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The etiology, frequency and prognosis of recurrent Bell's palsy were studied in patients with peripheral paresis of n.facialis of various etiology. Fourteen (11.9%) of 117 patients with Bell's palsy had a recurrent paresis of n.facialis. Nine of these were of homolateral and five contralateral type. Seven recurrent facial paralyses in idiopathic Bell's palsy (i.e. 10.4% of the patients with idiopathic facial palsy), 3 facial palsies of viral origin (i.e. 8.8% of the patients with viral facial palsy), one in association with diabetes mellitus, one during pregnancy, one combined with positive rheumatic serological tests, and one in a case of Melkersson-Rosenthal syndrome were found. The frequency and heterogenity of etiology of recurrent facial palsies suggest a predisposing factor or immune mechanisms. In eight patients there was within 6 to 8 weeks a good, in two patients a moderate and in four patients a poor recovery of function. The greater reduction of the compound action potential of the m.orbicularis oris in recurrent homolateral facial palsy in relation to patients with single manifestation point out the greater denervation and therefore the poorer prognosis of recurrent palsies. A prophylactic decompression to prevent a third attack of recurrent facial paresis is considered.
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PMID:Recurrent Bell's palsy. Etiology, frequency, prognosis. 7 1

Electrophysiological investigations were carried out on 20 healthy controls and 130 patients with peripheral facial nerve paralysis. The aetiology was as follows: idiopathic (Bell's palsy) in 60 cases, viral in 29, traumatic in 18, postoperative in 4, in connexion with chronic otitis media in 6, diabetes mellitus in 4, positive rheumatological tests in 3, disturbed lipid metabolism in 2, the Melkersson-Rosenthal syndrome in 1, as a complication of pregnancy in 2, and in association with a tumour in 1 case. The compound action potential (CAP) of the orbicularis oris muscle was determinedi n 370 occasions in a right/left comparision, the record of the muscle response was intergrated over the time of action (IAR) on 32 occasions and trison of 255 occasions. The normal values are given in the first place and their dependence of the age of the subject. Then, the prognostic sifnficance of the above-mentioned parameters is investigated in cases of peripheral facial nerve paralysis. It is apparent that the determination of the CAP in a right/left comparison is a valuable prognostic guide as early as the 4th day, insofar as a decrease in this parameter of under 50% can be interpreted as a favourable sign and satisfactory reversal of the paralysis can be expected within 6-8 weeks. By contrast, a decrease of over 70% in the CAP is a bad prognostic sign, indicative of presumably only a poor trend to reversal of the paralysis. An intermediate depression of the CAP in the range of 50-70% signifies an expected moderate recovery within 6-8 weeks ahe case of CAP determination at the time of maximum amplitude depression (as opposed to the 4th day), then a decrease of less than 70% is taken to be indicative of satisfactory functional recovery within 6-8 weeks; a decrease of 95-100% signifies a bad prognosis, whilst a decrease amounting to between 70 and 95% carries an uncertain prognosis. The maximum decrease in amplitude was registered on the 8th day on average; the range lay between the 4th and the 14th day. An exception to these figures was the delayed response of the CAP in the case of 6 patients, 5 of whom showed a maximum decrease during the 3rd week and the last patient as late as the 4th week following the onset of facial nerve paresis. Similar reliance can be placed on the prognostic value of the IAR. however, the decrease in the IAR is smaller than that of the CAP measured on the same potential in a right/left comparison, so that a decrease in the IAR of over 60% can already herald a poor recovery. Repeated determination of the latency in cases of facial nerve paralysis showed that the mean latency value for the entire group of patients was slightly prolonged at the end of the 1st week, but the latency values obtained in any one particular patient are of no prognostic significance. A comparison between CAP and latency values obtained with the opposite (i.e...
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PMID:[Prognostic assessment in peripheral facial nerve paralysis with particular reference to electroneurography (author's transl)]. 18 19

Many arguments lead us to think that a possible etiologic factor in idiopathic Bell's palsy is the ischemia of the facial nerve and that angiography could help in diagnosis: (1) the rapid progress of the paralysis; (2) the correlation between Bell's palsy occurring after embolization of the internal maxillary artery, the middle meningeal artery, the occipital or posterior auricular artery, and their participation in the blood supply of the facial nerve; (3) the already known ischemic third nerve paralysis reported in diabetes and extending further to the facial nerve. Even if it is technically impossible to study Bell's palsy by angiography, it is interesting to understand and consider some complications of embolization and perhaps to envisage a new kind of treatment.
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PMID:[Angiographic study of facial paralyses (author's transl)]. 74 Feb 5

A prospective, controlled, double-blind study was designed to evaluate the effect of steroid treatment on the natural history of Bell's palsy. Fifty-one patients were included in the study between 1972 and 1974. The patients were evaluated and started on treatment within two days of onset of Bell's palsy and followed for six months. Treatment was given in randomized double-blind fashion and consisted of either vitamins or a total of 410 mg of prednisone plus vitamins in descending doses over 10 days. The recovery of facial motor function was determined by three physicians who had no knowledge of the treatment received by the patients. They examined photographs of the patients taken six months after onset of paralysis in eight positions of facial function and categorized them as to complete fair, or poor recovery of facial function. These results of this evaluation were submitted to the biostatistician who broke the treatment code. The results of this study demonstrate no statistically significant beneficial effect of steroid therapy upon recovery from Bell's palsy. Factors considered included the patients' age, sex, the presence of pain, ageusia, hyperacusis, diabetes, hypertension, the progression and degree of palsy, the results of nerve excitability and salivary flow tests, and the time at which recovery was first noted or became complete. Bell's palsy remains without a proven efficacious treatment.
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PMID:The use of steroids in Bell's palsy: a prospective controlled study. 78 39

Four diabetic patients are presented with alternating facial palsy. The term alternating is meant to imply facial nerve paralysis, the onset of which occurs at different points in time on both sides of the face. Clinical findings are presented and a short review of the literature is summarized. The authors conclude that alternating facial palsy is often associated with diabetes mellitus. Alternating facial palsy is an infrequent finding. This is in marked contrast to the unilateral form. Approximately every 13 minutes someone in the United States incurs idiopathic facial paralysis or Bell's palsy (20 persons per 100,000 per year). It is apparent that the majority of unilateral facial palsies fall into the idiopathic category. The alternating form of facial paralysis, however, appears to be an unusual finding in a symptom complex of several diseases which will be discussed. It is the diagnostic significance of this alternating facial paralysis and its occasional association with diabetes mellitus that prompts this report.
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PMID:Alternating Bell's palsy associated with diabetes mellitus. A report of four cases. 103 Jun 53

Diabetes mellitus was present in 11.4 per cent of 684 patients with Bell's palsy, in 28.4 per cent of the sixty-seven with recurrent or bilateral palsy, and in 16.8 percent of the 440 with palsy who were thirty years or older. Diabetes was present in only 3.8 per cent of 27,399 persons thirty years or older who had never had Bell's palsy and who underwent multiphasic health testing. These figures clearly indicate that diabetes is more common among patients with Bell's palsy than among persons who have never had that disease; and that the risk of Bell's palsy is increased in patients with diabetes. The diabetic patient is more prone than the non-diabetic person to nerve degeneration, and this tendency to nerve degeneration is not age-related. Although 10 per cent of our patients with Bell's palsy and known diabetes were younger than thirty-nine years, we now advise screening for blood sugar elevation only for patients who are forty years or older, or who have recurrent or bilateral facial paralysis.
Diabetes 1975 May
PMID:Prevalence of concurrent diabetes mellitus and idiopathic facial paralysis (Bell's palsy). 112 88

The etiology of Bell's palsy is still obscure, but the hypothesis that hypoxia and compression of the nerve induced by edema in the Fallopian canal are the main causes of Bell's palsy is widely accepted. Tojima (1988) reported that the motor nerve conduction velocity (MCV) gradually decreased as degeneration of the nerve fibers progressed in Bell's palsy. The majority of facial nerve fibers are myelinated, and the greater the fiber diameter, the faster the conduction velocity. For this reason, Tojima suggested that Wallerian degeneration in Bell's palsy would begin from the thicker myelinated fibers. The measurement of MCV, however, reveals only the activities of the fastest velocity motor nerve fiber in the nerve trunk. This weak point can be resolved by measurement of the distribution of nerve conduction velocities (DNCV), which was introduced by Hopf in 1962 as the collision method. In the present report, the DNCV of facial nerve was measured using the collision method to estimate the distribution of the diameter of nerve fibers in normal subjects and patients with Bell's palsy and to elucidate the pathophysiology of Bell's palsy. The subjects were 14 normal adults (19 measurements) and 14 patients with Bell's palsy who visited our university clinic within 7 days to 18 days after onset, with no other complications such as diabetes. Results obtained are as follows. 1) The mean DNCV in 14 normal subjects (19 measurements) was unimodal, showing a peak at 20 to 22 m/s. 2) In DNCVs of patients with Bell's palsy, loss of thicker fibers with faster conduction velocity was recognized (11/14, 79%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Electrophysiological study on pathophysiology of Bell's palsy--distribution of nerve conduction velocities (DNCV) in facial nerve with collision method]. 191 58

Over a 10-year period the diagnosis Bell's palsy was made in 1293 patients. The files of 1235 patients were studied; the relevant data were stored in a computer and analysed. Factors analysed included the source of referral of the patients as well as their age and sex, the time of onset of the paralysis, recurrence, side of the face, and pregnancy. The incidence of hypertension, diabetes and other diseases was evaluated. The fate of the nerve is determined to a large extent in the first week of the disease. The nerve excitability test is a reliable predictor of the final outcome. The system of classification of recovery we have used for many years is compared to the International Facial Nerve grading system. If denervation and poor recovery are to be prevented as far as possible, early examination and treatment of selected patients with prednisone is mandatory. An important factor in recovery is the age of the patient.
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PMID:Incidence, prognosis and recovery of Bell's palsy. A survey of about 1000 patients (1974-1983). 232 75

Bell's palsy, an idiopathic facial paralysis of the seventh cranial nerve, is an important entity for clinicians to identify early because prognosis is more favorable with early intervention. Although the etiology is unknown, recent studies have indicated a familial tendency and increased incidence in patients with a history of diabetes, arterial hypertension and serum lipid disturbances. The specificity and severity of signs and symptoms are determined by the facial nerve fibers affected. Various diagnostic tests become an important factor in determining not only the differential diagnoses but also the severity of the occurrence and the prognosis for recovery.
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PMID:Primary care diagnosis and management of Bell's palsy. 235 37

An intensive search for 2 years for patients with Bell's palsy, conducted through the polyclinics, university hospitals and physiotherapy centres in Benghazi, revealed a total of 242 cases. The average annual incidence per 100,000 population was 23.35 and the age-adjusted incidence 35.72. The incidence increased with age up to the sixth decade. Seasonal clustering was noted in the months of December and January. Hypertension and diabetes mellitus were associated in 4.1% and 7% of patients, respectively. Only four patients presented during pregnancy. Recurrent facial paralysis was encountered in 5.4% of patients and was characterized by male preponderance and a tendency to recur more frequently on the same side as the initial paralysis. Familial incidence and bilateral involvement were rare features. Twelve per cent of patients who were followed up had moderate to severe residual weakness.
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PMID:Clinical and epidemiological study of Bell's palsy in Benghazi, Libya. 284 52


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