Bell Palsy, GBS, chronic fatigue, chronic spacity, RLS

Bell Palsy

onesided facial weakness, paralysis

• viral infx

• HSV most common

Symptoms of bell palsy

• cant close eye

• secretion issue (tears, saliva)

• expresions are difficult

• pain on ear, headache, jaw

• sagging, weakness, paralysis on one side

Non pharm bell palsy

Protect the eye

• eyepatch at night, tape eyelid closed

• sunglasses, goggles in day

• eyedrops to keep mois

  • drops in day

  • eye ointment at night

Bell Palsy tx

for all - want early tx within 72 hours of onset with CS

• prednisone 60-80mg/day for 1 wk

• prednisolone 60mg/day 5 days, reduced by 10mg daily UF

• no effect in children.

If severe, antiviral tx

Bell palsy is common in

pregnant women - 3rd trimester

• acetaminophen and non drug tx

• CS - caution, clef palate risk in 1st trimester

Breastfeeding

• CS ok, antivirals preferred.

monitoring bell palsy

facial expression, function - want full recovery with treatment

monitor CS side effects

do GBS pts resolve?

yes, most can walk independently at 6 months - 1 year after dx

• no cure, just supportive measures.

Tx for GBS

1. plasma exchange - remove aby that do nerve damage (AE: sepsis, hypotension)

2. High dose immunoglobulin tx (preferred) - neutralize aby

both best if started 2-4 weeks of neuropathic symptoms

GBS symptoms

initially bilateral weakness, burning, tingling in legs and arm, upper body, face

severe, delayed:

• breathing issue, swallowing, irregular HR, BP, bladder issue, walking issue

Can you get GBS from injection

1 / 1 million get it

if got GBS from vaccine and need more vaccines in that series do not complete series

withhold all imunnizations for a year after onset of GBS

GBS

autoimmune disease - body immunse system attack peripheral nervous system

• triggered by infection → weakness and parlysis of limbs (from attack of mylein sheath)

• Weakness, tingling of legs

Chronic fatigue syndrome

resting doesnt improve symptoms

Chornic fatigue presentation

• muscle, joint pain

• headahce

• sleep dysfunction

• cognitive issue

• GI abnormality, HR, hypersensitivity to light and sound

Assessment for chronic fatigue

1. SCHOLARE the symptoms

2. more testing for differential diagnosis

3. if everything normal → chronic fatigue

non pharm for chronic fatigue

symptomatic management of the symptom that bothers them the most

• no cure to chronic fatigue

Sleep hygiene

CBT

graded exercise

Activity pacing

balanced diet

Pharm tx for chronic fatigue

Sedatives

• antihistamine (dozylamine)

• hypnotic at lowest dose

Rituximab?

*****Stimulannts and TCA NOT RECOMMENDED

Chronic spasticity

increased in muscle tone - stiff, tighten

• imbalanced of excitatory and inhibitory input

chronic spacicity

• issue with reflexes, involuntary mvt

• , limited mvt

• deformity,

• skin brkdwn

in spasticity do we treat it?

can worsen gait and mvt by unmasking weakness in limbs

• only tx if cause pain and interfere with daily function

nonpharm for chronic spasticity (tailor to pt)

functional electrical stimulation

braces

daily stretching and exercise

Pharm tx (only if affecting daily life)

Focal (in one area)

• botulinum toxin or phenol injection (Q6months

• surgery to cut off nerve to muscle

General spasticity

• baclofen

• tizanidine

• gabapentin

• THC/CBD spray

• BZD

• baclofen intrathecal

Baclofen sudden d/c can lead to

seizure, hallucination, confusion

• need to taper.

(dont use in <12)

Tizanidine

don’t use in <18

spasticity improves with

hours to days of starting meds

RLS symptoms

• worse at night and inactivity

  • improve with activity

• want to move leg and have sensation of tugging or pulling (burning, nagging, aching, electric, itching)

medically induced RLS

• iron deficiency most common

• MS
  PD

• DM

• ESRD

• venous insufficiency

Drugs that worsen RLS

• EtOH

• caffiene

• nicotine

• anti-depressants (minus bupropion)

• antipsychotics

• antiepileptics (topiramate)

• 1st gen antihistamines

intermittent RLS

<2x week, PRN tx

chronic persistent RLS

>2x a week, mod-severe, need daily tx

refractory RLS

unresponsive to max dose of 1st line, inadequate response →augmentation

nonpharm for RLS

• mental stimulation (puzzle) to remove boredom

• avoid ETOH, caffeine, nicotine

• stretching, massage

• hot bath

• min aggrevating factor

INtermittent RLS tx

summary of RLS treatment

chronic RLS tx