Bell’s palsy is an acute peripheral facial paralysis with no detectable cause. Although the prognosis of Bell’s palsy is generally good, some patients experience poor recoveries and there is no established treatment for those that do not recover even after receiving the conventional treatment. Here we present two cases of refractory Bell’s palsy with facial nerve enhancement in magnetic resonance imaging who showed symptomatic improvement after the late administration of high-dose intravenous methylprednisolone.

Citations

• Development of the Korean Medicine Core Outcome Set for Facial Palsy: herbal medicine treatment of patients with facial palsy in primary clinics
  Soo-Dam Kim, Sungha Kim, Mi Ju Son, Jiyun Cha, Pyung-Wha Kim, Mi Mi Ko, Soobin Jang, Changsop Yang, Myeong Soo Lee
  Frontiers in Medicine.2024;[Epub]     CrossRef

Acute sarcoid myositis is rarely complicated by sarcoidosis, and steroid therapy is considered the standard treatment. We experienced a patient with acute sarcoid myositis who did not respond to aggressive high-dose corticosteroid therapy, but showed a dramatic improvement after the addition of weekly low-dose oral methotrexate (MTX). This intervention allowed the resumption of normal daily activities after 6 months. Our case strongly suggests that MTX should be considered in patients with acute sarcoid myositis that is resistant to corticosteroid therapy.

The adverse effects of systemic steroid medications are well known, whereas those of local steroid injections are unclear even to clinicians. We report two cases of localized lipoatrophy and depigmentation following local steroid injection. Although the incidence of soft tissue atrophy after local steroid injection is rare, it will increase in proportion to the frequency of the procedure. All clinicians, even those who do not perform steroid injections, should be aware of the occurrence of this cosmetically disturbing adverse effect.

Citations

• Delineating Injectable Triamcinolone-Induced Cutaneous Atrophy and Therapeutic Options in 24 Patients—A Retrospective Study
  Reena K. Sharma, Mudita Gupta, Ritu Rani
  Indian Dermatology Online Journal.2022; 13(2): 199.     CrossRef
• Intra-flexor retinaculum steroid injection in elderly patients with carpal tunnel syndrome: A randomized clinical trial
  Reza S. Roghani, Sam Kara, Mohammad J. Taheri, Faeze Gohari, Sara Sadrneshin, Hein Linn Thant, Jose J. Diaz, Johan Lokk
  Interventional Pain Medicine.2022; 1(3): 100106.     CrossRef

Background: Local steroid injection is used to treat carpal tunnel syndrome (CTS). The aim of this study was to evaluate the clinical and electrophysiological effects of local steroid injection in patients with CTS over a 3-months period.
Methods: Twenty-one satients (35 hands) with clinical and electrophysiological evidence of CTS were treated by injection of triamcinolone 40 mg to the carpal tunnel. Visual analog scale (VAS), Boston Carpal Tunnel Questionnaire (BCTQ), rates of paresthesia, night awakening, and electrophysiological studies were used as outcomes. Clinical and electrophysiological assessments were performed before, 1 and 3 months after treatment.
Results: Prior to treatment, 86% of patients complained of night awakening. At 1 and 3 months after injection, only 17% and 29% of the patients, respectively, had night awakening (p<0.001). All patients complained of paresthesia before the treatment. This symptom disappeared in 60% and 31% of the patients after 1 and 3 months, respectively (p<0.001). Compared to baseline, both BCTQ and VAS show significant improvement during the 3 months of the study (p<0.005). Although significant improvements in clinical parameters were shown, electrophysiological parameters were not significantly improved at 1 and 3 months.
Conclusions: Local corticosteroid injection for the treatment of CTS provides significant improvement in symptoms for 3 months. On the other hand, no significant improvement was observed in electrophysiological parameters.

Citations

• A Narrative Review of Carpal Tunnel Syndrome in Traditional Chinese Medicine: Using China National Knowledge Infrastructure Database
  Hyun-A Jeon, Won-Bin Shin, Su-Yeon Lim, Young-Joo Moon, Ji-Yun Lee, Seung-Hyeok Ku, Sung-Hyun Kim, Hyun-Woo Moon
  Journal of Korean Medicine Rehabilitation.2020; 30(4): 119.     CrossRef
• Miniscalpel Needle Therapy with Integrative Korean Medical Treatment for Carpal Tunnel or Tarsal Tunnel Syndrome: Case Series of Three Patients
  Jae Ik Kim, Hye Su Kim, Gi Nam Park, Ju Hyon Jeon, Jung Ho Kim, Young Il Kim
  The Acupuncture.2017; 34(3): 139.     CrossRef

Critical illness polyneuropathy (CIP) and critical illness myopathy (CIM) occur commonly in the patients who havebeen on mechanical ventilation for more than 1 week. Even in some patients diagnosed with CIP, an underlyingmyopathy may be the primary cause of the muscle weakness. The cormorbid status of CIP and CIM is called as criticalillness polyneuropathy and critical illness myopathy (CIPNM). We describe a 56-year-old man with acute quadriparesisand areflexia after systemic inflammatory response syndrome. The diagnosis of CIPNM is important to avoid unnecessaryinvestigations and unreasonably pessimistic prognosis. Electrophysiologic studies are essential for the diagnosis and forplanning further clinical management.

Autoimmune myasthenia gravis (MG) is the neuromuscular junction disorder mostly caused by antibody against the acetylcholine receptor (AChR antibody) at the muscle endplate. The goal of treatment is to induce and maintain remission, i.e., absence of symptoms, with the least cost-to-benefit ratio. Although corticosteroids are effective in inducing remission in most patients, they have numerous potentially serious adverse effects with their long-term use. In addition, some patients do not respond or are intolerant to the conventional treatment. In this article, we discuss the difficulties encountered in long-term immunosuppressive treatment of MG, and review useful tips for the use of corticosteroids. Long-term immunosuppressive agents that can be used in steroid-refractory or -dependent patients will be reviewed with their safety profiles and efficacy in MG.

Among drug-induced myopathy, steroids are probably the most common cause. The risk of steroid myopathy(SM)increases with the dose and duration of use. It is typically a proximal myopathy, preferentially affecting the hip girdlemuscles. Motor and sensory nerve conduction studies are normal. The needle EMG is usually within the normal rangeor may be minimally abnormal. Occasionally, low-amplitude, short-duration MUAPs may be seen in the proximal muscles.Of note, abnormal spontaneous activity is not seen. This point is often very useful in differentiatingpolymyositis(PM) from SM. It is common for patients with PM to be treated with steroids, respond well, and then havethe steroids tapered. If muscle weakness then returns, it may be very difficult to differentiate recurrent PM from SM onclinical grounds. The presence of abundant abnormal spontaneous activity strongly suggests PM rather than SM.