Facial nerve paralysis

Facial nerve paralysis - 100 mg twice daily for 14 to 21 days. 

An 80-year-old woman had severe difficulty in swallowing and flaccid paralysis of her cervical muscles starting 4 days after the periocular injection of botulinum toxin 120 MU for blepharospasm (12). She also developed bilateral facial nerve paralysis and slurred speech and could not fully close her eyes. Barium swallow and fluoroscopy showed signs of aspiration. The serum concentration of antiacetylcholine receptor antibodies was 6.9 units (reference range 0-0.7 units). Mestinone and prednisone improved her symptoms. She had been treated with botulinum toxin on 18 occasions over the previous 13 years without any untoward effects. 

As with middle ear adenomas, ELSTs occur over a broad age range (average = 40 years) and affect both sexes equally. Unilateral hearing loss, tinnitus, and vertigo are the usual presenting symptoms, occasionally associated with facial nerve paralysis. 

Cramps, Paresthesia, heaviness, and pain in the limbs, facial nerve paralysis, spasms, epilepsy, hemiplegia, migraine, neuralgia, arthritis... 

By destroying the protein, the toxin prevents the release of the neurotransmitter acetylcholine from small packets at the ends of nerves by exocytosis. These nerves, attached to voluntary muscles, need acetylcholine to allow the flow of signals (impulses) between the nerve and the muscle. By preventing the release of acetylcholine, botulinum toxin blocks muscle contraction, causing paralysis and relaxation. The therapeutic action relies on relaxation of muscles, generally in the face. It is therefore used to treat blepharospasm (uncontrolled contractions) and stroke-induced permanent facial muscle contractions. 

Botulism was described much later than tetanus (Kemer 1817 Midura and Amon 1976 Pickett et al. 1976), and this delayed recognition is due to its much less evident symptoms, which include a generalized muscular weakness with diplopia, ptosis, dysphagia, facial paralysis, and reduced salivation and lacrimation. The paralysis then progressively descends to affect the muscles of the trunk, including respiratory and visceral muscles. All the symptoms of botulism can be ascribed to the blockade of skeletal and autonomic peripheral cholinergic nerve terminals (Tacket and Rogawski 1989). 

Surgery for hemifecial spasm involves microvascular decompression of the fecial nerve by placement of a sponge under posterior fossa vessels (Jannetta procedure). Surgery for hemifecial spasm is associated with cure rates exceeding 80%, and beyond 2 years there appears to be little risk of relapse. However, surgical intervention can have serious complications such as permanent facial paralysis, deafness, stroke, and even death. 

IMS in OP-poisoned patients appears 24-96 h after an apparently well-treated acute cholinergic crisis phase. By definition, OP-poisoned patients should completely recover from the cholinergic crisis and then develop a syndrome. Clinically, IMS is characterized by acute paralysis and weakness in the territories of several cranial motor nerves, neck flexors, facial, extraocular, palatal, nuchal, proximal limb, and respiratory muscles 24-96 h after poisoning. Generalized weakness, depressed deep tendon reflexes, ptosis (drooping of the upper eyelids due to paralysis of the third cranial nerve), and diplopia (double vision of an object) are also evident. These symptoms may last for several days or weeks depending on the OP involved. Despite severe AChE inhibition, muscle fasciculations and muscarinic receptor-associated hypersecretory activities are absent. 

Neurological Ataxia, coma, convulsions, papilledema, headache, peripheral neuritis, wristdrop or footdrop, weakness, paralysis, mild facial or ocular motor nerve paresis, aphonia, laryngeal paralysis, fasciculations, encephalopathy, death... 

In the head and neck area, otolaryngologists treat infectious diseases, trauma, and tumors (such as those arising in the aerodigestive tract, thyroid, and salivary glands). They may perform plastic and reconstructive surgery. Cranial nerve disorders (such as facial paralysis) also represent an area of focus for some otorhinolaryngologists. 

Lead falls into a class of poisons called neurotoxins, and has been documented in human remains and artifacts from ancient civilizations Rome (in pipes and hair dyes), Egypt and Greece (in facial makeup), and China (in bronze weapons). A neurotoxin dismpts nerve cells, causing paralysis interferes with the beating of the heart, the rigidity of bones and the elimination of waste kills sperm and causes miscarriages. 

---