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Author Topic: Facial paralysis  (Read 2495 times)

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Offline frenchpat

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Facial paralysis
« on: April 05, 2007, 04:24:16 PM »
Hi all,

I am posting this here as I am not sure that the following is actually a side effect from HAART meds.

My boyfriend had to go to the hospital today for he had a partial paralysis of the face that started 3 days ago. The doctor gave him a variation of acyclovir, a medication that is primarily for treating herpes. He's supposed to take it for two weeks and will return for a check. They also drew some blood for further testing. He's on a pretty standard combination of Sustiva/Viread/Epivir, undetectable with cd4 in the lower 300's.

Because ours is a long distance relationship I could not be with him today. So I am coming here to seek any advice from those who've experienced something similar in the past.

thank you for your help

Pat

edited for a typo the spell checker did not catch
« Last Edit: April 05, 2007, 04:32:12 PM by frenchpat »
People have the power - Patti Smith

Offline Val

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Re: Facial paralysis
« Reply #1 on: April 05, 2007, 04:32:09 PM »
Sorry to hear that, Pat!  Hopefully someone who has more knowledge than I do will chime in to help you.  I will ask my doctor tomorrow and will get back to you.  In the meantime, try and be strong to help your boyfriend.

Love,
Val
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Offline sweetasmeli

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Re: Facial paralysis
« Reply #2 on: April 05, 2007, 04:38:35 PM »
Salut Pat
I've been wondering how you are.

I'm sorry to hear about your boyfriend.

I read my acyclovir info leaflet and there is no mention of paralysis under possible side effects. I'm afraid I don't know anything about side effects of hiv drugs but I'm sure others here who do will speak up soon enough.

I hope he manages to get to the crux of what's causing the problem soon.
Meanwhile my best wishes for a speedy recovery for him and healing thoughts to both of you.

Bisous
Melia xx
« Last Edit: April 05, 2007, 04:42:17 PM by sweetasmeli »
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Offline water duck

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Re: Facial paralysis
« Reply #3 on: April 05, 2007, 04:40:35 PM »
{{{{{{{{{{{{{{{{ PAT }}}}}}}}}}}}}}}}}}

Courage, this too shall pass !!

Bien à toi !!

Siang

Offline Ann

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Re: Facial paralysis
« Reply #4 on: April 05, 2007, 04:43:01 PM »
Hi Pat,

It sounds to me like the doctor suspects an outbreak of shingles is behind the paralysis - although it leaves me wondering if the doc ran additional tests. (the cyclovir family of drugs treats viruses in the herpes family - shingles is part of this family) Something like partial paralysis can also be due to a mild stroke. You might want to get a second opinion on this if it seems like the doc just decided it was shingles without further investigation.

Good luck and keep us posted!

Ann
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"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline puertorico2006

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Re: Facial paralysis
« Reply #5 on: April 05, 2007, 04:44:56 PM »
http://www.utmb.edu/oto/Grand_Rounds_Earlier.dir/Facial_Nerve_Paralysis_1996.txt

dont know if this helps..... 2 main causes for facial paralysis (other than trauma) i pasted below


Bell's Palsy

Bell's palsy is the most common cause of facial paralysis and accounts for
more than half of all cases.  Traditionally, this was considered to be a
diagnosis of exclusion after ruling out all other possible causes.
However, it has recently been considered a positive diagnosis if the
following are present: unilateral weakness of all facial muscles of sudden
onset, possibly associated with a viral prodrome, no evidence of central
nervous system pathology, no evidence of a CPA lesion, no history of
otologic disease.  Patients may exhibit evidence of concomitant sensory
cranial polyneuritis with otalgia or postauricular pain, dysacousis or
hyperacusis, dysgeusia, decreased tearing or epiphora, and facial
hypesthesias/dysesthesias of V or IX .  Although the exact etiology of
Bell's palsy is still unclear, most clinicians believe that herpes simplex
infection is the most likely agent.  This belief is supported by an
increased incidence of HSV antibodies in patients with Bell's palsy when
compared to age-matched controls.

In 1995, Sugita et al were successful in producing an acute and transient
facial paralysis in mice by inoculating herpes simplex virus into their
auricles (104) or tongues (30).  Facial paralysis developed in the mice
between six and nine days after inoculation, lasted for three to seven
days, and then resolved spontaneously.  Histopathological studies of the
facial nerve and nuclei from these mice revealed severe nerve swelling,
vacuolar degeneration, and infiltration of inflammatory cells.  HSV
antigens were detected in the facial nerve, geniculate ganglion, and the
facial nerve nucleus. They concluded that HSV could produce an acute and
transient facial paralysis through a natural infectious route from the
auricle or tongue to the geniculate ganglion.

Murakami et al (1996) also investigated the role of herpes simplex virus
in the pathogenesis of facial paralysis in mice by inoculating mouse
auricles with HSV.  On the third day following inoculation, HSV DNA was
noted in the ipsilateral facial nerve.  On the tenth day, HSV DNA was
noted in both facial nerves and brain stem in the mice with facial
paralysis, but absent in these tissues in the mice without facial
paralysis.  Between days 4 and 20, the neutralization antibody titer was
elevated in all of the mice.  In addition, facial paralysis developed only
on the inoculated side.  They concluded that HSV infection in the facial
nerve and brain stem must be a prerequisite for the development of facial
paralysis and suggested that an immunologic reaction after a viral
infection plays a role in the pathogenesis.

The incidence of Bell's palsy is estimated to be 20 to 30 per 100,000, but
appears to increase with age.  There is an equal male to female ration and
a 3.3 times greater incidence in pregnant females.  The left and right
sides of the face are equally involved, and less than 1% of cases are
bilateral.  The recurrence rate is about 10% and can be ipsilateral or
bilateral.  Patients with diabetes have 4 - 5 times more risk of
developing the disease.  A family history is positive in about 10% of
patients with Bell's palsy.

The most likely site of lesion in Bell's palsy is the meatal foramen
(junction of the internal auditory canal portion of the nerve and the
labyrinthine segment of the nerve), which is considered to be the
narrowest portion of the fallopian canal.  MRI with gadolinium will
usually show enhancement of the labyrinthine portion of the nerve.  As the
edema within the nerve increases, axonal flow and circulation are
inhibited resulting in varying degrees of nerve injury (first, second, and
third degree).  Patients who are most severely affected develop a high
level of third degree injury which can result in the loss of endoneural
tubules and misdirected axonal regeneration. Histological studies from
patients with Bell's palsy who died of nonrelated causes reveal diffuse
demyelination of the facial nerve with lymphocytic infiltrates.

The prognosis for Bell's palsy is generally good with 85 to 90% of
patients recovering completely within one month.  The remaining 15%
progress to complete degeneration and will not usually show signs of
recovery for three to six months.  The longer the time needed for
recovery, the greater the probability of sequelae.  The single most
important prognostic factor is the degree of paralysis.  Patients with
incomplete paralysis will recover with no sequelae 95% of the time.

The treatment of Bell's palsy is variable, ranging from observation to
surgical decompression.  Regardless of treatment given, all patients must
be counselled regarding proper eye care to prevent exposure keratitis.
Patients should use natural tears liberally during the day and should
place lacrilube ointment in the eye at night.  Taping of the eye lids
during sleep may be helpful as well as the use of a moisture chamber.
Patients should avoid fans and dust, and should consider wearing eye
protection when outside in the wind.

Oral prednisone in a divided dosage of 1 mg/kg/day may be helpful in
preventing or lessening degeneration, decreasing synkinesis, and relieving
pain, and may result in earlier recovery.  Patients should be reevaluated
within five days after starting steroids.  If some function is present
(paresis), taper the steroids over the next five days.  If no improvement
is noted, the full dose should be given for an additional ten days, then
tapered over five days.  Oral acyclovir may help improve recovery in
Bell's palsy.  The usual dosage is 500 mg po four times a day for ten
days.  For patients in whom steroids or acyclovir is contraindicated,
observation and eye care may be all that is possible.

Surgical decompression for Bell's palsy is somewhat controversial.  Most
surgeons agree, however, that in patients progressing to total paralysis
within two weeks, with an ENoG demonstrating 90% or greater degeneration,
decompression of the facial nerve may prevent further degeneration and may
improve outcome.  The rationale behind surgical decompression is based on
the assumption that the site of maximal facial nerve injury in Bell's
palsy is within the meatal foramen.  With increasing edema and decreasing
axoplasmic flow and microcirculation a pathological compression injury of
the nerve occurs at this point of maximal constriction.  This can range
from first degree to third degree.  Removal of the compression, if
performed before irreversible injury to the endoneural tubules occurs (two
weeks), will allow for axonal regeneration to occur.  This is usually
accomplished via a middle fossa approach.  Surgical decompression should
not be done in an only hearing ear.

In a retrospective study, Fisch (1981) compared fourteen patients with
>90% degeneration within 1 to 14 days after the onset of facial paralysis
who underwent decompression using the middle fossa approach to thirteen
similar patients who refused surgical decompression.  A subtle but
statistically significant improvement in long-term facial recovery was
noted in the operative group as compared to the patients who refused
surgery.  Fisch concluded that in order to obtain a satisfactory return of
facial function in all cases of Bell's palsy, surgical decompression of
the facial nerve should be performed within 24 hours when results of ENoG
indicate >90% degeneration has occurred.  


Otitis Media

In patients with evidence of acute otitis media, dehiscences in the
fallopian canal may serve as portals for direct bacterial invasion and
inflammation along the nerve.  Facial paralysis may begin within a few
days of onset of an acute otitis media and is usually incomplete.
Treatment includes a wide myringotomy, drainage, and culture with
antibiotic coverage for gram positive cocci and H. flu.  The facial palsy
associated with acute otitis media generally resolves with aggressive
management of the infection.  However, if a total paralysis is present,
serial ENoG should be obtained.  If axonal degeneration reaches > 90%,
surgical exploration and decompression should be performed.

Patients with chronic otitis media may also develop facial paralysis which
is usually secondary to cholesteatoma or from inflammation/osteitis
compressing the facial nerve.  In these cases a high resolution CT should
be obtained, and surgery should be performed as soon as possible
(tympanomastoidectomy, facial nerve exploration and decompression).
Infected Probably: may 2005
Diagnosed: 11/2006

11/28/2006 CD4:309 / VL: 1907 No meds yet
12/27/2006 CD4:339/  VL:1649 No meds yet
  4/28/2007 CD4:550/  VL:1800 No meds :-)

Offline Ann

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Re: Facial paralysis
« Reply #6 on: April 05, 2007, 04:55:31 PM »
Great info Puerto! It looks like the doc suspected Bell's.

Ann
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"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline sweetasmeli

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Re: Facial paralysis
« Reply #7 on: April 05, 2007, 05:28:45 PM »
How bizarre! Even though I'm meant to be going to sleep now I just popped in here to add that my ex experienced partial paralysis after his first mini stroke (TIA) and my dad also had it years ago from Bells Palsy.

Keep us posted Pat.

Melia
/\___/\       /\__/\
(=' . '=)    (=' . '=)
(,,,_ ,,,)/   (,,,_ ,,,)/ Cats rule!

The difference between cats and dogs is that dogs come when called, whereas cats take a message and get back to you.

Yeia kai hara (health and happiness) to everyone!

Offline Christine

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Re: Facial paralysis
« Reply #8 on: April 05, 2007, 05:37:50 PM »
I had Bell's palsy when I was first diagnosed. Doctor did not think it was realted to the hiv. It came on very fast, and lasted about two weeks. Cleared up completely, no lasting effects.

Hope all works out well for your bf.

Christine
Poz since '93. Currently on Procrit, Azithromax, Pentamidine, Valcyte, Levothyroxine, Zoloft, Epzicom, Prezista, Viread, Norvir, and GS-9137 study drug. As needed: Trazodone, Atavan, Diflucan, Zofran, Hydrocodone, Octreotide

5/30/07 t-cells 9; vl 275,000

Offline frenchpat

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Re: Facial paralysis
« Reply #9 on: April 05, 2007, 05:40:27 PM »
Thank you all for the hugs, support and info. I guess now is a time for waiting to see how the drug works. For my boyfriend a time to try to relax and not live in fear... easier said than done.

Pat
People have the power - Patti Smith

Offline frenchpat

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Re: Facial paralysis
« Reply #10 on: April 15, 2007, 04:29:58 AM »
Just to update all who have been suportive here,

my boyfriend is recovering very well and has almost no paralysis left!

 ;D we're happy ;D

thank you all

Pat
People have the power - Patti Smith

Offline Ann

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Re: Facial paralysis
« Reply #11 on: April 15, 2007, 07:41:23 AM »
Hey Pat, thanks for the update. I'd been wondering how it was going and I'm glad to hear he's getting better.

Ann
Condoms are a girl's best friend

Condom and Lube Info  



"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline IzPoz

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Re: Facial paralysis
« Reply #12 on: April 15, 2007, 08:28:55 AM »
Glad to hear he's recovering nicely!

I wish I had seen this earlier, but yes, sounds very much like Bells Pallsy.  I had it twice, actually, bilateral (once on each side).

Since I caught it early for both cases, it cleared up with minimal damage to the facial nerve.  I still have some instances where the muscles in my face are kinda tired or weak, but it's no biggy.  I'm the only one who notices it.

Also, the doctors say it's not related to HIV, but could be related to stress or a viral infection.  So, expect him to possibly to be tired for another couple of weeks or so.  This is normal.

Again, I'm glad that he's clearing up nicely :)
The reason angels can fly is that they take themselves so lightly. ~ Chesterton G. K.

 


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