scholarly journals F.03 Timing of incidence and recovery of delayed facial palsy after vestibular schwannoma resection: insight into mechanisms

2016 ◽  
Vol 43 (S2) ◽  
pp. S19-S19
Author(s):  
S Cháng ◽  
I Despot ◽  
C Dong ◽  
B Westerberg ◽  
R Akagami
Keyword(s):  
Facial Nerve ◽  
Facial Palsy ◽  
Early Onset ◽  
Late Onset ◽  
Bimodal Distribution ◽  
Postoperative Result ◽  
Grade 3 ◽  
One Year ◽  
Timing Of Onset ◽  
Insight Into

Background: Delayed facial palsy (DFP) after resection of vestibular schwannomas (VS) is described as worsening of facial nerve function after a normal postoperative result. Several mechanisms have been postulated to explain this phenomenon, although none satisfactorily explain all of its features. Furthermore, systematic documentation of recovery rates is lacking. Methods: 403 consecutive cases of VS resection between 2001 and 2015 were reviewed. Patients with preoperative facial palsy were excluded. Patients developing significant facial palsy (HB grade ≥ 3) were categorized into groups based on timing of onset: immediate facial palsy (IFP), “early-onset” DFP (within 48 h), and “late-onset” DFP (after 48 h). IFP patients were subdivided into “minor” (HB grade 3) and “major” (HB grade≥4) groups. These groups were compared with respect to demographics, intraoperative data, and recovery. Results: The late-onset DFP group demonstrated the quickest recovery to HB≤2 (2.9 weeks), followed by the minor IFP group (8.5 weeks), then the early-onset DFP group (53 weeks). Major IFP group exhibited the poorest recovery with only 32% recovering to HB grade≤2 within one year. Conclusions: The bimodal distribution in recovery time in delayed facial palsy patients implies separate underlying phenomena. We propose that a delayed demyelination of the facial nerve occurs in late-onset DFP, and best explains the uniformly rapid recovery observed.

Differential Recovery in Early- and Late-Onset Delayed Facial Palsy Following Vestibular Schwannoma Resection

2019 ◽  
Vol 18 (1) ◽  
pp. 34-40 ◽  
Author(s):  
Stephano Chang ◽  
Serge Makarenko ◽  
Ivan Despot ◽  
Charles Dong ◽  
Brian D Westerberg ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Facial Palsy ◽  
Early Onset ◽  
Late Onset ◽  
Motor Evoked Potentials ◽  
Historical Analysis ◽  
Study Cohort ◽  
Postoperative Result ◽  
Nerve Recovery ◽  
Timing Of Onset

AbstractBACKGROUNDDelayed facial palsy (DFP) after resection of vestibular schwannomas (VS) is worsening of facial nerve function after an initially normal postoperative result.OBJECTIVETo characterize different types of DFP, compare recovery rates, and review of series of outcomes in patients following resection of VS.METHODSBetween 2001 and 2017, 434 patients (51% female) with VS underwent resection. We categorized the patients who developed facial palsy into groups based on timing of onset after surgery, immediate facial palsy (IFP), early-onset DFP (within 48 h), and late-onset DFP (after 48 h). Introduction of facial nerve motor-evoked potentials (fMEP) in 2002 and a change of practice utilizing perioperative minocycline in 2005 allowed for historical analysis of these interventions.RESULTSMean age of study cohort was 49.1 yr (range 13-81 yr), with 19.8% developing facial palsy. The late-onset DFP group demonstrated a significantly faster recovery than the early-onset DFP group (2.8 ± 0.5 vs 47 ± 8 wk, P < .0001), had prolonged latency to palsy onset after initiating perioperative minocycline (7.3 vs 12.5 d, P = .001), and had a nonsignificant trend towards faster recovery from facial palsy with use of minocycline (2.6 vs 3.4 wk, P = .11).CONCLUSIONGiven the timings, it is likely axonal degeneration is responsible for early-onset DFP, while demyelination and remyelination lead to faster facial nerve recovery in late-onset DFP. Reported anti-apoptotic properties of minocycline could account for the further delay in onset of DFP, and possibly reduce the rate and duration of DFP in the surgical cohort.

scholarly journals Facial reanimation by hypoglossal-facial neurorrhaphy

2014 ◽  
Vol 33 (01) ◽  
pp. 17-21
Author(s):  
Yvens Barbosa Fernandes ◽  
Ricardo Ramina ◽  
Hélio Sérgio Fernandes Cyrino ◽  
Marcílio Silva Prôa Júnior
Keyword(s):  
Retrospective Study ◽  
Facial Nerve ◽  
Facial Palsy ◽  
Vestibular Schwannomas ◽  
Surgical Results ◽  
Good Outcome ◽  
Facial Reanimation ◽  
Radical Removal ◽  
One Year

Abstract Objective: Facial palsy may still occur after removal of large vestibular schwannomas. The aim of this paper is to describe the outcome of patients submitted to facial reanimation and make a concise revision about modern techniques available to reanimate a paralyzed face. Methods: A retrospective study of was performed about the surgical results of 12 patients submitted to hypoglossal-facial neurorrhaphy. These patients were submitted to radical removal of large vestibular schwannomas (> 3 cm) before and anatomic preservation of the facial nerve was not possible. Results: In 10 cases (83%) patients had a good outcome with House-Brackmann facial grading III. In two other cases the facial grading was IV and VI. All patients were follow-up for at least one year after the reanimation procedure. Conclusion: Hypoglossal-facial neurorrhaphy is a very useful technique to restore facial symmetry and minimize the sequela of a paralyzed face. Long last palsy seemed to be the main reason of poor outcome in two cases.

scholarly journals Predictors of Childhood Intractable Epilepsy- A Retrospective Study in A Tertiary Care Hospital

1970 ◽  
Vol 33 (1) ◽  
pp. 6-15
Author(s):  
AKM Moinuddin ◽  
MM Rahman ◽  
S Akhter ◽  
CA Kawser
Keyword(s):  
Early Onset ◽  
Late Onset ◽  
Intractable Epilepsy ◽  
Childhood Epilepsy ◽  
Care Hospital ◽  
Predictors Of Outcome ◽  
Myoclonic Seizure ◽  
One Year ◽  
Onset Group ◽  
Early Onset Group

Objective: To study the predictors of intractable childhood epilepsy and to comparethe predictors of outcome in early and late onset childhood epilepsy.Design: Retrospective study.Study place: Child Development and Neurology Unit in the Department of Paediatricsof Bangabandhu Sheikh Mujib Medical University (BSMMU).Study period: January 2004 to December 2005.Subjects: Children with epilepsy of 1 month to 15 years of age who attended theepilepsy clinic.Results: The predictors of outcome of childhood epilepsy were analyzed. Accordingto outcome there were two groups, well- controlled group (seizure free for more than 6months) and intractable epilepsy ( one or more seizures per month over a period of 6months). The predictors of early and late onset childhood epilepsy were also compared.Total 73 cases were studied. Out of them 38 patients had early onset epilepsy (lessthan one year) and 35 had late onset epilepsy (more than one year). Median age ofonset of early and late onset of childhood epilepsy group was 3.5 months and 60months respectively. Male and female ratio was 1.53:1 and 0.94:1 in early and lateonset group respectively. Major seizure type was tonic-clonic seizure in 57.9% and77.1% patients of early and late onset group respectively. In this study, 27 (77.1%)patients of late onset and 5(13.2%) patients of early onset group achieved seizureremission. Independent predictors of intractable childhood epilepsy were finally found.Conclusion: In this study symptomatic epilepsy, myoclonic seizure, initial highfrequency of seizure, infantile spasm, neonatal seizures and birth asphyxia weresignificantly higher among early onset group than in late onset group. Early onset ofseizure, myoclonic seizure, initial high frequency of seizure (≥1 seizure/day),symptomatic etiology, neonatal seizure and microcephaly were found independentpredictors of intractable epilepsy.Key words: Early onset; late onset; intractable seizures.DOI: 10.3329/bjch.v33i1.5669Bangladesh Journal of Child Health 2009; Vol.33(1): 6-15

Related Heterogeneity in Pathologically Confirmed Sporadic Alzheimer Disease

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000011772
Author(s):  
Denis S Smirnov ◽  
Douglas Galasko ◽  
Annie Hiniker ◽  
Steven Edland ◽  
David P. Salmon
Keyword(s):  
Early Onset ◽  
Age Of Onset ◽  
Late Onset ◽  
Functional Decline ◽  
Apoe Genotype ◽  
Executive Dysfunction ◽  
Bimodal Distribution ◽  
Cognitive Testing ◽  
Apoe Ε4 ◽  
Age Related

Objective:To characterize age-related clinical heterogeneity in Alzheimer’s disease (AD) and determine if it is modified by APOE genotype or concomitant non-AD pathology, we analyzed data from 1750 patients with sporadic, pathologically-confirmed severe AD.Methods:In this retrospective cohort study, regression and mixed effects models assessed effects of estimated age of onset, APOE genotype, and their interaction on standardized clinical, cognitive and pathologic outcome measures from the National Alzheimer’s Coordinating Center (NACC) database.Results:A bimodal distribution of age of onset frequency in APOE ε4- cases showed best separation at age 63. Using this age cut-off, cases were grouped as early onset (EO) AD ε4- (n=169), EOAD ε4+ (n=273), late onset (LO) AD ε4- (n=511), and LOAD ε4+ (n=797). EOAD were more likely than LOAD patients to present with non-cognitive behavioral or motor symptoms or non-memory cognitive complaints, and had more executive dysfunction, but less language impairment on objective cognitive testing. Age of onset and ε4- genotype were independently associated with lower baseline MMSE and greater functional impairment, and EOAD had faster cognitive and functional decline than LOAD regardless of APOE genotype. EOAD were more likely than LOAD patients to receive a non-AD clinical diagnosis even though they were more likely to have “pure” AD without concomitant vascular or other non-AD neurodegenerative pathology.Conclusions:Early onset sporadic AD is associated with a greater likelihood of an atypical, non-memory dominant clinical presentation, especially in the absence of the APOE ε4 allele, which may lead to misattribution to non-AD underlying pathology.

scholarly journals Age of Onset and Quality of Body Image During a Sex Reassignment Program

2016 ◽  
Vol 9 (1) ◽  
pp. 140-140
Author(s):  
C. Crespi ◽  
◽  
M. Molo ◽  
G. Motta ◽  
F. Lanfranco ◽  
...  
Keyword(s):  
Body Image ◽  
Early Onset ◽  
Age Of Onset ◽  
Late Onset ◽  
Hormonal Treatment ◽  
The Body ◽  
Life Questionnaire ◽  
Sex Reassignment ◽  
One Year

Objective: The aim of the study was to evaluate the quality of body image during a Sex Reassignment Program in a sample of gender dysphoric adults comparing subjects with early onset versus late onset subjects. Design and Method: The sample was composed of 70 gender dysphoric adults (35 transwomen and 35 transmen) before and one year after hormonal treatment. The clinical sessions and the WHO quality of life questionnaire (WHOQOL-100) were used to collect data; in particular we considered the Body Image subscale and some data about plastic surgery. The questionnaire was administered at the beginning of hormonal therapy and at least one year after hormonal treatment to compare the quality of the body image. Results: The majority of the subjects showed a better quality of body image one year after hormonal treatment: the Body Image subscale showed higher scores both in transmen and in transwomen. The comparison between early onset subjects versus late onset subjects didn’t show any statistical significant differences in the quality of body image. Also, no differences have been found between transmen and transwomen. Conclusions: The hormonal treatment showed a positive impact on body image. The quality of the body image doesn’t seem to be influenced by the age of onset.

Age at onset of eating disorders: A statistical validation of proposed cut-offs

2017 ◽  
Vol 41 (S1) ◽  
pp. S550-S551
Author(s):  
G. Patriciello ◽  
A.M. Monteleone ◽  
R. Amodio ◽  
M. Calvanese ◽  
U. Volpe ◽  
...  
Keyword(s):  
Eating Disorders ◽  
Normal Distribution ◽  
Early Onset ◽  
Late Onset ◽  
Age At Onset ◽  
Clinical History ◽  
Bimodal Distribution ◽  
Clinical Feature ◽  
Admixture Analysis ◽  
Statistical Validation

IntroductionDespite age at onset (AAO) of eating disorders (EDs) has classically been described in adolescence; to date there is not an univocal definition. While initial studies described a bimodal distribution of AAO for ED, recently several studies didn’t confirm these findings.ObjectivesAAO thresholds definition for anorexia nervosa (AN) and bulimia nervosa (BN) with statistical validation of proposed cut-offs is highly needed, since AAO represents a crucial clinical feature.AimsWe obtained data from subjects with AN and BN to perform a normal distribution admixture analysis to determine their AAO.MethodsA total of 806 ED patients (792 females; 379 AN and 427 BN) were recruited. Diagnosis of AN and BN were ascertained according to the DSM-IV-TR criteria by means of the SCID – Patient Edition. AAO was assessed by a clinical interview performed by a psychiatrist matched with a systematic review of medical records. To test AAO subgroups, we used a normal distribution admixture analysis.ResultsA bimodal normal distribution of AAO with an early onset and late onset component was found for both AN and BN. Most of the subjects with AN (75.3%) and BN (83.3%) belonged to the early onset group. Both groups had a mean AAO of about 18 years. No significant differences were found concerning the AAO between groups.ConclusionConsider clinical history and course of AAO for EDs may be crucial for planning treatment. To our knowledge, this is the first study that applied a validated statistical procedure to identify AAO cut-off points for AN and BN.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals AN OBSERVATIONAL STUDY OF BACTERIOLOGICAL PROFILE OF REFERRED NEONATES ADMITTED IN ATERTIARY CARE CENTER OF NORTH INDIA

2021 ◽  
Vol 9 (01) ◽  
pp. 680-685
Author(s):  
Divya Mishra ◽  
◽  
Arun Kumar Thakur ◽  
Rashmi Kispotta ◽  
Neeraj a ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Observational Study ◽  
Early Onset ◽  
Late Onset ◽  
Care Center ◽  
North India ◽  
Bacteriological Profile ◽  
Late Onset Sepsis ◽  
Sensitivity Pattern ◽  
One Year

A prospective observational study was conducted in a neonatal unit of referral teaching hospital of North India with an aim to study the bacteriological profile and sensitivity pattern of referred neonates. During this period of one year, incidence of culture positive sepsis was 34 % among which gram-negative bacilli predominated in both early onset and late onset sepsis. In early onset neonatal sepsis, predominant organism was Klebsiella pneumoniae followed by Staph aureus and Acinetobacter. In late onset sepsis, most common organism was again Klebsiella pneumoniae followed by Acinetobacter, Candida, Staph and E. coli. Sensitivity pattern of isolated organism and outcome of referred newborns are presented.

Crocodile tears syndrome after vestibular schwannoma surgery

2012 ◽  
Vol 116 (5) ◽  
pp. 1121-1125 ◽  
Author(s):  
Akira Nakamizo ◽  
Koji Yoshimoto ◽  
Toshiyuki Amano ◽  
Masahiro Mizoguchi ◽  
Tomio Sasaki
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Late Onset ◽  
Retrospective Chart Review ◽  
Clinical Information ◽  
Bimodal Distribution ◽  
Sufficient Information ◽  
Lateral Suboccipital Approach ◽  
The Mean ◽  
Onset Group

Object Crocodile tears syndrome (CTS) is a lacrimal hypersecretion disorder characterized by excessive tearing with gustatory stimulation while eating, drinking, or smelling food. Surgeons tend to overlook CTS after vestibular schwannoma (VS) surgery because its symptoms are less obvious compared with facial paralysis. The authors aim to elucidate the precise incidence and the detailed natural course of CTS after VS surgery. Methods This study included 128 consecutive patients with unilateral VSs resected via a retrosigmoid, lateral suboccipital approach. Clinical information on the patients was obtained by retrospective chart review. The presence of, time of onset of, and recovery of patients from CTS were obtained from the chart or evaluated from the most recent outpatient visit. Results A total of 14 patients (10.9%) developed CTS. Motor function of the facial nerve at discharge was statistically related to the occurrence of CTS (p < 0.001). The odds ratio of House-Brackmann Grade 4 compared with Grade 1 was 86.4 (p < 0.001). A bimodal distribution of CTS onset was observed, with a mean onset of 6.1 ± 4.0 months after resection. The CTS improved in 10 patients (71%) at various intervals, whereas CTS resolved in only 7 patients (50%) at a mean interval of 10.9 ± 7.9 months. The mean interval to recovery in the early-onset group was 9.7 ± 7.9 months, and it was 18 months in the late-onset group; the mean is given ± SD throughout. Conclusions The occurrence of CTS following VS surgery was more common than expected; however, a surgical procedure intended to protect the functioning of the facial nerve appears to be conducive to reduction of the occurrence of CTS. To reduce the distress caused by CTS, all patients should be given sufficient information and provide their informed consent prior to surgery.

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