultaneously diagnosed herpesvirus infection, 1 with puerperal facial palsy, 1 with Melkersson-Rosenthal syndrome). The control group included 36 patients, most with diagnosed or suspected Borreliosis and facial palsy or sudden deafness. RESULTS One patient with Bell's palsy had HHV-6 DNA in CSF. Neither HSV-1 nor VZV DNA was detected in patients or controls.
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Affiliation(s)
- Mervi Kanerva
- Department of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki, Finland.
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Ljøstad U, Økstad S, Topstad T, Mygland A, Monstad P. Acute peripheral facial palsy in adults. J Neurol 2005; 252:672-6. [PMID: 15778908 DOI: 10.1007/s00415-005-0715-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2004] [Revised: 10/08/2004] [Accepted: 10/19/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To collect epidemiological data of peripheral facial palsy, and especially to chart the incidence and clinical characteristics of Lyme associated facial palsy. MATERIAL AND METHODS We included consecutive adult patients presenting with peripheral facial palsy in Vest-Agder County from January 1997 to December 1998. The facial palsy was graded according to the House and Brackman facial function scoring system,and cerebrospinal fluid and serum samples were examined for Borrelia burgdorferi antibodies and virus antibodies. Final outcome was evaluated by follow up visits or telephone interview. RESULTS Sixty nine patients were included and followed until complete recovery, or for 5 years. Ten per cent were caused by Lyme disease, 17% by virus infection, 4% by other causes and 68% were classified as Bell's palsy. All patients with Lyme facial palsy had additional neurological symptoms, and 87% reported constitutional complaints. The overall final outcome was good with complete recovery in 77%, slight sequelae in 20% and moderate sequelae in 3%. No patients experienced severe sequelae. Two of 28 patients examined with neurography had absent compound muscle action potentials in orbicularis oculi. Both made good recovery with only slight sequelae. CONCLUSIONS Peripheral facial palsy is a common disorder with a favourable prognosis. Lyme disease seems to be an infrequent cause of facial palsy in patients without constitutional symptoms or additional neurological findings.
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Affiliation(s)
- Unn Ljøstad
- Dept. of Neurology, Sørlandet Sykehus HF, Kristiansand, 416, 4604 Kristiansand, Norway.
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Skogman BH, Croner S, Odkvist L. Acute facial palsy in children--a 2-year follow-up study with focus on Lyme neuroborreliosis. Int J Pediatr Otorhinolaryngol 2003; 67:597-602. [PMID: 12745151 DOI: 10.1016/s0165-5876(03)00061-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Acute facial palsy in children is believed to be a rather benign neurological condition. Follow-up-studies are sparse, especially including a thorough otoneurological re-examination. The aim of this study was to examine children with a history of facial palsy in order to register the incidence of complete recovery and the severity and nature of sequelae. We also wanted to investigate whether there was a correlation between sequelae and Lyme Borreliosis, treatment or other health problems. METHODS Twenty-seven children with a history of facial palsy were included. A re-examination was performed by an Ear-Nose-Throat (ENT) specialist 1-2.9 years (median 2) after the acute facial palsy. The otoneurological examination included grading the three branches of the facial nerve with the House-Brackman score, otomicroscopy and investigation with Frenzel glasses. A paediatrician interviewed the families. Medical files were analysed. RESULT The incidence of complete recovery was 78% at the 2-year follow-up. In six out of 27 children (22%), the facial nerve function was mildly or moderately impaired. Four children reported problems with tear secretion and pronunciation. There was no correlation between sequelae after the facial palsy and gender, age, related symptoms, Lyme neuroborreliosis (NB), treatment, other health problems or performance. CONCLUSION One fifth of children with an acute facial palsy get a permanent dysfunction of the facial nerve. Other neurological symptoms or health problems do not accompany the sequelae of the facial palsy. Lyme NB or treatment seems to have no correlation to clinical outcome. Factors of importance for complete recovery after an acute facial palsy are still not known.
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Affiliation(s)
- B Hedin Skogman
- Division of Pediatrics, Department of Molecular and Clinical Medicine, Faculty of Health Sciences, University Hospital, SE-581 85, Linköping, Sweden.
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10
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Yetiser S, Satar B, Kazkayasi M. Immunologic abnormalities and surgical experiences in recurrent facial nerve paralysis. Otol Neurotol 2002; 23:772-8; discussion 778. [PMID: 12218633 DOI: 10.1097/00129492-200209000-00027] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To document immunologic findings in patients with recurrent facial paralysis (RFP) and to compare the results of the surgery with the results of medical treatment. STUDY DESIGN Retrospective case review. SETTING Tertiary care referral center. PATIENTS Nine patients with RFP were reviewed. INTERVENTION Patients underwent nonspecific antibody detection, protein electrophoresis (in blood and cerebrospinal fluid [CSF]) and oligoclonal band determination for immunoglobulin G, A, and M (in CSF). The extended subtotal facial nerve decompression via the transmastoid and transattic route was performed in four patients. Five patients received medical treatment only (steroids, vitamin B). RESULTS Two patients had the complete and four patients had the oligosymptomatic form of Melkersson-Rosenthal syndrome. The other three patients were diagnosed with idiopathic RFP. Serum immunoglobulin G was high in seven of nine patients (77%). CSF protein electrophoresis demonstrated an elevated albumin fraction in six of nine patients (66%). CSF immunoglobulin G was high in four of nine patients (44%). The oligoclonal band in CSF was negative in all patients. Mean follow-up time was 5.2 +/- 2.6 years and 3 +/- 1.5 years for surgically treated patients and medically treated patients, respectively. None of the patients who underwent the surgery demonstrated recurrence. Although marked recovery was observed in patients who had received medical treatment, three of them had recurrence during the follow-up period. CONCLUSION Serologic test results have demonstrated immune system involvement in cases of idiopathic RFP and in cases of Melkersson-Rosenthal syndrome, providing no distinction between the two. There was no sign substantiating local antibody production in CSF, which implies that the elevated antibodies in CSF were peripheral in origin. Although the serologic test results were not conclusive for a specific diagnosis, they support an immune-mediated pathogenesis. Despite the small number of patients who underwent the extended transmastoid facial nerve decompression, our follow-up data were suggestive for the prevention of recurrences.
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Affiliation(s)
- Sertac Yetiser
- Department of Otorhinolaryngology-Head and Neck Surgery, Gulhane Medical School, Etik-Ankara, Turkey.
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Peltomaa M, Pyykkö I, Seppälä I, Viljanen M. Lyme borreliosis and facial paralysis--a prospective analysis of risk factors and outcome. Am J Otolaryngol 2002; 23:125-32. [PMID: 12019479 DOI: 10.1053/ajot.2002.123434] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the incidence of Lyme borreliosis in patients with acute idiopathic facial paralysis with special emphasis on the risk factors that explain the poor outcome of facial paralysis and occurrence of Lyme borreliosis. MATERIALS AND METHODS During a 2-year period, we prospectively studied 503 consecutive patients with acute idiopathic facial paralysis for the presence of Lyme borreliosis. We screened the patients for antibodies to Borrelia burgdorferi and for symptoms or signs related to Lyme borreliosis. Chi-square and logistic regression tests were used for the statistical analysis. Special attention was paid to strict criteria for the diagnosis of Lyme borreliosis. RESULTS Eleven (2.2%) of the 503 patients with facial paralysis had Lyme borreliosis. Fever, headache, pharyngalgia, enlarged cervical lymph nodes, bilateral paralysis, and arthralgia were more common in patients with Lyme borreliosis than in those without it. In the logistic regression modeling the best combination of explanatory variables for predicting the occurrence of Lyme borreliosis included summer season at the onset of facial paralysis, presence of enlarged cervical lymph nodes, and arthralgia. The best combination of explanatory variables to predict the poor outcome of facial paralysis was total paralysis of facial nerves, recurrent facial paralysis, and hyperacusis. CONCLUSIONS Lyme borreliosis is an important infectious cause of facial paralysis. In our study, 11 of 503 patients with acute idiopathic facial paralysis had Lyme borreliosis. The screening for serum antibodies in addition to the thorough evaluation of the history of the patient and of the patient's clinical signs or symptoms possibly linked with Lyme borreliosis, are essential when diagnosing Lyme borreliosis.
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Affiliation(s)
- Miikka Peltomaa
- Department of Otolaryngology, Helsinki University Central Hospital, Helsinki, Finland
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Birkmann C, Bamborschke S, Halber M, Haupt WF. Bell's palsy: electrodiagnostics are not indicative of cerebrospinal fluid abnormalities. Ann Otol Rhinol Laryngol 2001; 110:581-4. [PMID: 11407851 DOI: 10.1177/000348940111000614] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Electrodiagnostic testing (electromyography, electroneuronography, and blink reflex) and cerebrospinal fluid (CSF) examination (cell count, immunoglobulins, and antigen-specific intrathecal immunoglobulin G synthesis against herpes simplex virus, varicella zoster virus, cytomegalovirus, and Borrelia burgdorferi sensu latu) were performed in 56 patients with Bell's palsy. The CSF was normal in 45 patients and abnormal in 11 patients. Acute borreliosis was the most common specific pathological CSF finding (4 of 11). Electromyography revealed abolished volitional activity in 22% of patients with normal CSF and in 36% with pathological CSF. Electroneuronographic tests with an amplitude decrease of more than 90% on the affected side or abolished responses were found in 20% of patients with normal CSF and in 18% with pathological CSF. Abolished orbicularis oculi reflexes were seen in 67% of patients with normal CSF and in 82% with pathological CSF Concerning electrodiagnostic testing, no statistically significant difference between patients with normal and abnormal CSF was found, so we conclude that electrodiagnostic testing has no indicative value for abnormal CSF in Bell's palsy.
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Affiliation(s)
- C Birkmann
- Department of Neurology, University of Cologne, Germany
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13
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Terry LA, Stewart JP, Nash AA, Fazakerley JK. Murine gammaherpesvirus-68 infection of and persistence in the central nervous system. J Gen Virol 2000; 81:2635-2643. [PMID: 11038374 DOI: 10.1099/0022-1317-81-11-2635] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Murine gammaherpesvirus-68 (MHV-68) was originally isolated from a bank vole by passage through mouse brain. Given its ability to replicate in mouse brain and its subsequent reisolation from trigeminal ganglia, it was originally considered to be an alphaherpesvirus. Molecular studies have now firmly established MHV-68 to be a gammaherpesvirus. Other gammaherpesviruses have been suggested to cause and in some cases shown to cause neurological disease. Given the isolation history of MHV-68, we have studied the ability of this virus to gain access to, to replicate in and to persist in the mouse CNS. Following intranasal inoculation the virus was not generally neuroinvasive. However, in mice with a deletion of the type-I interferon receptor gene, peripheral virus titres are higher and perivascular CNS infection was observed. There was no evidence of virus spread via olfactory routes. Direct intracerebral inoculation of virus was fatal with widespread infection and destruction predominantly of meningeal and ependymal cells. Hippocampal pyramidal neurons, oligodendrocytes, Bergmann glia cells in the cerebellar cortex and neural progenitor cells in the rostral migratory stream were also infected. A similar infection was observed in younger mice. CNS infection following virus reactivation was investigated by implantation of infected glial cells. Implantation into a brain ventricle led to widespread fatal infection, principally involving ependymal and meningeal cells. Implantation into the striatum resulted in a predominantly neuronal infection. Implantation of cells into mice transiently treated with the antiviral thionucleoside analogue 2'-deoxy-5-ethyl-beta-4'-thiouridine resulted in survival with detection of virus-infected cells in the brain 1 year later.
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Affiliation(s)
- Linda A Terry
- Laboratory for Clinical and Molecular Virology, University of Edinburgh, Summerhall, Edinburgh EH9 1QH, UK1
| | - James P Stewart
- Laboratory for Clinical and Molecular Virology, University of Edinburgh, Summerhall, Edinburgh EH9 1QH, UK1
| | - Anthony A Nash
- Laboratory for Clinical and Molecular Virology, University of Edinburgh, Summerhall, Edinburgh EH9 1QH, UK1
| | - John K Fazakerley
- Laboratory for Clinical and Molecular Virology, University of Edinburgh, Summerhall, Edinburgh EH9 1QH, UK1
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Bhattacharyya AK, Ghosh S. Paediatric facial paralysis. Current opinion in evaluation and management. Indian J Otolaryngol Head Neck Surg 1999; 51:21-7. [PMID: 23119539 PMCID: PMC3451039 DOI: 10.1007/bf02996523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Facial palsy in the paediatric age group is less common than in adults, but poses its own problems because clinical diagnosis and investigations are more difficul. i' perform. In recent years, electroneuronography (EnoG) has proved to be useful for prognosis, and in many endemic areas, neuroborreliosis (Lyme'sDisease) has proved to be the commonest cause of this condition in children. Fortunately the prognosis in children appears to be better than in adults.
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Inci IO, Gedizlioglu M, Mavioglu H, Uzuncan N. IgG index in acute idiopathic peripheral facial palsy. Acta Neurol Scand 1999; 99:117-20. [PMID: 10071171 DOI: 10.1111/j.1600-0404.1999.tb00668.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Etiologic hypotheses in acute idiopathic peripheral facial palsy (AIPFP) mostly point to an immunologic dysfunction, probably virus-induced. Though various immunologic abnormalities are reported, the problem is still unsolved. We investigated intrathecal immunoglobulin synthesis in AIPFP as a clue for central nervous system (CNS) immunopathology. MATERIAL AND METHODS We studied IgG index in 24 patients with AIPFP, 10 with other neurological diseases (OND) and 17 with multiple sclerosis (MS). CSF and serum IgG were measured by radial immunodiffusion technique. IgG index is calculated according to Tibbling's formula. RESULTS IgG indexes were abnormal in 6 patients with AIPFP, 3 with OND and 10 with MS patients. There was no statistical difference between AIPFP and OND groups, while marked difference existed between AIPFP and MS groups. CONCLUSION Though IgG indexes were high in 25% of AIPFP patients, statistical analyses did not show any significance of this finding. Lack of a positive result might reflect non-existence of an extensive immunologic pathology within CNS, excluding a very limited one.
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Affiliation(s)
- I O Inci
- Neurology Dept, Izmir Social Security Hospital, Turkey
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Peltomaa M, Saxen H, Seppälä I, Viljanen M, Pyykkö I. Paediatric facial paralysis caused by Lyme borreliosis: a prospective and retrospective analysis. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1998; 30:269-75. [PMID: 9790136 DOI: 10.1080/00365549850160927] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The incidence of Lyme borreliosis (LB) was studied prospectively in 49 children (< 17 years of age) with 50 episodes of acute FP. In addition, 43 children with a history of FP (average follow-up of 5.2 y) were studied retrospectively for the outcome of FP and for the symptoms and signs of late LB. In the prospective study, 17 (34%) patients with FP proved to have acute LB. They all received antibiotic treatment and their FP had a favourable outcome. In the retrospective study the patients had had FP before the diagnostic tests for LB were available. Thus, none of the 43 patients had been diagnosed to have, or treated for, LB. The outcome of their FP had generally been favourable. None of them had any signs of late LB at the follow-up visit. Our results indicate that LB is a frequent cause of acute paediatric FP in an endemic area. In addition our data suggests that FP caused by LB in children has a favourable prognosis, even when left untreated.
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Affiliation(s)
- M Peltomaa
- Department of Otolaryngology, Helsinki University Central Hospital, Finland
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Jain VK, Hilton E, Maytal J, Dorante G, Ilowite NT, Sood SK. Immunoglobulin M immunoblot for diagnosis of Borrelia burgdorferi infection in patients with acute facial palsy. J Clin Microbiol 1996; 34:2033-5. [PMID: 8818908 PMCID: PMC229180 DOI: 10.1128/jcm.34.8.2033-2035.1996] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
We used immunoblotting to improve the specificity of the serologic diagnosis of Lyme borreliosis in cases of acute facial palsy. Twelve of 15 patients (80%) with suspected Lyme borreliosis, versus 0 of 10 controls, were positive by immunoglobulin M immunoblotting of acute-phase sera and 3 were negative, including 2 with borderline enzyme immunoassay results. Immunoglobulin M immunoblotting is a useful test to confirm Borrelia burgdorferi infection in patients with acute facial palsy and a positive enzyme immunoassay result.
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Affiliation(s)
- V K Jain
- Division of Infectious Diseases, Schneider Children's Hospital, New Hyde Park, New York 11040, USA
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Roberg M, Forsberg P, Frydén A, Hederstedt B, Hydén D, Odkvist L. Long-term findings in patients with facial palsy and antibodies against Borrelia burgdorferi. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1994; 26:559-67. [PMID: 7855553 DOI: 10.3109/00365549409011814] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Little is known about the long-term effects of Borrelia burgdorferi (Bb) infection in untreated patients with peripheral facial palsy. We investigated 12 patients with elevated serum Bb antibody levels, with a median follow-up time of 11 years, during which 3 of the 12 still exhibited intrathecal antibody production of antibodies against Bb flagellar antigen, and 2 of the 3 had normal serum Bb antibodies. Four of the 12 had elevated serum antibody titres at the late follow-up examination. Arthralgia, reported by 7 patients, was the single most common complaint. Four patients showed extensive oculomotor disturbances, which were not correlated to antibody titres or intrathecal antibody synthesis. In 1 of the patients with intrathecal Bb antibody production, most symptoms were eradicated by antibiotic treatment 6 years after the initial infection. We conclude that even several years after a Bb infection, intrathecal Bb antibody production can still occur in serum Bb IgG antibody negative patients with a history of facial palsy.
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Affiliation(s)
- M Roberg
- Department of Infectious Diseases, Faculty of Health Sciences, University Hospital, Linköping, Sweden
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Hanner P, Edström S, Slagsvold P, Kaijser B. Peripheral facial palsy: antibody levels to Borrelia in serum and CSF. Clin Otolaryngol 1993; 18:419-22. [PMID: 8877212 DOI: 10.1111/j.1365-2273.1993.tb00605.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Serum antibodies to Borrelia burgdorferi antigen were determined in 71 consecutive patients with an acute peripheral facial palsy. The study was conducted for one year in a south western coastal region in Sweden. Twenty-one per cent of the patients had significantly elevated serum levels of antibodies to Borrelia burgdorferi antigen. CSF was examined in 13 of the sero-positive patients. In three of these (23%) Borrelia antibodies were found. Another five patients had a pathological protein and cell pattern in the CSF. No seasonal differences were observed. Four of the sero-positive patients had a long-term history of dermatological neurological manifestations compatible with the late third stage of the disease.
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Affiliation(s)
- P Hanner
- Department of Audiology, Sahlgrenska Hospital, University of Göteborg, Gothenburg, Sweden
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Hydén D, Roberg M, Forsberg P, Fridell E, Frydén A, Linde A, Odkvist L. Acute "idiopathic" peripheral facial palsy: clinical, serological, and cerebrospinal fluid findings and effects of corticosteroids. Am J Otolaryngol 1993; 14:179-86. [PMID: 8393307 DOI: 10.1016/0196-0709(93)90027-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION The causes for peripheral facial palsy remain obscure in many patients. Evidence exists suggesting viruses, especially those belonging to the herpesvirus group, may be causative. This study was developed to evaluate this theory. METHODS One hundred forty-seven patients with acute peripheral facial palsy of primarily unknown origin were studied. All were examined within 1 week of onset. Subsequent follow-up was undertaken until the palsy had recovered or become static. Paried cerebral spinal fluid and serum samples were obtained for serological evaluation to detect herpes simplex, varicella zoster, cytomegalovirus, measles, mumps, rubella, tick-borne encephalitis, adenovirus, Epstein-Barr virus, and human immunodeficiency virus, as well as the antibodies to Borrelia burgdorferi. RESULTS Elevated antibiotic titers to Borrelia burgdorferi were observed in 11% of patients, whereas 9% of patients demonstrated elevated viral titers. Antibody pattern consistent with Epstein-Barr virus reactivation was present in 13%. A total of 67% were classified as idiopathic. CONCLUSION Patients with reactivated Epstein-Barr virus were characterized by having a higher incidence of auricular pain and displayed diabetes mellitus in a higher frequency than in other groups. In the Borrelia group, neck/back pain was more common. Healing was less favorable in the Borrelia group despite an equal rate of palsy at onset and adequate antibiotic treatment. Corticosteroid treatment used in 44% of the patients did not significantly improve the functional outcome.
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Affiliation(s)
- D Hydén
- Department of Oto-Rhino-Laryngology, Linköping University, Stockholm, Sweden
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