Peripheral Blood T and B Lymphocyte Subpopulations in Bell's Palsy

Abstract

A prospective clinical, virological and immunological study was performed on 25 consecutive Bell's palsy (BP) patients. Multiple cranial nerve involvement was found in 15 patients. A significant decrease in the peripheral blood T lymphocyte percentage as well as an increase in B lymphocyte percentage (p less than 0.001) were found in 13 of the BP patients during the first 24 days from the clinical onset of the paralysis. No correlation was found between the peripheral blood lymphocyte subpopulations and the patient's age, sex, degree of paralysis or recovery rate. No changes were detected in the levels of immunoglobulins (IgG, IgM), complement (C3, C4) and antiviral antibodies to herpes simplex and zoster, EBV, cytomegalic virus, adenovirus, influenza and mumps. The clinical and immunological data of BP show a similar pattern to those of Guillain-Barre syndrome suggesting that BP may be an antoimmune demyelinating cranial polyneuritis which may be caused by a preceding viral infection.

Bell’s Palsy: An Immune Complex Disease

“…An infectious cause associated with an autoimmune response may be in volved in the disease [1,2], This is in agree ment with the finding of a prolonged immu nological response during the course of the disease [3]. In accordance with an immuno logical dysfunction, elevated serum levels of complement component Clq-and comple ment component C3-containing circulating immune complexes have been reported in the acute stage of Bell's palsy [4,5].…”

“…The cellular immune response in Bell's palsy in some ways resembles the findings in Guillain-Barre syndrome [2,9]. Beneficial treatment of this syndrome with extracor poreal circulation over protein A columns has been reported [10].…”

“…This will enhance the antibody re sponse to the antigen in the immune com plex. Total or partial C4 deficiency has been shown to be related to an increased inci dence of autoimmune disease [6], It has been speculated that an autoimmune reaction fol lowing an infection is an important factor in the pathogenesis of Bell's palsy [1,2,8].…”

Immune Complexes and Complement Components in Bell’s Palsy

“…Lymphocytes from patients with Bell's palsy, when cultured and exposed to periph eral nerve P|L basic protein, show an in vitro response with increased blast transfor mation [1], In the acute stage a depression in the percentage of the T lymphocytes in pe ripheral blood occurs [2][3][4][5] whereas the acti vated T lymphocytes arc increased [6], Fur ther, interferon levels in the serum as mea sured by the antiviral activity were found to be increased in the acute stage of the palsy by some workers [7] and in both the acute and convalescent stages by other workers [Jons son et al, unpublished].…”

Can blood parameters be used to assess the recovery time of Bell's palsy patients? A retrospective case-controlled study

“…Associations with several infectious pathogens, such as cytomegalovirus, Epstein-Barr virus, mumps, rubella and human immunodeficiency virus have also been documented. [12] Among immunological mechanisms, Aviel et al [25] found changes in lymphocyte subsets in peripheral blood at acute phase. Following the description by Abramsky et al [26] of immunemediated mechanisms against the basic myelin protein in the disease's pathogenesis, cellular and humoral Microcirculatory failure theory is another theory proposed in pathogenesis of Bell's palsy.…”