ABSTRACT
[Objective] This report describes a patient with bilateral peripheral facial paralysis who was strongly suspected to have neurosarcoidosis and whose facial paralysis improved after acupuncture treatment.[Case] A 73-year-old man developed right facial nerve paralysis on July 24, X followed by left facial nerve paralysis three days later. The patient visited our Department of Neurology on August 2 and was hospitalized the next day. Upon examination, neurosarcoidosis was strongly suspected, and steroid pulse therapy was performed until he was discharged from the hospital on August 26. On September 13, still experiencing bilateral facial paralysis, the patient was referred to our department for acupuncture treatment. The patient's height was 159 cm and weight was 48.6 kg. Valley signs and pathologic reflexes were negative, and deep tendon reflexes and sensory tests of the upper and lower extremities were normal. MMT was fair only for the dorsiflexion movement of the left ankle. The Yanagihara score was 26 on the right and 10 on the left. Facial muscle contraction response to electrical acupuncture stimulation targeting the facial nerve showed contraction at 0.04 mA on the right side and no contraction at 0.30 mA on the left side. According to these examinations, the right side was considered to be mildly paralyzed and the left side was considered to be severely paralyzed, and acupuncture was performed to improve the symptoms of paralysis and prevent sequelae.[Treatment] Acupuncture was applied to GB2 and ST7 on the right side of the face. On the left side, acupuncture needles were placed on the frontalis muscle, orbicularis oculi muscle, elevator muscle of upper lip and wing of nose, nasalis muscle, zygomaticus major and minor muscle, orbicularis oris muscle, depressor angle oris muscle, and platysma muscle. From the 106th day of illness, asynchronous electroacupuncture was applied to the left side only. Acupuncture was performed once or twice a week for 10 minutes per session. The degree of paralysis was assessed by the Yanagihara score.[Progress] Acupuncture was combined with corticosteroids prescribed by the Department of Neurology. As a result, the right side had a score of 38 points after 170 days after start of illness and the left side had a score of 38 points after 204 days.[Discussion and Conclusion] The combined treatment of medication and acupuncture was effective and showed excellent results for this patient taking into account the degree of facial nerve damage. Acupuncture may be considered as an effective treatment option for bilateral peripheral facial paralysis.
ABSTRACT
We evaluated body constituent patterns of 130 consecutive patients with symptomatic acute cerebral infarction. They comprise lacunar infarction (n = 47), atherothrombotic infarction (n = 70), cardiogenic embolism (n = 11), and other type of infarction (n = 2). We compared body constituent patterns between them and 93 consecutive patients with other neurological diseases of the same age. We used qi-ketsu-sui scores to evaluate body constituent patterns in all cases. Qi-ketsu-sui scores measure six factors : qi deficiency (kikyo), qi stagnation (kiutsu), qi counterflow (kigyaku), blood deficiency (kekkyo), blood stasis (oketsu), and fluid retention (suitai). As a result of multivariate model analysis, symptomatic acute cerebral infarction had the largest weight of blood stasis and an adjusted odds ratio (95% confidence interval) was 4.6 (2.45-8.91). Even when gender as a confounding factor was adjusted by stratified analysis, adjusted odds ratios of blood stasis (95% confidence interval) were 7.46 (3.02-20.25) for males and 2.63 (1.02-7.11) for females, and those were maximum. The point (median, interquartile range) of blood stasis was more severe in acute cerebral infarction (24 points, 18-33 points) than other neurological diseases (16 points, 9-23 points). We examined relationships between body constituent patterns and clinical disease type, severity at hospitalization, and sex in patients with symptomatic acute cerebral infarction. Ratio of blood stasis was the largest in any clinical disease type, severity and sex. Blood stasis seemed to be the most important factor in symptomatic acute cerebral infarction.
