-----Original Message-----
From: Spielholz, Neil I <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: Friday, February 19, 1999 12:48 PM
Subject: RE: Bell's Palsy
>In light of what's been said, pro and con, of using electrical stimulation
>(ES) in the treatment of Bell's Palsy, I am summarizing below an Abstract
>from a paper which appeared in a journal that shall, for now, remain
>unidentified (this is to avoid bias on the part of some readers who may be
>so inclined). I am also omiting certain statements from the Abstract so
that
>you may focus on the ES components.
>
> I am curious how list members will respond to this. Does this sound
>like an article that could be used to show insurance companies that ES is
>beneficial in the treatment of Bell's Palsy? On the other hand, does it
>support the concept that ES may have retarded recovery? What do you think?
>At the end of all this, I will give the full reference, as well as my
>thoughts on the matter. The modified Abstract is as follows:
>
>"OBJECTIVE: This report discusses high-voltage electrical muscle
stimulation
>and ... used to treat two patients who suffered from Bell's Palsy. CLINICAL
>FEATURES: Case A: A 15-year old with left sided facial palsy was seen 2
days
>after the onset of symptoms. Upon observation, the left upper and lower
>eyelids were drooping and the left eye had excessive tearing ... A clinical
>diagnosis of Bell's Palsy ... was made. Case B: A 17-year old with left
>sided facial palsy was seen 8 days after onset of symptoms. Upon
>observation, the patient showed left sided facial paralysis and inability
to
>close the left eye completely ... A clinical diagnosis of Bell's Palsy was
>made. INTERVENTION AND OUTCOME: Both patients were treated with
high-voltage
>pulsed galvanic current at 80 peaks/sec with a 7-inch hand-held probe for
10
>minutes each visit. In addition ... (omitted for reasons mentioned above).
>Case A was resolved after 6 wk of treatment and case B was resolved after 3
>wk of treatment. CONCLUSION: Both patients benefited from these procedures
>with complete resolution of symptoms. The techniques outlined should be
used
>at an early stage to accelerate progress toward normal facial function."
>
> Comments are requested.
>
Neil and list members: -Here's my 2 cents worth...............
The conclusion does not at all follow from the data presented. How does the
outcome of these 2 cases compare to the natural history of Bell's Palsy? And
even if they improved faster than expected ( given the natural course of the
disorder ) - is any apparently faster recovery just by chance, i.e. within
the normal range of expected outcome, or is there a real treatment effect in
there somewhere?
There IS NO WAY you can justify treatments based on 2 case studies. This
report should only serve to prompt someone to investigate ES more
thoroughly.
A reasonable conclusion regarding the efficacy of treatment is much more
plausible if there is a randomisation between Rx and control groups, and
ideally the patient and examiner should be blinded to the assignment.
Regardless of the source of this report, I am definitely very biased (a good
thing sometimes) - the report is hardly worth the space it takes up on my
mail server!!
So what is the source anyway?? And what's the catch you have for us?
> Neil I. Spielholz
>
sincerely,
Michael Meddows PT CSCS
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