Acupuncture treatment of idiopathic periphereal facial paralysis using two distal points.
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Acupuncture treatment of idiopathic periphereal facial paralysis using two distal points.

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Acupuncture treatment of idiopathic periphereal facial paralysis using two distal points. Acupuncture treatment of idiopathic periphereal facial paralysis using two distal points. Presentation Transcript

  • ACUPUNCTURE TREATMENT OF BELL’S PALSY USING TWO DISTAL PONINTS: SHENMAI (V62) AND HOUXI (ID3) DR. OSCAR RODRIGO MENDIZABAL POLANCO MÉDICO CIRUJANO UNAM ESPECIALISTA EN ACUPUNTURA IPN
  • Definition  Acute unilateral paralysis or paresis of facial expression muscles consistent with a peripheral nerve damage, without a detectable cause. Coker NJ, Vrabec JT: Acute Paralisys of the Facial Nerve. En Bailey BJ, Calhoun KH, Healy GB, Pillsburry HC, Johnson JT et al. Head and Neck Surgery-Otolaryngology. 2006, 4th Ed. Lippincott Williams & Wilkins. Ch 144 pp 1843-1858.
  • Etiology  Associated to viral infections:  HSV 1  EBV  Positive serology in 6-10% of patients Linder T, Bossart W, Bodmer D. Bell’s palsy and herpes simplex virus: fact or mystery? Otol Neurotol 2005;26:109-13.
  • Pathophysiology ??? Facial n. edema Nerve compression Neuropraxia Axonomnesis Neuromnesis Facial palsy Danner CJ. Facial Nerve Paralysis Otolaryngol Clin North Am 2008; 41(3): 619-32,
  • Cuadro clínico
  • Diagnsis  Sudden onset  Unilateral paresis or paralysis of all muscle groups on one side of the face  Absence of central neurological signs  Absence of otic and cerebropontine angle pathology Mattox DE: Clinical Disorders of the Facial nerve. En Cummings CW, Haughey BH, Thomas JR, Harker LA, Flint PW. Cummings Otolaryngology: Head and Neck Surgery. 2005, 4th Ed. Mosby. Ch 147 pp 3333-3354.
  • Stadification House-Brackmann scale Benecke JE: Facial Paralysis. Otlolaryngol Clin N Am. 2002; 35:357-365. I Normal Normal function II Mild Thorough inspection III Moderate Obvious with maximum effort IV Moderately severe Disfigures w/movement V Severe Disfigures at rest VI Complete No movement
  • Treatment  Prednisone 1 mg/kg/day for 7 days.  Antivirals have not shown better outcomes.  85% full recovery at 2 months.  4% sequels after 6 months. Danner CJ. Facial Nerve Paralysis Otolaryngol Clin North Am 2008; 41(3): 619-32.
  • Rehabilitation  Surgical reanimation.  Auricular major N.  Sural N.  Hypoglossal n.  Botox.  Facial excercises. Danner CJ. Facial Nerve Paralysis Otolaryngol Clin North Am 2008; 41(3): 619-32.
  • CHINESE MEDICINE APPROACH
  • Definition  Qi and Xue stagnation in channels and colaterals of the face, mainly the yangming system due to invasión of wind and cold. Zhaofa Z, Ding Z (Editors), Tai W (Translator): Fundament and Clinical Practice of Electroacupuncture. 1994. Beijing Science and Technology Press. Ch 6, pp 185-187. Mayor DF: Electroacupuncture: An Introduction and its use for Periphereal Facial Paralysis. J Chin Med. 2007. 84: 1-19.
  • Staging o Four stages: - Acute stage: from onset to day 7, symptoms usually progressive. - Stable stage: day eight to fourteen. Mayor DF: Electroacupuncture: An Introduction and its use for Periphereal Facial Paralysis. J Chin Med. 2007. 84: 1-19.
  • Staging - Convalesence stage: from day 15 until begining of second month. - Chronic stage: from month 2. Mayor DF: Electroacupuncture: An Introduction and its use for Periphereal Facial Paralysis. J Chin Med. 2007. 84: 1-19.
  • ETIOLOGY AND PATHOPHISIOLOGY
  • Facial paralysis Zheng Qi deficiency Qi/Xue stagnation on Jingluo Poor Qi/Xue circulation on face Jingluo Pre existing phlegm Liver Qi stagnation Wind/cold Couli not compacted
  • Syndromes a) Invasion of wind/cold. b) Jingluo obstuction by wind and phlegm. c) Internal wind due tu Xue deficiency. Zuo Y (Compiler in chief), Zhongbao Z, Yezhong H, Jinwen T, Zhaoguo L (Translators). A Newly Compiled Practical English-Chinese Library of Traditional Chinese Medicine: Chinese Acupuncture and Moxibustion. 2002. Publishing House of Shanghai University of Traditional Chinese Medicine. Ch 5, pp 299-300. Zhaofa Z, Ding Z (Editors), Tai W (Translator): Fundament and Clinical Practice of Electroacupuncture. 1994. Beijing Science and Technology Press. Ch 6, pp 185-187. Ross J: Acupuncture Point Combinations: The Key to Clinical Success. 2005. Churchill Livingstone. Ch 32, pp 426.
  • Treatment Acute stage  distal points; local points with shallow insertion and no manipulation. Stable stage  local points with strong stimulation. Zuo Y (Compiler in chief), Zhongbao Z, Yezhong H, Jinwen T, Zhaoguo L (Translators). A Newly Compiled Practical English-Chinese Library of Traditional Chinese Medicine: Chinese Acupuncture and Moxibustion. 2002. Publishing House of Shanghai University of Traditional Chinese Medicine. Ch 5, pp 299-300.
  • Prevention Avoid spicy foods. Protection from wind and cold. Relaxed emotional life. Zhaofa Z, Ding Z (Editors), Tai W (Translator): Fundament and Clinical Practice of Electroacupuncture. 1994. Beijing Science and Technology Press. Ch 6, pp 185-187. Ross J: Acupuncture Point Combinations: The Key to Clinical Success. 2005. Churchill Livingstone. Ch 32, pp 426.
  • Rehabilitation Focused on stage 4  local points with strong stimulation. Synkinesis (internal wind and K-H deficiency )  very hard to treat. Zhaofa Z, Ding Z (Editors), Tai W (Translator): Fundament and Clinical Practice of Electroacupuncture. 1994. Beijing Science and Technology Press. Ch 6, pp 185-187.
  • Complemetary treatment methods  Low frequency electro acupuncture  Better results compared with manual acupuncture (not to be used during the first 15 days from onset).  Cupping  Moxibustion  Tuina Zhaofa Z, Ding Z (Editors), Tai W (Translator): Fundament and Clinical Practice of Electroacupuncture. 1994. Beijing Science and Technology Press. Ch 6, pp 185-187. Mayor DF: Electroacupuncture: An Introduction and its use for Periphereal Facial Paralysis. J Chin Med. 2007. 84: 1-19. Zuo Y (Compiler in chief), Zhongbao Z, Yezhong H, Jinwen T, Zhaoguo L (Translators). A Newly Compiled Practical English-Chinese Library of Traditional Chinese Medicine: Chinese Acupuncture and Moxibustion. 2002. Publishing House of Shanghai University of Traditional Chinese Medicine. Ch 5, pp 299-300.
  • Points to use  Houxi - Location:  At the ulnar side of the hand, at the depression proximal to the head of the 5th metacarpal, between the two skins. Deadman P, Al-Khafaji M, Baker K: A Manual of Acupuncture. 1998. Journal of Chinese Medicine Publications. Ch 11, pp 233-234.
  • Points to use  Houxi - Actions:  Benefits the nape, neck and back, activates the cannel and relieves pain, disperses wind and hot, calms the spirit and treats epilepsy, clears heat and benefits sense organs, regulates Du Mai. Deadman P, Al-Khafaji M, Baker K: A Manual of Acupuncture. 1998. Journal of Chinese Medicine Publications. Ch 11, pp 233-234.
  • Points to use  Shenmai - Location:  On the lateral aspect of the foot, 0.5 cun inferior to the inferior border of the external maleolus, at a depression posterior to the fibular tendons. Deadman P, Al-Khafaji M, Baker K: A Manual of Acupuncture. 1998. Journal of Chinese Medicine Publications. Ch 11, pp 320-322.
  • Points to use  Shenmai - Actions:  Pacifies internal wind and expells external wind, calms the mind and treats epilepsy, benefits the head and eyes, opens and regulates Yang Qiaomai, activates the cannel and aleviates pain. Deadman P, Al-Khafaji M, Baker K: A Manual of Acupuncture. 1998. Journal of Chinese Medicine Publications. Ch 11, pp 233-234.
  • Material and methods  Inclusion criteria:  Patients between 18 and 70 years old attending to the acupuncture clinic of the ENMyH, with periphereal facial paralysis.
  • Material and methods  Exclusion criteria:  Central facial paralysis.  Periphereal facial paralysis of known cause.  Repetition paralysis.  Evolution greater than two months.
  • Material and methods  Elimination criteria:  Patients who wished to abandon the study.  Patients who did not completed at least 80% of sessions.
  • Material and methods  Variables:  Independent: acupuncture at Houxi (ID3) and Shenmai (V62).  Dependent: staging according to House- Brackmann scale.
  • Material and methods  Technique:  Patient lying on his back.  Needle insertion at the proposed points with monomanual bidigital technique, starting with Shenmai (V62), then Houxi (ID3) on the affected side.
  • Material and methods Wind dispersing manipulation technique at Shenmai (V62). Cold dispersing technique at Houxi (ID3). Needle retention for 30 min, manipulation at 0, 15 and 30 min.
  • Material and methods A total of 3 weekly sessions during 3 consecutive weeks with weekly staging according to House- Brackmann scale.
  • RESULTS  A total of 18 patients, 10 female and 8 male, 15 of them met inclusion criteria. Thirteen completed the three week treatment course.
  • RESULTS 46% 54% Sex distribution female male Male: 8; female: 7
  • RESULTS 46% 54% Laterality right left Left: 8; right: 7
  • RESULTS 10 2 3 0 2 4 6 8 10 12 < 2 weeks < 1 month < 2 months Time of onset
  • RESULTS 1 4 4 2 3 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 21-30 31-40 41-50 51-60 61-70 Age distribution
  • RESULTS 7 6 1 1 0 1 2 3 4 5 6 7 8 VI V IV III Initial stage
  • Name Age Sex Time Side W0 W1 W2 W3 MIR 48 F 5 d L IV III I I AMG 38 M 4 d R V III II I ETJ 69 M 2 m R V IV IV IV VGG 59 M 2 m R V IV III III MEF 42 M 9 d R VI III II I JGS 50 F 7 d L VI IV III III CCP 66 F 9 d R VI V V IV JLA 36 M 3 d R III I I I IIS 34 M 8 d L VI V IV III MZR 45 M 1 m R VI V V V SST 60 M 2 m L V IV III III RTM 30 F 3 s L VI V III - PGF 68 F 7 d L VI V IV - GHA 50 F 8 d L V IV III III AGA 29 F 9 d R V IV II I
  • RESULTS  All of the patients diminished one stage according House-Brackmann scale at the end of week one.  Recovery percentage at week 1 of 25.42% (p<0.05).
  • RESULTS  At the end of week 3, 5 patients (33.3%) were fully recovered, all of them had less tan 10 days of evolution.  Total improvement percentage was 52% (p < 0.05)
  • CONCLUSIONS  Acupuncture at Shenmai (V62) and Houxi (ID3) has a beneficial effect on patients with acute or sub acute Bells palsy and should be considered as an adjuvant to conventional therapy.