Varicella and isolated acute peripheral facial nerve palsy: A systematic review on natural history, prognosis and treatment

@#Background & Objective: Varicella is a common infection during childhood and generally self-limiting. However, it can rarely cause neurological complications. Isolated acute peripheral facial palsy (APFP) is extremely rare during primary varicella infection with estimated incidence of <0.01%. There have also been conflicting opinions on its natural history, prognosis and management worldwide. We aimed to establish the natural history, prognosis and treatment for varicella-related isolated APFP in immunocompetent individuals, without co-morbids. Methods: Systematic review was performed with systematic literature search in Google Scholar and PubMed. Data was analysed with statistical analysis software. Results: Thirty cases were included. The complete remission rate of APFP was 66.67% for nontreatment group and 72.22% for treatment group (p=0.643). Early and late treatment group had a similar complete remission rate of 88.89% and 80% respectively (p=1.000). However, early treatment group (within 3 days of onset) had achieved complete remission 3 weeks earlier than the late treatment group (p=0.091). Antiviral group tends to have better outcome than steroid monotherapy group, although statistically insignificant (p=0.055). Conclusions: This condition generally has good prognosis even without treatment. However, early treatment and antiviral therapy may at least accelerate remission and reduce morbidities although these cannot alter the final outcome. Clinicians may consider antiviral therapy if patients present within 3 days of onset. These findings need to be applied with caution, considering the limitations of our review.

<b>The Effectiveness of Acupuncture for Crocodile Tears Syndrome </b> / 日本東洋医学雑誌

I treated crocodile tears syndrome (gustatory-lacrimal reflex) after right facial nerve palsy with acupuncture. The patient was a 74-year-old female. Her right peripheral facial nerve palsy had started one and a half years earlier.<br>Most of her facial nerve palsy symptoms disappeared in about 5 months. Sixteen months after onset of the condition, her crocodile tear phenomenon occurred spontaneously. Three acupuncture points on the face were stimulated with fine needles for 10 minutes. Her crocodile tears disappeared completely with the first acupuncture session. This case suggests the possibility of acupuncture treatment for aberrant regeneration after facial nerve palsy.