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Published in: BMC Neurology 1/2009

Open Access 01-12-2009 | Research article

Correlates of degree of nerve involvement in early Bell's palsy

Authors: Ru-Lan Hsieh, Chia-Wei Wu, Ling-Yi Wang, Wen-Chung Lee

Published in: BMC Neurology | Issue 1/2009

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Abstract

Background

This study aimed to evaluate the still unknown factors correlating with the degree of nerve involvement in early Bell's palsy.

Methods

This retrospective chart review study of newly diagnosed cases of Bell's palsy was conducted over a three-year period. Information on age, sex, day of onset, comorbidities, corticosteroid use, and electroneurographic test results were collected. The electroneurographic quotient (amplitude of compound muscle action potential on the affected side divided by that on the healthy side and expressed in percent) was used as an index of nerve involvement, with lower quotient indicating more severe disease.

Results

Data were collected on 563 patients. The mean electroneurographic quotient varied inversely with age (p < 0.001) and was higher in patients who used corticosteroids than those who did not (47.1% vs. 40.3%; p = 0.002). There was no correlation between the degree of nerve involvement and sex, season of onset, hypertension, or diabetes.

Conclusion

The degree of nerve involvement in early Bell's palsy correlates positively with age and negatively with corticosteroid use.
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Literature
1.
go back to reference Ushino M, Kondo K, Takeuchi N, Tojima H, Yamaguchi T, Kaga K: Prediction of the prognosis of Bell's palsy using multivariate analyses. Otol Neurotol. 2007, 29: 69-72. 10.1097/mao.0b013e31815c2aa0.CrossRef Ushino M, Kondo K, Takeuchi N, Tojima H, Yamaguchi T, Kaga K: Prediction of the prognosis of Bell's palsy using multivariate analyses. Otol Neurotol. 2007, 29: 69-72. 10.1097/mao.0b013e31815c2aa0.CrossRef
2.
go back to reference Fisch U: Prognostic value of electrical tests in acute facial paralysis. Am J Otol. 1984, 5: 494-498.PubMed Fisch U: Prognostic value of electrical tests in acute facial paralysis. Am J Otol. 1984, 5: 494-498.PubMed
3.
go back to reference Hughes GB: Prognostic tests in acute facial palsy. Am J Otol. 1989, 10: 304-311.PubMed Hughes GB: Prognostic tests in acute facial palsy. Am J Otol. 1989, 10: 304-311.PubMed
4.
go back to reference Adour KK, Hetzler DG: Current medical treatment for facial palsy. Am J Otol. 1984, 5: 499-502.PubMed Adour KK, Hetzler DG: Current medical treatment for facial palsy. Am J Otol. 1984, 5: 499-502.PubMed
5.
go back to reference Smith IM, Heath JP, Murray JAM, Cull RE: Idiopathic facial (Bell's) palsy: a clinical survey of prognostic factors. Clin Otolaryngol. 1988, 13: 17-23. 10.1111/j.1365-2273.1988.tb00276.x.CrossRefPubMed Smith IM, Heath JP, Murray JAM, Cull RE: Idiopathic facial (Bell's) palsy: a clinical survey of prognostic factors. Clin Otolaryngol. 1988, 13: 17-23. 10.1111/j.1365-2273.1988.tb00276.x.CrossRefPubMed
6.
go back to reference Smith IM, Maynard C, Mountain RE, Barr-Hamilton R, Armstrong M, Murray AM: The prognostic value of facial electroneurography in Bell's palsy. Clin Otolaryngol Allied Sci. 1994, 19: 201-203. 10.1111/j.1365-2273.1994.tb01215.x.CrossRefPubMed Smith IM, Maynard C, Mountain RE, Barr-Hamilton R, Armstrong M, Murray AM: The prognostic value of facial electroneurography in Bell's palsy. Clin Otolaryngol Allied Sci. 1994, 19: 201-203. 10.1111/j.1365-2273.1994.tb01215.x.CrossRefPubMed
7.
go back to reference Gantz BJ, Rubinstein JT, Gidley P, Woodworth GG: Surgical management of Bell's palsy. Laryngoscope. 1999, 109: 1177-1188. 10.1097/00005537-199908000-00001.CrossRefPubMed Gantz BJ, Rubinstein JT, Gidley P, Woodworth GG: Surgical management of Bell's palsy. Laryngoscope. 1999, 109: 1177-1188. 10.1097/00005537-199908000-00001.CrossRefPubMed
8.
go back to reference Chow LCK, Tam RCN, Li MF: Use of electroneurography as a prognostic indicator of Bell's palsy in Chinese patients. Otol Neurotol. 2002, 23: 598-601. 10.1097/00129492-200207000-00033.CrossRefPubMed Chow LCK, Tam RCN, Li MF: Use of electroneurography as a prognostic indicator of Bell's palsy in Chinese patients. Otol Neurotol. 2002, 23: 598-601. 10.1097/00129492-200207000-00033.CrossRefPubMed
9.
go back to reference de Ru JA, Braunius WW, van Benthem PP, Busschers WB, Hordijk GJ: Grading facial nerve function: why a new grading system, the MoReSS, should be proposed. Otol Neurotol. 2006, 27: 1030-1036. 10.1097/01.mao.0000227896.34915.4f.CrossRefPubMed de Ru JA, Braunius WW, van Benthem PP, Busschers WB, Hordijk GJ: Grading facial nerve function: why a new grading system, the MoReSS, should be proposed. Otol Neurotol. 2006, 27: 1030-1036. 10.1097/01.mao.0000227896.34915.4f.CrossRefPubMed
10.
go back to reference Hato N, Yamada H, Kohno H, Matsumoto S, Honda N, Gyo K, Fukuda S, Furuta Y, Ohtani F, Aizawa H, Aoyagi M, Inamura H, Nakashima T, Nakata S, Murakami S, Kiguchi J, Yamano K, Takeda T, Hamada M, Yamakawa K: Valacyclovir and prednisolone treatment for Bell's palsy: a multicenter, randomized, placebo-controlled study. Otol Neurotol. 2007, 28: 408-413. 10.1097/01.mao.0000265190.29969.12.CrossRefPubMed Hato N, Yamada H, Kohno H, Matsumoto S, Honda N, Gyo K, Fukuda S, Furuta Y, Ohtani F, Aizawa H, Aoyagi M, Inamura H, Nakashima T, Nakata S, Murakami S, Kiguchi J, Yamano K, Takeda T, Hamada M, Yamakawa K: Valacyclovir and prednisolone treatment for Bell's palsy: a multicenter, randomized, placebo-controlled study. Otol Neurotol. 2007, 28: 408-413. 10.1097/01.mao.0000265190.29969.12.CrossRefPubMed
11.
go back to reference Mehta RP, Zhang S, Hadlock TA: Novel 3-D video for quantification of facial movement. Otolaryngol Head Neck Surg. 2008, 138: 468-472. 10.1016/j.otohns.2007.12.017.CrossRefPubMed Mehta RP, Zhang S, Hadlock TA: Novel 3-D video for quantification of facial movement. Otolaryngol Head Neck Surg. 2008, 138: 468-472. 10.1016/j.otohns.2007.12.017.CrossRefPubMed
12.
go back to reference Seok JI, Lee DK, Kim KJ: The usefulness of clinical findings in localizing lesions in Bell's palsy: comparison with MRI. J Neurol Neurosurg Psychiatry. 2008, 79: 418-420. 10.1136/jnnp.2007.118489.CrossRefPubMed Seok JI, Lee DK, Kim KJ: The usefulness of clinical findings in localizing lesions in Bell's palsy: comparison with MRI. J Neurol Neurosurg Psychiatry. 2008, 79: 418-420. 10.1136/jnnp.2007.118489.CrossRefPubMed
13.
go back to reference Bagger-Sjöbäck D, Remahl S, Ericsson M: Long-term outcome of facial palsy in neuroborreliosis. Otol Neurotol. 2005, 26: 790-795. 10.1097/01.mao.0000178148.98762.00.CrossRefPubMed Bagger-Sjöbäck D, Remahl S, Ericsson M: Long-term outcome of facial palsy in neuroborreliosis. Otol Neurotol. 2005, 26: 790-795. 10.1097/01.mao.0000178148.98762.00.CrossRefPubMed
14.
go back to reference Sinha PK, Keith RW, Pensak ML: Predictability of recovery from Bell's palsy using evoked electromyography. Am J Otol. 1994, 15: 769-771.PubMed Sinha PK, Keith RW, Pensak ML: Predictability of recovery from Bell's palsy using evoked electromyography. Am J Otol. 1994, 15: 769-771.PubMed
15.
go back to reference Jori J, Szekely L, Kiss JG, Toth F: The prognostic value of facial nerve conduction velocity in patients with Bell's palsy. Clin Otolaryngol Allied Sci. 1998, 23: 520-523. 10.1046/j.1365-2273.1998.2360520.x.CrossRefPubMed Jori J, Szekely L, Kiss JG, Toth F: The prognostic value of facial nerve conduction velocity in patients with Bell's palsy. Clin Otolaryngol Allied Sci. 1998, 23: 520-523. 10.1046/j.1365-2273.1998.2360520.x.CrossRefPubMed
16.
go back to reference Vargish L, Schumann SA: For Bell's palsy, start steroids early; no need for an antiviral. J Fam Practice. 2008, 57: 22-25. Vargish L, Schumann SA: For Bell's palsy, start steroids early; no need for an antiviral. J Fam Practice. 2008, 57: 22-25.
17.
go back to reference Adour KK, Hilsinger RL, Callan EJ: Facial paralysis and Bell's palsy: a protocol for differential diagnosis. Am J Otol. 1985, 68-73. Suppl Adour KK, Hilsinger RL, Callan EJ: Facial paralysis and Bell's palsy: a protocol for differential diagnosis. Am J Otol. 1985, 68-73. Suppl
18.
go back to reference Ikeda M, Abiko Y, Kukimoto N, Omori H, Nakazato H, Ikeda K: Clinical factors that influence the prognosis of facial nerve paralysis and the magnitude of influence. Laryngoscope. 2005, 115: 855-860. 10.1097/01.MLG.0000157694.57872.82.CrossRefPubMed Ikeda M, Abiko Y, Kukimoto N, Omori H, Nakazato H, Ikeda K: Clinical factors that influence the prognosis of facial nerve paralysis and the magnitude of influence. Laryngoscope. 2005, 115: 855-860. 10.1097/01.MLG.0000157694.57872.82.CrossRefPubMed
19.
go back to reference Salinas RA, Alvarez G, Ferreira J: Corticosteroids for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev. 2004, 18: CD001942- Salinas RA, Alvarez G, Ferreira J: Corticosteroids for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev. 2004, 18: CD001942-
20.
go back to reference Adour KK, Wingerd J, Bell DN, Manning JJ, Hurley JP: Prednisone treatment for idiopathic facial paralysis (Bell's palsy). New Engl J Med. 1972, 287: 1268-1272.CrossRefPubMed Adour KK, Wingerd J, Bell DN, Manning JJ, Hurley JP: Prednisone treatment for idiopathic facial paralysis (Bell's palsy). New Engl J Med. 1972, 287: 1268-1272.CrossRefPubMed
21.
go back to reference Austin JR, Peskind SP, Austin SG, Rice DH: Idiopathic facial nerve paralysis: a randomized double blind controlled study of placebo versus prednisone. Laryngoscope. 1993, 103: 1326-1333. 10.1288/00005537-199312000-00002.CrossRefPubMed Austin JR, Peskind SP, Austin SG, Rice DH: Idiopathic facial nerve paralysis: a randomized double blind controlled study of placebo versus prednisone. Laryngoscope. 1993, 103: 1326-1333. 10.1288/00005537-199312000-00002.CrossRefPubMed
23.
go back to reference Kannikeswaran N, Mahajan PV, Kamat D: Acute facial asymmetry. Clin Pediatr. 2006, 45: 289-292. 10.1177/000992280604500315.CrossRef Kannikeswaran N, Mahajan PV, Kamat D: Acute facial asymmetry. Clin Pediatr. 2006, 45: 289-292. 10.1177/000992280604500315.CrossRef
24.
go back to reference Kerbavaz RJ, Hilsinger RL, Adour KK: The facial paralysis prognostic index. Otolaryngol Head Neck Surg. 1983, 91: 284-289.CrossRefPubMed Kerbavaz RJ, Hilsinger RL, Adour KK: The facial paralysis prognostic index. Otolaryngol Head Neck Surg. 1983, 91: 284-289.CrossRefPubMed
25.
go back to reference Aramimed M, Valls-Sole J, Cruccu G, Ongerboer de Visseret BW: Disorders of the Cranial Nerves. Neuromuscular Function and Disease: Basic, Clinical, and Electrodiagnostic Aspects. Edited by: Brown WF, Bolton CF, Aminoff MJ. 2002, Philadelphia: W.B. Saunders Company, 1: 761-1 Aramimed M, Valls-Sole J, Cruccu G, Ongerboer de Visseret BW: Disorders of the Cranial Nerves. Neuromuscular Function and Disease: Basic, Clinical, and Electrodiagnostic Aspects. Edited by: Brown WF, Bolton CF, Aminoff MJ. 2002, Philadelphia: W.B. Saunders Company, 1: 761-1
26.
go back to reference Hurley SD, Coleman PD: Facial nerve axotomy in aged and young adult rats: analysis of the glial response. Neurobiol Aging. 2003, 24: 511-518. 10.1016/S0197-4580(02)00097-0.CrossRefPubMed Hurley SD, Coleman PD: Facial nerve axotomy in aged and young adult rats: analysis of the glial response. Neurobiol Aging. 2003, 24: 511-518. 10.1016/S0197-4580(02)00097-0.CrossRefPubMed
27.
go back to reference Nacimiento W, Brook GA, Noth J: Lesion-induced neuronal reorganization in the spinal cord: morphological aspects. Adv Neurol. 1997, 73: 37-59.PubMed Nacimiento W, Brook GA, Noth J: Lesion-induced neuronal reorganization in the spinal cord: morphological aspects. Adv Neurol. 1997, 73: 37-59.PubMed
28.
go back to reference Kostyuk PG: Plasticity in nerve cell function. Monographs of the Physiological Society. 1998, Oxford: Oxford Medical Publications: Clarendon Press, 66-82. Kostyuk PG: Plasticity in nerve cell function. Monographs of the Physiological Society. 1998, Oxford: Oxford Medical Publications: Clarendon Press, 66-82.
29.
go back to reference Kiziltan ME, Uzun N, Kiziltan G, Savrun FK: The influence of age in peripheral facial palsy on brainstem reflex excitability. Neurol India. 2005, 53: 318-322.CrossRefPubMed Kiziltan ME, Uzun N, Kiziltan G, Savrun FK: The influence of age in peripheral facial palsy on brainstem reflex excitability. Neurol India. 2005, 53: 318-322.CrossRefPubMed
30.
go back to reference Gilden DH, Tyler KL: Bell's palsy-is glucocorticoid treatment enough?. New Engl J Med. 2007, 357: 1653-1655. 10.1056/NEJMe078188.CrossRefPubMed Gilden DH, Tyler KL: Bell's palsy-is glucocorticoid treatment enough?. New Engl J Med. 2007, 357: 1653-1655. 10.1056/NEJMe078188.CrossRefPubMed
31.
go back to reference Sullivan FM, Swan IR, Donnan PT, Morrison JM, Smith BH, McKinstry B, Davenport RJ, Vale LD, Clarkson JE, Hammersley V, Hayavi S, McAteer A, Stewart K, Daly F: Early treatment with prednisolone or acyclovir in Bell's palsy. New Engl J Med. 2007, 357: 1598-1607. 10.1056/NEJMoa072006.CrossRefPubMed Sullivan FM, Swan IR, Donnan PT, Morrison JM, Smith BH, McKinstry B, Davenport RJ, Vale LD, Clarkson JE, Hammersley V, Hayavi S, McAteer A, Stewart K, Daly F: Early treatment with prednisolone or acyclovir in Bell's palsy. New Engl J Med. 2007, 357: 1598-1607. 10.1056/NEJMoa072006.CrossRefPubMed
32.
go back to reference Merwarth HR: The occurrence of peripheral facial paralysis in hypertensive vascular disease. Ann Intern Med. 1942, 17: 298-307.CrossRef Merwarth HR: The occurrence of peripheral facial paralysis in hypertensive vascular disease. Ann Intern Med. 1942, 17: 298-307.CrossRef
33.
go back to reference May M, Blumenthal F, Klein SR: Acute Bell's palsy: prognostic value of evoked electromyography maximal stimulation and other electrical tests. Am J Otol. 1983, 5: 1-7.PubMed May M, Blumenthal F, Klein SR: Acute Bell's palsy: prognostic value of evoked electromyography maximal stimulation and other electrical tests. Am J Otol. 1983, 5: 1-7.PubMed
34.
go back to reference Hsieh RL: Re: Cutaneous electrical stimulation in unresolved facial nerve paralysis. Am J Phys Med Rehabil. Hsieh RL: Re: Cutaneous electrical stimulation in unresolved facial nerve paralysis. Am J Phys Med Rehabil.
35.
go back to reference Gantz BJ, Gmuer AA, Holliday M, Fisch U: Electroneurographic evaluation of the facial nerve: method and technical problems. Ann Otol Rhinol Laryngol. 1984, 93: 394-398.CrossRefPubMed Gantz BJ, Gmuer AA, Holliday M, Fisch U: Electroneurographic evaluation of the facial nerve: method and technical problems. Ann Otol Rhinol Laryngol. 1984, 93: 394-398.CrossRefPubMed
36.
go back to reference Silverstein H, McDaniel AB, Hyman SM: Evoked serial electromyography in the evaluation of the paralyzed face. Am J Otol. 1985, 80-87. Suppl Silverstein H, McDaniel AB, Hyman SM: Evoked serial electromyography in the evaluation of the paralyzed face. Am J Otol. 1985, 80-87. Suppl
Metadata
Title
Correlates of degree of nerve involvement in early Bell's palsy
Authors
Ru-Lan Hsieh
Chia-Wei Wu
Ling-Yi Wang
Wen-Chung Lee
Publication date
01-12-2009
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2009
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/1471-2377-9-22

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