[Dysphagia] Tx for Bell's Palsy

[kgoertz at paphr.sk.ca (Clarke-Goertz, Kim (PAPHR))]

Further to Barbara's response, see below an article ICT shared prior on the
listserv.
Kim
-----------------------------------------------------------
Clarke-Goertz, Kim (PAPHR)" <kgoertz@paphr.sk.ca> wrote: 
I spoke with a PT today who said she finds that laser and estim work well
although she acknoweledged little support for either in the literature. 

That would, of course, depend on the exact reason for the swallowing
impairment i.e. which aspect of swallowing dynamics is affected. I've found
it most useful to discuss with the patient appropriate placement of adjusted
consistency foods, rate of eating etc. while waiting for the medical
treatment to be effective. The following seems to cover current thinking:
***
Efficacy of early treatment of Bell's palsy with oral acyclovir and
prednisolone.
 
Otol Neurotol 2003 ;24:948-51 
  
Hato N; Matsumoto S; Kisaki H; Takahashi H; Wakisaka H; Honda N; Gyo K;
Murakami S; Yanagihara N 
 
 
OBJECTIVE: To investigate the therapeutic effects of acyclovir and
prednisolone in relation to the timing of treatment in Bell's palsy. STUDY
DESIGN: This was a retrospective study of 480 Bell's palsy patients who were
treated with oral acyclovir and prednisolone (94 cases) or prednisolone
alone (386 cases). PATIENTS: Patients met the after criteria: (1) severe or
complete Bell's palsy with a score lower than 20 on the 40-point Yanagihara
facial score and (2) treatment started within 7 days after onset. The
patients were treated with oral prednisolone (60-40 mg/day) with or without
oral acyclovir (2,000 mg/day). MAIN OUTCOME MEASURE: Rate of recovery, which
was defined as a facial score of 36 or more, and the absence of contracture
with synkinesis. RESULTS: The overall recovery rate of patients treated with
acyclovir and prednisolone was 95.7 percent, which was better than that of
patients treated with prednisolone alone (88.6%). The recovery rate in
patients who began the combined therapy within 3 days of the onset of palsy
was 100 percent and early treatment resulted in early remission. In
contrast, the recovery rate in patients who started the combined therapy
more than 4 days after onset was 86.2 percent. CONCLUSION: These results
suggest that early diagnosis and treatment within 3 days of the onset of
paralysis are necessary for maximal efficacy of combined acyclovir and
prednisolone therapy for Bell's palsy.
  
   
 
 
Decompression for Bell's palsy: why I don't do it.
  
Eur Arch Otorhinolaryngol 2002 ;259:40-7    
   
Adour KK 
 
 All decompression surgery is based on the lack of understanding that Bell's
palsy is a viral demyelinating disease that is longitudinal--not
perpendicular--to the facial canal and that surgery cannot possibly help a
viral disease. These findings exclude the etiologic possibility of an
"ischemic paralysis" and are in accord with our logically derived belief
that treatment directed to relieve neural entrapment is a wasted effort.
  
   
 
Oculostapedial synkinesis following Bell's palsy.
  
J Laryngol Otol 2000 ;114:135-6    
   
Donne AJ; Homer JJ; Woodhead CJ 
 
A case of oculostapedial synkinesis occurring after Bell's palsy is
described. This rare phenomenon has not previously been reported following
Bell's palsy. The authors discuss the method of objectively proving the
diagnosis, which can be difficult. The patient was successfully treated by
stapedius tendon section under local anaesthesia.
  
   
 
Treatment of Bell's palsy with acyclovir and prednisolone]
   
Nippon Jibiinkoka Gakkai Kaiho 2000 ;103:133-8   
   
Hato N; Honda N; Gyo K; Aono H; Murakami S; Yanagihara N 
 
Many current studies have suggested that herpes simplex virus is a probable
cause of Bell's palsy, and that treatment with antiviral agents such as
acyclovir might benefit the patients. In the present study, 69 patients with
Bell's palsy were treated with oral administration of acyclovir (2000
mg/day) and prednisolone (60-40 mg/day) at Ehime University Hospital between
Oct. 1995 and Dec. 1998. Patients enrolled in this study met the following
criteria: 1) severe or complete paralysis with a score lower than 20 by the
40-point Japanese grading system, and 2) treatment started within 7 days of
onset. The overall recovery rate was 95.7% (66/69). The rate in patients who
started this treatment within 3 days after disease onset was 100%, and this
early treatment was highly efficacious in the prevention of nerve
degeneration and resulted in a significantly better recovery. By comparison,
the recovery rate in patients whose treatment was started 4 days or more
after onset was only 84.2%. All patients who were given a diagnosis of
zoster sine herpete and treated with acyclovir-prednisolone had a good
outcome. These results suggest that early treatment, within 3 days after
palsy onset, is necessary for effective acyclovir-prednisolone therapy of
Bell's palsy.
   
   
Predictability of recovery from Bell's palsy using evoked electromyography.
   
Am J Otol 1994 Nov;15(6):769-71    
   
Sinha PK; Keith RW; Pensak ML 

The role of surgery in the treatment of idiopathic facial paralysis (Bell's
Palsy) has been the subject of much controversy. Some have advocated
aggressive surgical therapy to prevent nerve injury based on evoked
electromyography (EEMG) results. The present study analyzes the outcome of
23 patients who presented with Bell's palsy and were evaluated with EEMG. Of
the 15 patients who showed greater than 90 percent compound action potential
reduction in the affected side, a widely used criterion for surgical
decompression of the facial nerve, almost half (47%) had normal to
near-normal recovery, and only three (20%) had residual severe dysfunction.
Results infer that patients who meet surgical criteria based on EEMG results
but who do not undergo surgery do not show a greater morbidity. The authors
conclude that conservative criteria should be used when recommending facial
nerve decompression.

Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com




-----Original Message-----
From: Barbara C. Sonies [mailto:bsonies@comcast.net]
Sent: Tuesday, December 06, 2005 14:31
To: Meyer, Jennifer; Copeland, Karen; dysphagia@b9.com
Subject: Re: [Dysphagia] Tx for Bell's Palsy



Bells Palsy usually clears on its own in 3-6 weeks (Zemlin)  and other
articles.


> From: "Meyer, Jennifer" <JMeyer@mail.twu.edu>
> Date: Tue, 6 Dec 2005 11:33:56 -0600
> To: "Copeland, Karen" <kcopeland@sjmc.org>, <dysphagia@b9.com>
> Conversation: Tx for Bell's Palsy
> Subject: RE: [Dysphagia] Tx for Bell's Palsy
> 
> One of my graduate students developed a Bell's Palsy this semester.  She
did
> not want to go the medication route so since we have some e-stim equipment
on
> hand, we used it to help limit muscle atrophy while the condition ran it's
> course.  She had only 5 sessions which lasted approx. 30 min. each. during
> which she performed OM ex. or simply ate her lunch.  Within 2-3 weeks her
> Palsy was completely resolved.  I DO NOT claim the e-stim was responsible
for
> a rather quick resolution of the condition, but it might merit further
study?
> Jennifer S. Meyer, M.A. CCC-SLP
> Asst. Clinical Professor
> Texas Woman's University
> 
> -----Original Message-----
> From: dysphagia-bounces@b9.com on behalf of Copeland, Karen
> Sent: Mon 12/5/2005 8:27 AM
> To: dysphagia@b9.com
> Cc: 
> Subject: [Dysphagia] Tx for Bell's Palsy
> 
> 
> 
> 
> 
> I am looking for any information regarding SLP involvement in the
> treatment of Bell's Palsy.  Specifically, what, if any, treatment
> interventions are appropriate and effective?  Also, any good support
> resources would be helpful.  I have a friend who has a friend diagnosed
> following childbirth and they are seeking guidance.
> 
> Thanks in advance.
> karen
> 
> _______________________________________________
> Dysphagia mailing list
> Dysphagia@b9.com
> http://lists.b9.com/mailman/listinfo/dysphagia
> 
> 
> 
> _______________________________________________
> Dysphagia mailing list
> Dysphagia@b9.com
> http://lists.b9.com/mailman/listinfo/dysphagia


_______________________________________________
Dysphagia mailing list
Dysphagia@b9.com
http://lists.b9.com/mailman/listinfo/dysphagia