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The records of 42 women with Bell's palsy during pregnancy, and of 91 nonpregnant women, whose dats of onset of Bell's palsy and of the preceding menstrual cycle were precisely known, were studied for factors that might show relation between pregnancy or the menstrual cycle and Bell's palsy. Of the 42 cases in pregnancy, 31 occurred in the third trimester, five in the first two weeks postpartum, and six in the first two trimesters combined. Our calculated frequency of Bell's palsy in pregnant women is 45.1/100,000 births; for nonpregnant women of the same age group the calculated incidence is 17.4/100,000 per year. No causative relation was found between toxemia, hypertension or primigravidity, and Bell's palsy. Over 60% of the cases in nonpregnant women occurred in the first 14 days of the menstrual cycle with peaks on the first and seventh days and near ovulation. No clear evidence for an etiologic relationship was seen with edema or hormonal changes in either pregnancy or the menstrual cycle. A number of factors in pregnancy and the menstrual cycle suggested an etiologic role for herpes simplex virus reactivation in Bell's palsy. There was no evidence that prednisone treatment is contraindicated during pregnancy.
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PMID:Idiopathic facial paralysis, pregnancy, and the menstrual cycle. 16 2

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

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

The clinical feature of isolated unilateral peripheral facial nerve paralysis (PFP), seen in 153 consecutive Nigerians over a 14-year period at the University College Hospital (UCH), Ibadan, are presented. The hospital incidence rate was 2.67 per 10,000 with a mean annual rate of 11 per 100,000. Although males (61%) were more frequently affected than females (39%), the peak incidence for both sexes was in the third decade, and 53% of the cases were between 20 years old and 39 years old. Bell's palsy (ninety-three cases) was the most common type encountered. Hypertension (eleven cases) was associated with PFP only in patients above 50 years old. Herpes zoster infection (six cases) and otogenous (eight patients) were not uncommon. Although conjunctivitis (8%) was the most frequent complication, post-paralytic motor features in the form of synkinesia (eight cases), hemispasmas or contractures, and autonomic disturbances such as the crocodile-tear phenomenon (three cases) and auriculo-temporal syndrome (one case) were rare.
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PMID:Clinical study of unilateral peripheral facial nerve paralysis in Nigerians. 283 Jul 81

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

This study included 625 patients with Bell's palsy and 124 patients with Ramsay Hunt syndrome. Seven percent of the cases of Bell's palsy and 1.6% of the cases of Ramsay Hunt syndrome were associated with diabetes mellitus, while 14.1% of the cases of Bell's palsy and 10.4% of the cases of Ramsay Hunt syndrome were associated with hypertension. In the patients over 40 years of age, rates of association with diabetes and hypertension were 11.2% and 23.0% in Bell's palsy and 1.3% and 10.4% in Ramsay Hunt syndrome, respectively. The rates of diabetes and hypertension in association with Bell's palsy were significantly high compared with those of the general population.
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PMID:Association of diabetes mellitus and hypertension with Bell's palsy and Ramsay Hunt syndrome. 314 32

Eight hundred and seventy-nine patients with Bell's Palsy were seen over a 10-year period. There was a distinct female preponderance and the peak incidence occurred in the second to fourth decades. There did not appear to be an increased incidence of either hypertension or diabetes but there was a definite increased risk during pregnancy. Half of the patients had an incomplete palsy and they all recovered within a few weeks of onset. Those patients with complete palsy but without evidence of degeneration also all recovered but took longer to do so. If degeneration was evident the chance of recovery was only 50 per cent. Steroids did not appear to influence the outcome of Bell's Palsy.
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PMID:Idiopathic facial nerve palsy (the effect of treatment with steroids). 339 32

The average annual incidence of Bell's palsy per 100,000 population in Rochester, Minnesota, for 1968 through 1982 was 25.0 for both sexes combined; crude rates for males and females were 22.8 and 26.9, respectively, based on 85 males and 121 females. The relationship between various clinical features, patient characteristics, and the type of recovery was analyzed. In 206 patients, 28 (14%) experienced incomplete recovery and 178 (86%) had complete recovery, based on evidence in the medical records. Using logistic regression, complete facial weakness, non-ear pain, and hypertension were identified as the most important risk factors for incomplete recovery. Patients were divided into two groups for comparison of treatment results; one group (n = 94) was without any of the three identified risk factors, and the other group (n = 112) consisted of patients who had one or more risk factors. Results suggested that among the latter group, those treated with steroids fared better than those in any of the other treatment groups.
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PMID:Incidence, clinical features, and prognosis in Bell's palsy, Rochester, Minnesota, 1968-1982. 378 75

Hypertension in childhood is diagnosed according to age-adjusted values for each sex. It is more commonly diagnosed now than it was 2 decades ago because blood pressure is more frequently measured in children today. Surgically curable forms of hypertension are not common but usually present as moderate or severe hypertension (diastolic blood pressure greater than or equal to 110 mm Hg). Although many patients in this group are asymptomatic, some present with Bell's palsy, enlarged hearts, heart failure, encephalopathy, or stroke. Newer imaging techniques have proved particularly useful for localizing tumors, such as pheochromocytoma. Many antihypertensive drugs are now available, and therapy should be tailored to the patient's needs, with as few adverse or side effects as possible.
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PMID:Evaluation and management of childhood hypertension. 407 63


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