Bell Paralizi Tedavisinde Alfa Lipoik Asitin Etkinliğinin Değerlendirilmesi

Abstract

Amaç: Bu çalışma, Bell paralizisi tedavisinde alfa-lipoik asidin etkinliğini House-Brackmann derecelendirme sistemi ve elektromyografi kullanarak değerlendirmeyi amaçlamaktadır.

Gereç ve Yöntemler: Bu retrospektif çalışmaya toplam 33 hasta dahil edildi. Hastalar iki gruba ayrıldı. Grup 1, Bell paralizisi tedavisine ek olarak günde 300 mg alfa-lipoik asit alan 18 hastayı içeriyordu. Grup 2, sadece Bell paralizisi tedavisi alan 15 hastayı içeriyordu. Her iki grupta da kabulde, 21. günde ve 3. ayda House-Brackmann derecelendirme skoru kaydedildi. 21. günde yapılan elektromyografi sonuçları da tarandı. Hastalar elektromyografi sonuçlarına göre iyi prognoz (nöropraksi) ve kötü prognoz (aksonotmezis ve nörotmezis) olarak sınıflandırıldı. İki grup House-Brackmann dereceleri ve elektromyografi sonuçlarına göre karşılaştırıldı.

Bulgular: Grup 1, 10 kadın ve 8 erkekten, Grup 2 ise 6 kadın ve 9 erkekten oluşuyordu. Bell felcinin sağda veya solda olmasına göre iki grup arasında fark yoktu. Grupların 21. gün ve 3. aydaki House-Brackmann derecelendirme skoru, başvuru sırasında House-Brackmann derecelendirme skorundan anlamlı derecede düşüktü. House-Brackmann derecelerine göre iki grup arasında anlamlı fark yoktu. Gruplar arasında bileşik kas aksiyon potansiyeli oranı ve prognoz açısından fark yoktu.

Sonuç: Alfa-lipoik asit çeşitli hastalıklarda sinir rejenerasyonu için kullanılmasına rağmen çalışmamızda Bell paralizisi tedavisine anlamlı bir etki göstermemiştir.

Keywords

• Alfa-lipoik Asit
• Elektromyografi
• House-Brackmann Derecelendirme Sistemi
• Bell paralizi

EVALUATION OF THE EFFECTIVENESS OF ALPHA LIPOIC ACID IN THE TREATMENT OF BELL'S PALSY

Abstract

Objective: This study aims to evaluate the efficacy of alpha-lipoic acid in the treatment of Bell’s palsy by using the House-Brackmann grading system and electromyography.

Material and Methods: A total of 33 patients were included in this retrospective study. Patients were divided into two groups. Group 1 included 18 patients who received 300 mg daily alpha-lipoic acid in addition to Bell’s palsy treatment. Group 2 included 15 patients who only received Bell’s palsy treatment. House-Brackmann grading score at admission, 21st day and at 3rd month were noted in both groups. The results of electromyography performed at 21st day were also scanned. Patients were classified as good prognosis (neuropraxia) and poor prognosis (axonotmesis and neurotmesis) according to electromyography results. The two groups were compared according to House-Brackmann grades and electromyography results.

Results: Group 1 consisted of 10 women and 8 men, while Group 2 consisted of 6 women and 9 men. There was no difference between the two groups according to whether Bell’s palsy was on the right or left side. House-Brackmann grading score of the groups at 21st day and 3rd month were significantly lower than House-Brackmann grading score at admission. There was no significant difference between the two groups according to House-Brackmann grades. There was no difference between the groups in terms of compound muscle action potential ratio and prognosis.

Conclusion: Although alpha-lipoic acid is used for nerve regeneration in various diseases, it did not demonstrate a significant effect on Bell’s palsy treatment in our study.

Keywords

• Alpha-lipoic acid
• Bell’s palsy
• Electromyography
• House-Brackmann grading system

References

1. 1. Baugh RF, Basura GJ, Ishii LE, Schwartz SR, Drumheller CM, Burkholder R et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013;149(3 Suppl):1-27.
2. 2. Salinas RA, Alvarez G, Daly F, Ferreira J. Corticosteroids for Bell’s palsy (idiopathic facial paralysis). Cochrane Database Syst Rev. 2010;(3):CD001942.
3. 3. Lockhart P, Daly F, Pitkethly M, Comerford N, Sullivan, F. Antiviral treatment for Bell’s palsy (idiopathic facial paralysis). Cochrane Database Syst Rev. 2009;(4):CD001869.
4. 4. Gantz BJ, Rubinstein JT, Gidley P, Woodworth GG. Surgical management of Bell’s palsy. Laryngoscope. 1999;109(8):1177-88.
5. 5. de Sousa CNS, da Silva Leite CMG, da Silva Medeiros I, Vasconcelos LC, Cabral LM, Patrocínio CFV et al. Alpha-lipoic acid in the treatment of psychiatric and neurological disorders: a systematic review. Metab Brain Dis. 2019;34(1):39-52.
6. 6. Yang L, Wen Y, Lv G, Lin Y, Tang J, Lu J et al. α-Lipoic acid inhibits human lung cancer cell proliferation through Grb2-mediated EGFR downregulation. Biochem Biophys Res Commun. 2017;494(1-2):325-31.
7. 7. Nagamatsu M, Nickander KK, Schmelzer JD, Raya A, Wittrock DA, Tritschler H et al. Lipoic acid improves nerve blood flow, reduces oxidative stress and improves distal nerve conduction in experimental diabetic neuropathy. Diabetes Care. 1995;18(8):1160–7.
8. 8. Han T, Bai J, Liu W, Hu Y. A systematic review and meta-analysis of a-lipoic acid in the treatment of diabetic peripheral neuropathy. Eur J Endocrinol. 2012;167(4):465–71.

9. 9. Eviston TJ, Croxson GR, Kennedy PG, Hadlock T, Krishnan AV. Bell's palsy: aetiology, clinical features and multidisciplinary care. J Neurol Neurosurg Psychiatry. 2015;86(12):1356-61.
10. 10. Croxson GR. The assessment of facial nerve dysfunction. J Otolaryng Soc Austral. 1990;4:252–63.
11. 11. Bayındır T, Tan M, Selimoğlu E. Diagnosis and management of Bell palsy. KBB-Forum. 2011;10(1).
12. 12. House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg. 1985;93(2):146–7.
13. 13. Jung SY, Jung J, Byun JY, Park MS, Kim SH, Yeo SG. The effect of metabolic syndrome on Bell's palsy recovery rate. Acta Otolaryngol. 2018;138(7):670-4.
14. 14. Madhok VB, Gagyor I, Daly F, Somasundara D, Sullivan M, Gammie F et al. Corticosteroids for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev. 2016;7(7):CD001942.
15. 15. Agathos E, Tentolouris A, Eleftheriadou I, Katsaouni P, Nemtzas I, Petrou A et al. Effect of α-lipoic acid on symptoms and quality of life in patients with painful diabetic neuropathy. J Int Med Res. 2018;46(5):1779-90.
16. 16. Papanas N, Ziegler D. Efficacy of α-lipoic acid in diabetic neuropathy. Expert OpinPharmacother. 2014;15(18):2721-31.
17. 17. Vasconcelos GS, Ximenes NC, de Sousa CN, Oliveira Tde Q, Lima LL, de Lucena DF et al. Alpha-lipoic acid alone and combined with clozapine reverses schizophrenia-like symptoms induced by ketamine in mice: Participation of antioxidant, nitrergic and neurotrophic mechanisms. Schizophr Res. 2015;165(2-3):163-70.
18. 18. Ziegler D, Hanefeld M, Ruhnau KJ, Meissner HP, Lobisch M, Schütte K et al. Treatment of symptomatic diabetic peripheral neuropathy with the antioxidant alpha-lipoic acid. A 3-week multicentre randomized controlled trial (ALADIN Study). Diabetologia. 1995;38(12):1425-33.
19. 19. Ametov AS, Barinov A, Dyck PJ, Hermann R, Kozlova N, Litchy WJ et al. The sensory symptoms of diabetic polyneuropathy are improved with alphalipoic acid. The SYDNEY Trial. Diabetes Care 2003;26(3):770-6.
20. 20. Ziegler D, Low PA, Freeman R, Tritschler H, Vinik AI. Predictors of improvement and progression of diabetic polyneuropathy following treatment with α-lipoic acid for 4 years in the NATHAN 1 trial. J Diabetes Complications. 2016;30(2):350-6.