Bell s palsy

Wallace VC, Blackbeard J et al (2007a) Pharmacological, behavioural and mechanistic analysis of HIV-1 gpl20 induced painful neuropathy. Pain 133(l-3) 47-63 Wallace VC, Blackbeard J et al (2007b) Characterization of rodent models of HIV-gpl20 and anti-retroviral-associated neuropathic pain. Brain 130(Pt 10) 2688-2702 Wechsler AF, Ho DD (1989) Bilateral Bell s palsy at the time of HIV seroconversion. Neurology 39(5) 747-748... 

Bell s palsy It increases the recovery time for facial nerve function in Bell s palsy. 

In 120 patients with type 1 diabetes, acarbose lowered postprandial glucose but did not reduce HbAlc (22). Four patients taking acarbose withdrew because of gastrointestinal effects, which improved after withdrawal. One of the placebo group withdrew because of gastrointestinal problems and one other patient taking acarbose withdrew with a Bell s palsy, which was not considered to be related to acarbose. 

If exposure keratopathy is the result of an ocular or systemic abnormaUty, the underlying condition should be addressed. Patients with exposure keratopathy resulting from Bell s palsy or Graves disease often are comanaged by a physician caring for the systemic problem together with the eye care practitioner attending to the ocular complications. 

By 1988 it was possible to summarize the adverse effects reported after the distribution of over 1.8 million doses of plasma-derived hepatitis B vaccine (Table 1) (2). From 1982 onwards, the Centers for Disease Control, the Food and Drug Administration, and the manufacturers, Merck Sharp Dohme, had supported a special surveillance system to monitor spontaneous reports of reactions to plasma-derived hepatitis vaccine. During the first 3 years, about 850 000 persons were immunized. In all, 41 reports were received for one of the following neurological adverse events convulsion (n = 5), Bell s palsy (n — 10), Guillain-Barre syndrome (n = 9), lumbar radiculopathy (n — 5), brachial plexus neuropathy (n = 3), optic neuritis (n — 5), and transverse myelitis (n = 4). Half of these events occurred after the first vaccine dose. However, no conclusive causal association could be made between any neurological adverse event and the vaccine (3). 

There have been reports of interferon alfa-induced cranial nerve palsies, including Bell s palsy. 

Two other cases of Bell s palsy, which reversed after interferon alfa withdrawal, have been reported (60). Although the delay in onset (7.5 and 8 weeks) suggested that interferon alfa might be the cause, one patient had no recurrence after rechallenge. A coincidental adverse event cannot therefore be completely ruled out. 

Ogundipe O, Smith M. Bell s palsy during interferon therapy for chronic hepatitis C infection in patients with haemorrhagic disorders. Haemophilia 2000 6(2) 110-12. 

Hwang I, Calvit TB, Cash BD, Holtzmuller KC. Bell s palsy. A rare complication of interferon therapy for hepatitis C. Am J Gastroenterol 2002 87(Suppl) 207-8. 

Of 49 patients with advanced renal cell carcinoma treated with subcutaneous interleukin-4 (4 micrograms/kg/ day for 28 days followed by a 7-day rest), nine had 13 episodes of grade 4 toxicity (3). Severe unexpected toxic effects included three cases of Bell s palsy and one episode of severe hypoglycemia in a previously well-con-trolled patient with diabetes mellitus. 

In 1995, live virus Varicella vaccine (Oka strain) was licensed in the USA. Of the 6574 reported adverse events 4% (67.5 per 100 000 doses) after immunization were serious, while the majority were minor reactions, such as rash, redness, or injection site pain (9). About 10% of immunized children developed mild chickenpox. A total 193 vaccinees reported neurological symptoms, including Bell s palsy, convulsions, and demyelinating syndromes febrile seizures accounted for half of the cases of convulsions. There were 14 deaths, but a role for the vaccine was not proven. 

Bell s palsy Steroids, acyclovir, artificial tears and lubricants Weakness, paresthesias... 

Hurlbut KM, Bernstein JN, Burgess JL, et al Bell s palsy and frontal lobe functional deficit from ethylene oxide exposure (abstract). Vet Hum Toxicol 34 357, 1992 Kelafant GA, Berg RA, Schleenhaker R Toxic encephalopathy due to 1,1,1-trichloro-ethane exposure. Am J Ind Med 25 439-446,1994 Klees JE, Lash A, Bowler RM, et al Neuropsychologic impairment in a cohort of hospital workers chronically exposed to ethylene oxide. Clin Toxicol 28 21-28,1990 Lauwerys R, Herbrand J, Buchet JP, et al Health surveillance of workers exposed to tetrachloroethylene in dry-cleaning shops. Int Arch Occup Environ Health 52 69-77, 1983... 

D. O. Zenker and E. P. Fowler, Medical Treatment of Sudden Deafness, Meniere s Disease, and Bell s Palsy, New York Stated. Med., 63, 1137 (1963). 

Daptomycin is a fermentation product having a cyclic lipopeptide structure. It is primarily active against Gram-positive infections, especially those involved in skin/skin structure infections. It is given IV but must be administered over a period of 30 minutes or more. It binds to cell membranes and causes depolarization, which interrupts protein, DNA, and RNA synthesis. Daptomycin is bactericidal. Although resistance can be achieved in vitro, resistance has been slow to emerge in the clinic. Patients should be monitored for muscle pain or weakness, because some incidence of elevated serum creatinine phosphokinase is associated with its use. A small number of clinical trial patients also developed conditions related to decreases in nerve conduction (e.g., paresthesias and Bell s palsy). Daptomycin is eliminated primarily by the kidney, so dose adjustment may be necessary in cases of renal insufficiency. 

Facial modeling of a person with right Bell s palsy and a surprised expression by using data from Lo et al. [42]. (a) 3D model (generated using FaceGen) (b) the underlpng mesh. 

Placebo-controlled studies In a doubledummy, randomized, placebo-controUed study of 839 patients aged 18-75 years with Bell s palsy, prednisolone, alone and in combination with valaciclovir, shortened the time to recovery [6 ]. Headache and... 

Engstrom M, Berg T, Stjernquist-Desatnik A, Axelsson S, Pitkaranta A, Hultcrantz M, Kanerva M, Manner P, Jonsson L. Prednisolone and valaciclovir in Bell s palsy a randomised, doubleblind, placebo-controlled, multicentre trial. Lancet Neurol 2008 7(11) 993-1000. 

Neurosarcoidosis most frequently involves the cranial nerves (143,146). A peripheral seventh nerve palsy (Bell s Palsy) is the most common neurologic manifestation of sarcoidosis (29,146). It may be unilateral, bilateral, and frequently predates the diagnosis of sarcoidosis (146). Any other cranial nerve may be affected, and in many series the nerves supplying the extraocular muscles or optic nerves are not rarely involved (148-150). 

Some types of head or facial pain are mediated through three cranial nerves bearing sensory fibers—V, VI, and VII. Most notable among these are trigeminal neuralgia and Bell s palsy. 

Myofascial soft tissue treatment with counterstrain and muscle energy techniques may relieve the facial pain associated with Bell s palsy. The occipitomastoid compression should be released and the temporal bone assisted into normal internal/external rotation. Normal lymphatic flow should be assured by correcting dysfunctions of the cervical spine, cranial motion, and sacrum. C3 should always be evaluated and any dysfunction corrected. 

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