한 대학병원에서 시행한 벨마비 환자의 임상양상 분석
Clinical Analysis of Bellʼs Palsy in One University Hospital
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Background: Bellʼs palsy (BP) is the most frequent disease of the seventh cranial nerve, and has a relatively good prognosis. However, the precise etiology of the disorder has not been well understood. During the last decade, many researchers have focused on the conditions that are associated with BP, including diabetes, hypertension, and viral infection. We therefore analyzed that the etiology and clinical course of acute BP in patients in one university hospital. Methods: The study comprised 241 BP patients who were examined over a 60-month period. Their clinical history was taken, and neurologic examinations, laboratory tests, electrophysiologic studies, and brain imaging was performed. The clinical severity of the facial palsy was assessed using the House-Brackman (HB) facial nerve grading scale. Patients were followed up once a week during the first month, and for up to 2 months. Results: Of the 241 patients, 103 (43.5%) were men and 138 (56.5%) were women, whose ages were 46.4±16.6 and 48.4±17.6 years, respectively (mean±SD). The initial examination revealed that 36.7% of the cohort had an HB grade below 4, while in 63.3% the HB grade was above 3. Combined symptoms were as follows: postauricular pain (77.5%),increased tear flow (23.4%), taste change (15.6%), and hyperacusis (15.1%). The initial facial nerve conduction study performed within 1 week of presentation revealed a low compound muscle action potential amplitude in 140 (57.8%)and an absent blink reflex in 225 (93%). On follow-up examination, 134 (59%) of the patients exhibited a partial improvement by 4 weeks, and 166 (79.8%) had recovered completely within 2 months. Conclusions: We describe the epidemiologic, clinical, electrophysiologic, and radiologic characteristics of BP patients at one university hospital.
Abstract
Background: Bellʼs palsy (BP) is the most frequent disease of the seventh cranial nerve, and has a relatively good prognosis. However, the precise etiology of the disorder has not been well understood. During the last decade, many researchers have focused on the conditions that are associated with BP, including diabetes, hypertension, and viral infection. We therefore analyzed that the etiology and clinical course of acute BP in patients in one university hospital. Methods: The study comprised 241 BP patients who were examined over a 60-month period. Their clinical history was taken, and neurologic examinations, laboratory tests, electrophysiologic studies, and brain imaging was performed. The clinical severity of the facial palsy was assessed using the House-Brackman (HB) facial nerve grading scale. Patients were followed up once a week during the first month, and for up to 2 months. Results: Of the 241 patients, 103 (43.5%) were men and 138 (56.5%) were women, whose ages were 46.4±16.6 and 48.4±17.6 years, respectively (mean±SD). The initial examination revealed that 36.7% of the cohort had an HB grade below 4, while in 63.3% the HB grade was above 3. Combined symptoms were as follows: postauricular pain (77.5%),increased tear flow (23.4%), taste change (15.6%), and hyperacusis (15.1%). The initial facial nerve conduction study performed within 1 week of presentation revealed a low compound muscle action potential amplitude in 140 (57.8%)and an absent blink reflex in 225 (93%). On follow-up examination, 134 (59%) of the patients exhibited a partial improvement by 4 weeks, and 166 (79.8%) had recovered completely within 2 months. Conclusions: We describe the epidemiologic, clinical, electrophysiologic, and radiologic characteristics of BP patients at one university hospital.
참고문헌 (39)
- Adams RD, "Disease of the peripheral nerve. In: Principle of Neurology. 9th ed", pp.1251~1325 (2009), New York: McGraw Hill
- Brackmann DE, "Cranial nerve VII. IN Textbook of Clinical Neurology. 3rd ed", pp.196~197 (2007), Philadelphia: Saunders
- Jung HY, "Prognostic evaluation of facial palsy", J Korean Acad Rehabil Med, 14, pp.184~189 (1990)
- Coulson SE, "Expression of emotion and quality of life after facial nerve paralysis", Otol Neurotol, 25, pp.1014~1019 (2004)
- 유지훈, "급성 벨마비 환자의 자가보고형 불안 및 우울평가", 대한임상신경생리학회, 11(2), pp.48~53 (2009), 대한임상신경생리학회
- Moon DH, "Prognostic value elactrophysiologic tests in Bellʼs palsy", J Korean Neurol Assoc, 14, pp.781~788 (1996)
- 김태일, "급성 벨마비에서 Acyclovir의 효과", 대한임상신경생리학회, 3(2), pp.122~127 (2001), 대한임상신경생리학회
- Pornchai S, "Clinical prognostic factors for treatment outcome in Bellʼs palsy: A prospective study", J Med Assoc Thai, 91, pp.1182~1188 (2008)
- House JW, "Facial nerve grading system", Otolaryngol Head Neck Surg, 93, pp.146~147 (1985)
- Oh SJ, "Nerve conduction studies. In: Principles of Clinical Electromyography Case Study. 2nd ed", pp.152~153 (1993), New York: Williams & Wilkins
- Kimura J, "Electrophysiological study of Bell palsy: Electrically elicited blink reflex in assessment of prognosis", Arch Otolaryngol, 102, pp.140~143 (1976)
- Peitersen E, "Bellʼs palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies", Acta Otolaryngol Suppl, pp.4~30 (2002)
- Spengos K, "Seasonal variation of Bellʼs palsy in Athens, Greece.a hospitalbased retrospective evaluation over fifteen years", Eur Neurol, 55, pp.84~88 (2006)
- De Diego JI, "Seasonal pattern of idiopathic facial paralysis: a 16-year study", Otolaryngol Head Neck Surg, 120, pp.269~271 (1999)
- 김경집, "Bell마비의 임상적 분석", 대한임상신경생리학회, 9(1), pp.5~10 (2007), 대한임상신경생리학회
- Park HW, "Facial paralysis; Analysis of 500 cases", Arch Phys Med Rehabil, 30, pp.749~761 (1949)
- Adour KK, "The true nature of Bellʼs palsy: analysis of 1000 consecutive patients", Laryngoscope, 88, pp.787~801 (1978)
- Knudstrup P, "Familial peripheral facial palsy", Dan Med Bull, 11, pp.224~225 (1964)
- De-Santo LW, "Bellʼs palsy: ten cases in a family", Arch Otolaryngol, 89, pp.700~702 (1969)
- Murakami S, "Bellʼs palsy and herpes simplex virus: identification of viral DNA in endoneurinal fluid and muscle", Ann Intern Med, 124, pp.27~30 (1996)
- Belec L, "Peripheral facial paralysis and HIV infection:. report of four African cases and review of the literature", J Neurol, 236, pp.411~414 (1989)
- Odebode TO, "Facial nerve palsy after head injury: Case incidence, cause, clinical profile and outcome", J Trauma, 61, pp.388~391 (2006)
- Smith IM, "Bellʼs palsy--which factors determine final recovery", Clin Otolaryngol Allied Sci, 19, pp.465~466 (1994)
- De Diego-Sastre JI, "The epidemiology of Bellʼs palsy", Rev Neurol, 41, pp.287~290 (2005)
- Vasconcelos BC, "Facial nerve paralysis after impacted lower third molar surgery: a literature review and case report", Med Oral PatolOral Cir Bucal, 11, pp.175~178 (2006)
- Yildiz B, "Bellʼs palsy and hepatitis infection", Pediatr Int, 48, pp.493~494 (2006)
- Hilsinger RL Jr, "Idiopathic facial paralysis, pregnancy, and the menstrual cycle", Ann Otol Rhinol Laryngol, 84, pp.433~442 (1975)
- Mastroianni A, "Bellʼs palsy in HIV infection", Minerva, 85, pp.117~119 (1994)
- Ellis SL, "Bellʼs palsy in an older patient with uncontrolled hypertension due to medication nonadherence", Ann Pharmacother, 33, pp.1269~1273 (1999)
- Adour K, "Prevalence of concurrent diabetes mellitus and idiopathic facial paralysis (Bellʼs palsy)", Diabetes, 24, pp.449~451 (1975)
- 박재한, "벨마비의 예후 추정에 있어서 반복적인 전기생리검사의 유용성", 대한근전도 전기진단의학회지, 10(2), pp.107~112 (2008), 대한근전도전기진단의학회
- Bae SB, "Relationship between prognosis and serial electrophysiologic study in Bellʼs palsy", J Korean Neurol Assoc, 17, pp.668~674 (1999)
- 이동희, "벨마비 및 이성대상포진 환자에서 예후인자로서의신경전도검사의 유용성", 대한이비인후과학회지 두경부외과학, 48(10), pp.1205~1210 (2005), 대한이비인후과학회
- Gordana D, "Early prognostic value of electrophysiological tests in Bellʼs palsy-estimating the duration of clinical recovery", Medicine and Biology, 12, pp.47~54 (2005)
- Kohsyu H, "Facial nerve enhancement in Gd-MRI in patients with Bellʼs pals", Acta Otolaryngol Suppl, 511, pp.165~169 (1994)
- Yanagida M, "MRI enhancement of the facial nerve with Gd-DTPA", Nippon Jibinkoka Gakkai Kaiho, 96, pp.1329~1339 (1993)
- Murphy TP, "Magnetic resonance imaging of the facial nerve during Bellʼs palsy", Otolaryngol Head Neck Surg, 105, pp.667~674 (1991)
- Mineta M, "Prognosis and MRI findings in patients with peripheral facial palsy", Nippon Igaku Hoshasen Gakkai Zasshi, 57, pp.110~113 (1997)
- Seok JI, "The usefulness of clinical findings in localising lesions in Bellʼs palsy: comparison with MRI", J Neurol Neurosurg Psychiatry, 79, pp.418~420 (2008)