ABSTRACT
Acute idiopathic facial paralysis, or Bell's palsy, is frequently encountered in clinical practice. The present study compares knowledge of Bell's palsy assessment and management between a group of family physicians and otolaryngologists practising in Nova Scotia. Respondents completed a questionnaire and statistical analyses were performed on selected data. There were similarities regarding Bell's palsy assessment and management, but there were notable differences in the ability to distinguish Bell's palsy on the basis of symptomatic complaints, specific counselling strategies, length of patient follow-up, and use of appropriate diagnostic tests. This needs assessment suggests several areas where a family physician continuing medical education program on management of acute facial paralysis may be beneficial.
Subject(s)
Bell Palsy/diagnosis , Clinical Competence , Family Practice , Otolaryngology , Anti-Inflammatory Agents/therapeutic use , Bell Palsy/drug therapy , Bell Palsy/etiology , Confidence Intervals , Counseling , Data Interpretation, Statistical , Diagnosis, Differential , Education, Medical, Continuing , Family Practice/education , Follow-Up Studies , Glucocorticoids/therapeutic use , Humans , Medical History Taking , Nova Scotia , Otitis Media/diagnosis , Otolaryngology/education , Physical Examination , Pilot Projects , Prednisone/therapeutic use , Prognosis , Surveys and QuestionnairesABSTRACT
Glial cell line-derived neurotrophic factor, the newest member of the transforming growth factor-beta superfamily, has been shown to promote the survival and differentiation of dopaminergic neurons in the ventral mesencephalon. Glial cell line-derived neurotrophic factor has been implicated in both the in vitro and in vivo recovery of mesencephalic dopaminergic cells challenged with the neurotoxins 1-methyl-4-phenylpyridinium and 6-hydroxydopamine. Previous studies have shown increased survival of intrastriatally transplanted dopaminergic cells when followed by infusion of neurotrophic factors such as basic fibroblast growth factor, brain-derived neurotrophic factor and glial cell line-derived neurotrophic factor. However, the effects of glial cell line-derived neurotrophic factor co-administered with dopaminergic cells prior to implantation in the host striatum have not been studied. In the present study, the hypothesis was that treating fetal ventral mesencephalic tissue containing the dopaminergic substantia nigra with glial cell line-derived neurotrophic factor either during storage or at the time of transplantation, would enhance grafted dopaminergic cell survival and functional reinnervation of the host striatum in the unilaterally 6-hydroxydopamine-lesioned rat. To test this hypothesis, two experiments were performed. In the first experimental group (n = 7), fetal ventral mesencephalons from embryonic day 14 rats were maintained in hibernation medium containing glial cell line-derived neurotrophic factor (1 migrogram/ml) at 4 degrees C for six days prior to dissociation and stereotactic implantation into the host striatum: the control group (n = 5) received tissue hibernated without glial cell line-derived neurotrophic factor. The second experimental group (n = 8) received fresh fetal ventral mesencephalic tissue treated with glial cell line-derived neurotrophic factor (0.2 microgram/microliter) while the control group (n = 5) received the fresh graft with no glial cell line-derived neurotrophic factor. Transplantation success was assessed by behavioural analysis (rotometry) and tyrosine hydroxylase immunohistochemistry. Cell counts of tyrosine hydoxylase-stained sections revealed a statistically significant increase in tyrosine hydroxylase-positive neurons in grafts exposed to glial cell line-derived neurotrophic factor during hibernation as compared to control grafts. In addition, there was a statistically significant enhancement of fibre density in the glial cell line-derived neurotrophic factor hibernation graft group as compared to the glial cell line-derived neurotrophic factor fresh graft group. Behavioural analysis three weeks post-grafting exhibited a statistically significant decrease in amphetamine-induced rotations in animals transplanted with glial cell line-derived neurotrophic factor grafts as compared to control grafts. These findings suggest that storing dopaminergic cells in a glial cell line-derived neurotrophic factor-containing medium prior to transplantation increases graft survival, graft derived fibre outgrowth, and behavioural recovery in the adult host. This observation has potential implications for enhancing the efficacy of neural transplantation in the treatment of Parkinson's disease.
