Bell’s Palsy

Neurologic Risk Slight After COVID Vaccines, Extensive Review Shows

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Immune-mediated neurologic events may include Guillain-Barre syndrome or

A photo of a woman receiving a covid vaccination.

Risk associated with SARS-CoV-2 vaccination and Guillain-Barré syndrome (GBS) — or possibly with Bell’s palsy — is slight and shouldn’t change vaccine recommendations, reviewers concluded.

An analysis of 69 papers on neuro-immunologic disease and COVID vaccines showed that 11 studies specifically assessed relationships with GBS, reported Hans-Peter Hartung, MD, of University Hospital Düsseldorf in Germany, and co-authors in JAMA Neurologyopens in a new tab or window.

Ten of these studies found links between GBS and the adenoviral vector vaccines from Johnson & Johnson (Ad.26.COV2.S) or AstraZeneca (ChAdOx1). One also reported an association between GBS and Pfizer’s BNT162b2 mRNA vaccine (Comirnaty). One study showed no connection between GBS and COVID vaccination.

Of four studies that analyzed the occurrence of Bell’s palsy after vaccination, the relationship was unclear.

GBS is an acquired demyelinating polyneuropathy that often begins in the lower extremities and ascends over time with loss of reflexes, causing muscle weakness, or in the most severe cases, paralysis. Some cases start a few days or weeks after respiratory or gastrointestinal viral infection. Often, GBS is reversible.

“GBS remains the neurological condition with the clearest evidence of a causal link with SARS-CoV-2 vaccination,” Hartung and colleagues wrote. “However, neither SARS-CoV-2 nor adenoviruses have been convincingly associated with GBS pathogenesis.”

“In general, evidence that vaccination is causally significant in the pathogenesis of autoimmune neurological syndromes is rarely validated even by large, well-conducted epidemiological studies,” with the exception being vaccine-associated immune thrombosis and thrombocytopenia (VITT)opens in a new tab or window, a rare, specific complication mainly associated with adenoviral vector vaccines, the researchers noted.

“An increased risk of developing other neurological autoimmune disorders has been extensively sought, but only the very low incidence of GBS following adenoviral vector vaccine administration has been supported by significant evidence,” they pointed out.

In June 2021, reports from two countries detailed cases of an unusual variant of GBSopens in a new tab or window associated with the AstraZeneca COVID vaccine. In July 2021, the FDA issued a warningopens in a new tab or window that Johnson & Johnson’s COVID-19 vaccine may trigger GBS in a small number of people.

An analysis of surveillance data in 2022 from the Vaccine Safety Datalink showed the overall risk of GBS was low, but unusually highopens in a new tab or window after the Johnson & Johnson shot. In May 2023, Johnson & Johnson’s Janssen unit requested the voluntary withdrawalopens in a new tab or window of its emergency use authorization for its adenoviral vector COVID vaccine in the U.S., saying the company did not intend to update the shot to address emerging variants.

Hartung and co-authors evaluated 69 unique articles about neurologic disease occurrence or worsening after SARS-CoV-2 vaccination. Neurologic disease included central and peripheral nervous system complications, including autoimmune diseases. Risks were measured against expected or background rates.

In the 11 studies that examined GBS occurrence, the post-vaccination window spanned from 0 to 42 days. In a retrospective study in Mexicoopens in a new tab or window, an association emerged between GBS and the Pfizer vaccine. A case series analysis in the U.K. and Spain showed no relationship between GBS and either adenoviral vector or mRNA vaccination.

Four studies in the analysis assessed Bell’s palsy risk. The window after vaccination ranged from 1 to 30 days, and the association between COVID vaccines and Bell’s palsy “was unclear,” Hartung and colleagues wrote.

The phase III mRNA vaccine trials identified a numerical imbalance of Bell’s palsy in the vaccinated group compared with placebo, they noted. This concern was investigated in the World Health Organization’s VigiBaseopens in a new tab or window, which showed mRNA vaccines did not have a higher reported rate of facial paralysis compared with other viral vaccines. “This finding of no association was supported by an interim analysis of surveillance dataopens in a new tab or window from 6.2 million individuals in the U.S. vaccinated with 11.8 million doses of mRNA vaccine,” the researchers said.

Hartung’s team also reported that other studies in their analysis found no quantifiable excess risk for myasthenia gravis, multiple sclerosis, or neuromyelitis optica spectrum disorders.

All studies in their review had substantial confounding factors, the researchers acknowledged. “Vaccination of a substantial proportion of the world’s population happened after a year of severe pandemic illness and restricted interperson mixing, with background health and environmental risk substantially modifying health and immune exposures,” they wrote.

“The global search for a vaccine solution was met in many quarters by suspicion and criticism of new technology,” they added. Physicians, the public, and politicians were motivated to report perceived complications, and it’s “very unlikely that the risks of vaccination for any associated condition have been underestimated.”

Corticosteroids for Bell`s palsy (idiopathic facial paralysis)

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BACKGROUND: Inflammation and oedema of the facial nerve are implicated in causing Bell’s palsy. Corticosteroids have a potent anti-inflammatory action that should minimise nerve damage. This is an update of a review first published in 2002 and last updated in 2010.

OBJECTIVES: To determine the effectiveness and safety of corticosteroid therapy in people with Bell’s palsy.

SEARCH METHODS: On 4 March 2016, we searched the Cochrane Neuromuscular Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and LILACS. We reviewed the bibliographies of the randomised trials and contacted known experts in the field to identify additional published or unpublished trials. We also searched clinical trials registries for ongoing trials.

SELECTION CRITERIA: Randomised trials and quasi-randomised trials comparing different routes of administration and dosage schemes of corticosteroid or adrenocorticotrophic hormone therapy versus a control group receiving no therapy considered effective for this condition, unless the same therapy was given in a similar way to the experimental group.

DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodology. The main outcome of interest was incomplete recovery of facial motor function (i.e. residual facial weakness). Secondary outcomes were cosmetically disabling persistent sequelae, development of motor synkinesis or autonomic dysfunction (i.e. hemifacial spasm, crocodile tears) and adverse effects of corticosteroid therapy manifested during follow-up.

MAIN RESULTS: We identified seven trials, with 895 evaluable participants for this review. All provided data suitable for the primary outcome meta-analysis. One of the trials was new since the last version of this Cochrane systematic review. Risk of bias in the older, smaller studies included some unclear- or high-risk assessments, whereas we deemed the larger studies at low risk of bias. Overall, 79/452 (17%) participants allocated to corticosteroids had incomplete recovery of facial motor function six months or more after randomisation; significantly fewer than the 125/447 (28%) in the control group (risk ratio (RR) 0.63, 95% confidence interval (CI) 0.50 to 0.80, seven trials, n = 895). The number of people who need to be treated with corticosteroids to avoid one incomplete recovery was 10 (95% CI 6 to 20). The reduction in the proportion of participants with cosmetically disabling sequelae six months after randomisation was very similar in the corticosteroid and placebo groups (RR 0.96, 95% CI 0.40 to 2.29, two trials, n = 75, low-quality evidence). However, there was a significant reduction in motor synkinesis during follow-up in participants receiving corticosteroids (RR 0.64, 95% CI 0.45 to 0.91, three trials, n = 485, moderate-quality evidence). Three studies explicitly recorded the absence of adverse effects attributable to corticosteroids. One trial reported that three participants receiving prednisolone had temporary sleep disturbances and two trials gave a detailed account of adverse effects occurring in 93 participants, all non-serious; the combined analysis of data from these three trials found no significant difference in adverse effect rates between people receiving corticosteroids and people receiving placebo (RR 1.04, 95% CI 0.71 to 1.51, n = 715).

AUTHORS’ CONCLUSIONS: The available moderate- to high-quality evidence from randomised controlled trials showed significant benefit from treating Bell’s palsy with corticosteroids.

Migraine May Raise Risk for Bell’s Palsy, Study Suggests .

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People who experience migraine headaches may be at heightened risk for the form of facial paralysis known as Bell’s palsy, a new study finds.

According to background information in the study, between 11 and 40 people per 100,000 develop Bell’s palsy each year. Most of them recover completely.

Reporting in the Dec. 17 online edition of Neurology, Taiwanese researchers followed two groups of almost 137,000 adults — one group of migraine sufferers and another group without migraines — for an average of three years.

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During that time, 671 of the people in the migraine group developed Bell’s palsy, compared with 365 of the those in the non-migraine group.

Even after the researchers accounted for other factors, such as sex, high blood pressure and diabetes, the study found that people with migraines were twice as likely to develop Bell’s palsy than those without migraines.

“This is a very new association between migraine and Bell’s palsy,” Dr. Shuu-Jiun Wang, of the National Yang-Ming University and Taipei Veterans General Hospital in Taipei, said in a journal news release.