Efficacy of Early Physical Therapy in Severe Bell’s Palsy

Nicastri, Maria; Mancini, Patrizia; Seta, Daniele De; Bertoli, G. A.; Prosperini, Luca; Toni, Danilo; Inghilleri, Maurizio; Filipo, Roberto

doi:10.1177/1545968313481280

Cited by 47 publications

(71 citation statements)

References 51 publications

(74 reference statements)

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“…Unfortunately, since this retrospective analysis was performed in the framework of a broader study on the management of Bell's palsy patients [Nicastri et al, ], no data on virus detection during the follow‐up are available. Perhaps the major limitation of this study is that the species of HHV‐6 detected in samples were not characterized, so further studies are needed to establish whether the association demonstrated is peculiar to one HHV‐6 species.…”

Section: Discussionmentioning

confidence: 99%

“…This study represents a further attempt to address this issue. In the framework of a broader project designed to gain new insights into the management of Bell's palsy patients [Nicastri et al, ], saliva and sera samples were collected from patients at the onset of paralysis symptoms. The presence of HSV‐1, VZV, and HHV‐6, and the serum antibody response were evaluated retrospectively.…”

Section: Introductionmentioning

confidence: 99%

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Early collection of saliva specimens from Bell's palsy patients: Quantitative analysis of HHV-6, HSV-1, and VZV

et al. 2014

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Bell's palsy is the most common cause of facial paralysis. Although it has been associated with diabetes mellitus, hypertension, pregnancy, and preeclampsia, the etiology of Bell's palsy remains unknown. The reactivation of latent herpes simplex virus (HSV) or varicella-zoster virus (VZV) with subsequent inflammation and entrapment of the facial nerve in the narrow labyrinthine segment has been implicated as a cause of facial paralysis, but the active role of these viruses in Bell's palsy is still discussed. This study quantified HSV-1 DNA, VZV DNA, and HHV-6 DNA in 95 saliva samples collected from patients within 48 hr from the onset of paralysis. HSV-1, VZV, and HHV-6 were detected in 13%, 3%, and 61% of patients, respectively. The detection rate did not differ significantly between patients and a control group of healthy donors. Interestingly, however, the value of HHV-6 DNA copies was significantly higher than that detected in healthy donors. In addition, the mean value of HHV-6 DNA recorded in patients who had at least a one grade improvement of palsy at the first visit was significantly lower than that detected in patients who showed no change in facial palsy grade or an increase of at least one grade. These findings call into question the role of HSV-1 and VZV in the etiology of Bell's palsy, and suggest that HHV-6 may be involved in the development of the disease or that the underlying disease mechanism might predispose patients to HHV-6 reactivation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Early collection of saliva specimens from Bell's palsy patients: Quantitative analysis of HHV-6, HSV-1, and VZV

et al. 2014

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“…In a randomized controlled trial (RCT) by Beurskens and colleagues, 112,113 patients with long-standing NFFP following BP, AN resection, VZV infection, and trauma receiving 3 months of comprehensive facial PT as opposed to being waitlisted demonstrated statistical improvements in patient-reported facial stiffness and FDI scores and quantitative assessment of lip length; however, no statistical benefit was seen in blinded expert-assessed FGS scores 12 months after therapy (level Ib). In the 2014 RCT by Pourmomeny and colleagues, 114 114 An RCT by Nicastri and colleagues 115 demonstrated that 74% of patients with BP presenting with severe to complete FFP (ie, HBG V/ VI) who received combination pharmacologic therapy (CPT) with prednisone and valacyclovir plus comprehensive PT within 10 days of symptom onset progressed to an HBG of I or II as assessed by 1 blinded expert within 6 months, compared with only 48% of those receiving CPT alone (adjusted P 5 .038) (level Ib). In summary, recent evidence supports the use of PT in acute FFP and long-standing NFFP.…”

Section: Physiotherapymentioning

confidence: 98%

An Evidence-Based Approach to Facial Reanimation

Jowett

Hadlock

2015

Facial Plastic Surgery Clinics of North America

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“…Approximately 70% of all patients recover completely, and a higher percentage of improvement is achieved if corticosteroid therapy is prescribed [14,15]. Early physical rehabilitation is performed in severe grades of paresis [16]. Electrical nerve stimulation is a proposed method of accelerating recovery in patients through invoked muscle stimulation but, further studies will be required to assess clinical applicability [17,18].…”

Section: Discussionmentioning

confidence: 99%

Recovery in 61-Year-Old Male After Bell’s Palsy: A Case Report

Heidari¹

2017

Ann Clin Lab Res

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Peripheral facial nerve palsy is the most common cranial nerve motor neuropathy. In majority of the cases, the cause is idiopathic and improvement of facial muscle function begins within first 3 weeks after onset of disease. This report presents a case of 61-year-old male patient who recourse to the emergency department with facial pain and asymmetry followed by peripheral unilateral facial nerve paralysis that there was no obvious cause. The patient eventually was discharged from hospital with an outpatient therapy of corticosteroid for 3 weeks, the regular courses of physical rehabilitation for the facial muscles weakness and recommendation to return for follow up in the future. Finally, after 4 months of treatment, the patient's facial weakness disappeared thoroughly without complication. In most cases, Bell's palsy has a good prognosis and the patients will recover with outpatient therapy without complication.

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Efficacy of Early Physical Therapy in Severe Bell’s Palsy

Abstract: Physical therapy appears to be effective only in the more severe BP (baseline HB grade V/VI), whereas less severe BP (baseline HB grade IV) results in complete spontaneous recovery, regardless of physical therapy.

Cited by 47 publications

References 51 publications

Early collection of saliva specimens from Bell's palsy patients: Quantitative analysis of HHV-6, HSV-1, and VZV

Early collection of saliva specimens from Bell's palsy patients: Quantitative analysis of HHV-6, HSV-1, and VZV

An Evidence-Based Approach to Facial Reanimation

Recovery in 61-Year-Old Male After Bell’s Palsy: A Case Report

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