Mervi Kanerva

University of Helsinki, Helsinki, Southern Finland Province, Finland

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Publications (18)68.28 Total impact

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    ABSTRACT: OBJECTIVE: Microbiologic causes of facial palsy in children were investigated. STUDY DESIGN: Prospective clinical study. SETTING: Tertiary referral center. PATIENTS: Forty-six children aged 0 to 16 years with peripheral facial palsy. INTERVENTIONS: Paired serum samples and cerebrospinal fluid were tested to find indications of microbes associated with facial palsy. The microbes tested were herpes simplex virus 1 and 2, varicella-zoster virus, human herpesvirus-6, Mycoplasma pneumoniae, Borrelia burgdorferi, influenza A and B virus, picorna, cytomegalovirus, parainfluenza virus, respiratory syncytial virus, coxsackie B5 virus, adenovirus, and enterovirus, Chlamydia psittaci, and Toxoplasma gondii. Besides the routine tests in clinical practice, serum and cerebrospinal fluid samples were tested with a highly sensitive microarray assay for DNA of herpes simplex virus 1 and 2; human herpes virus 6A, 6B, and 7; Epstein-Barr virus, cytomegalovirus, and varicella zoster virus. RESULTS: Incidence for facial palsy was 8.6/100,000/children/year. Cause was highly plausible in 67% and probable in an additional 11% of cases. Borrelia burgdorferi caused facial palsy in 14 patients (30%), varicella zoster virus in 5 (11%) (one with concomitant adenovirus), influenza A in 3 (6%), herpes simplex virus 1 in 2 (4%) (one with concomitant enterovirus), otitis media in 2 (4%), and human herpesvirus 6 in 2 (4%). Mycoplasma pneumoniae, neurofibromatosis, and neonatal age facial palsy affected 1 child (2%) each. CONCLUSION: Microbiologic etiology association of pediatric facial palsy could frequently be confirmed. Borreliosis was the single most common cause; hence, cerebrospinal fluid sampling is recommended for all pediatric cases in endemic areas. Varicella zoster virus accounted for 11% of the cases, being the second most common factor.
    Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 05/2013; · 1.44 Impact Factor
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    ABSTRACT: To evaluate the treatment effect of prednisolone and/or valaciclovir in Bell's palsy patients with different baseline severity of palsy. Patient data were collected from the Scandinavian Bell's Palsy Study, a prospective, randomised, double-blind, placebo-controlled, multi-centre trial. Sixteen otorhinolaryngological centres in Sweden and one in Finland. Altogether, 829 patients aged 18-75 years were treated within 72 h of palsy onset. Patients were randomly assigned to treatment with prednisolone plus placebo (n = 210), valaciclovir plus placebo (n = 207), prednisolone plus valaciclovir (n = 206), placebo plus placebo (n = 206). Follow-up was 12 months. Facial function was assessed using the Sunnybrook grading scale at baseline and at 12 months. Complete recovery was defined as Sunnybrook score = 100. All patients, regardless of baseline severity, showed significantly higher complete recovery rates if treated with prednisolone compared with no prednisolone. In patients with severe palsy, recovery at 12 months was 51% with prednisolone treatment versus 31% without prednisolone (P = 0.02). Corresponding results were 68%versus 51% (P = 0.004) for moderate, and 83%versus 73% (P = 0.02) for mild palsy. In patient groups with moderate and mild palsy at baseline, significantly fewer prednisolone-treated patients had synkinesis at 12 months (P = 0.04 and P < 0.0001, respectively). For patients with severe palsy at baseline, prednisolone versus no prednisolone made no significant difference regarding synkinesis at 12 months. Valaciclovir did not add any significant effect to prednisolone regarding recovery rate or synkinesis at 12 months. Prednisolone treatment resulted in higher complete recovery rates, regardless of severity at baseline. Prednisolone treatment should be considered in all patients irrespective of degree of palsy.
    Clinical otolaryngology: official journal of ENT-UK; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery 07/2012; 37(4):283-90. · 1.87 Impact Factor
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    ABSTRACT: To study whether prednisolone reduces sequelae in Bell's palsy. Prospective, randomized, double-blind, placebo-controlled, multicenter trial with 12 months of follow-up. Seventeen referral centers. In all, 829 patients aged 18 to 75 years. Randomization within 72 hours in a factorial fashion to placebo plus placebo (n = 206); prednisolone, 60 mg/d for 5 days, with the dosage then tapered for 5 days, plus placebo (n = 210); valacyclovir hydrochloride, 1000 mg 3 times daily for 7 days, plus placebo (n = 207); or prednisolone plus valacyclovir (n = 206). Facial function at 12 months assessed with the Sunnybrook and House-Brackmann grading systems. In 184 of the 829 patients, the Sunnybrook score was less than 90 at 12 months; 71 had been treated with prednisolone and 113 had not (P < .001). In 98 patients, the Sunnybrook score was less than 70; 33 had received prednisolone and 65 had not (P < .001). The difference between patients who received prednisolone and who did not in House-Brackmann gradings higher than I and higher than II was also significant (P < .001 and P = .01, respectively). No significant difference was found between patients who received prednisolone and those who did not in Sunnybrook scores less than 50 (P = .10) or House-Brackmann grades higher than III (P = .80). Synkinesis was assessed with the Sunnybrook score in 743 patients. Ninety-six patients had a synkinesis score more than 2, of whom 33 had received prednisolone and 63 had not (P = .001). Sixty patients had a synkinesis score more than 4, of whom 22 had received prednisolone and 38 had not (P = .005). Prednisolone significantly reduces mild and moderate sequelae in Bell's palsy. clinicaltrials.gov Identifier: NCT00510263.
    Archives of otolaryngology--head & neck surgery 05/2012; 138(5):445-9. · 1.92 Impact Factor
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    ABSTRACT: To study the correlation between Sunnybrook and House-Brackmann facial grading systems at different time points during the course of peripheral facial palsy. Prospective multicenter trial. Seventeen otorhinolaryngological centers. Data are part of the Scandinavian Bell's palsy study. The facial function of 1920 patients with peripheral facial palsy was assessed 5397 times with both Sunnybrook and House-Brackmann (H-B) facial grading systems. Grading was done at initial visit, at days 11 to 17 of palsy onset, and at 1 month, 2 months, 3 months, 6 months, and 12 months. Statistical evaluation was by Spearman correlation coefficient and box plot analysis. Spearman correlation coefficient varied from -0.81 to -0.96, with the weakest correlation found at initial visit. Box plot analysis for all assessments revealed that Sunnybrook scores were widely spread over different H-B grades. With 50% of the results closest to the median, Sunnybrook composite scores varied in H-B grades as follows: H-B I, 100; H-B II, 71 to 90; H-B III, 43 to 62; H-B IV, 26 to 43; H-B V, 13 to 25; and H-B VI, 5 to 14. Gradings correlated better in follow-up assessments than at initial visit. As shown by the wide overlap of the grading results, subjective grading systems are only approximate. However, a conversion table for Sunnybrook and H-B gradings was obtained and is included in the article. It can be used for further development of facial grading systems.
    Otolaryngology Head and Neck Surgery 04/2011; 144(4):570-4. · 1.73 Impact Factor
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    ABSTRACT: To evaluate if treatment start and age are related to the outcome in Bell's palsy patients treated with prednisolone. Prospective, randomized, double-blind, placebo-controlled, multicenter trial. Sixteen otorhinolaryngologic centers in Sweden and 1 in Finland. Data were collected from the Scandinavian Bell's palsy study. A total of 829 patients were treated within 72 hours of onset of palsy. Follow-up was 12 months. Patients were randomly assigned to treatment with placebo plus placebo (n = 206), prednisolone plus placebo (n = 210), valacyclovir plus placebo (n = 207), or prednisolone plus valacyclovir (n = 206). Facial function was assessed with the Sunnybrook grading system, and complete recovery was defined as Sunnybrook = 100. Time from onset of palsy to treatment start was registered. Patients treated with prednisolone within 24 hours and 25 to 48 hours had significantly higher complete recovery rates, 66% (103/156) and 76% (128/168), than patients given no prednisolone, 51% (77/152) and 58% (102/177) (p = 0.008 and p = 0.0003, respectively). For patients treated within 49 to 72 hours of palsy onset, there were no significant differences. Patients aged 40 years or older had significantly higher complete recovery rates if treated with prednisolone, whereas patients aged younger than 40 years did not differ with respect to prednisolone treatment. However, synkinesis was significantly less in patients younger than 40 years given prednisolone (p = 0.002). Treatment with prednisolone within 48 hours of onset of palsy resulted in significantly higher complete recovery rates and less synkinesis compared with no prednisolone.
    Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 01/2011; 32(1):141-6. · 1.44 Impact Factor
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    ABSTRACT: Among the ailments of the ocular region, the use of botulin has become established in the treatment of blepharospasm and hemifacial spasm in Finland. Botulin has also been used successfully after peripheral facial palsy to improve facial symmetry, reduce lachrymal flow, treat dribbling of saliva as well as spasmodic dysphonia of laryngeal muscles. It may be effective in dysphagia caused by tightness of the upper esophageal sphincter or in several dyshidroses. Gastroenterologic indications include anal fissure and spasm and achalasia of the lower esophageal sphincter. In urology, botulin is effective in overactive bladder and incomplete voiding.
    Duodecim; lääketieteellinen aikakauskirja 01/2011; 127(22):2431-43.
  • The Lancet Neurology 07/2009; 8(6):509-10. · 23.92 Impact Factor
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    ABSTRACT: To evaluate the effect of prednisolone and valacyclovir on ipsilateral pain around the ear and in the face or neck in Bell's palsy. The incidence and intensity of pain during the first 2 months of palsy and its prognostic value were also assessed. Prospective, randomized, double-blind, placebo-controlled, multicenter trial. Sixteen tertiary referral centers in Sweden and 1 in Finland. Data are part of the Scandinavian Bell's palsy study; 829 patients aged 18 to 75 years with onset of palsy within 72 hours were included. Follow-up time was 12 months. Patients were assigned to 1 of 4 treatment arms in a factorial fashion: placebo plus placebo; prednisolone 60 mg daily for 5 days, then tapering for 5 days, plus placebo; valacyclovir 1,000 mg 3 times daily for 7 days plus placebo; or prednisolone plus valacyclovir. Pain was registered on a visual analog scale within 72 hours, at Days 11 to 17, 1 month, and 2 months. Facial function was assessed with the Sunnybrook and House-Brackmann systems. Prednisolone and/or valacyclovir did not significantly affect the incidence or intensity of pain during the first 2 months. Pain was registered in 542 (65%) of 829 patients. At 2 months, 53 (8%) of 637 patients still reported pain. Subjects with pain at Days 11 to 17 had lower facial recovery rates at 12 months than those with no pain (p < 0.0001). Prednisolone and/or valacyclovir did not affect the incidence or intensity of ipsilateral pain in Bell's palsy. The incidence of pain was similar during the first 2 weeks and then decreased. Presence of pain at Days 11 to 17 indicated a worse prognosis for facial recovery.
    Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 06/2009; 30(6):842-6. · 1.44 Impact Factor
  • Clinical otolaryngology: official journal of ENT-UK; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery 01/2009; 34(1):59-59. · 1.87 Impact Factor
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    ABSTRACT: Previous trials of corticosteroid or antiviral treatments for Bell's palsy have been underpowered or have had insufficient follow-up. The aim of this study was to compare the short-term and long-term effects of prednisolone and valaciclovir in the recovery of the affected facial nerve in a large number of patients. In this randomised, double-blind, placebo-controlled, multicentre trial, patients aged 18 to 75 years who sought care directly or were referred from emergency departments or general practitioners within 72 h of onset of acute, unilateral, peripheral facial palsy, between May, 2001, and September, 2006, were assessed. Patients were randomly assigned in permuted blocks of eight to receive placebo plus placebo; 60 mg prednisolone per day for 5 days then reduced by 10 mg per day (for a total treatment time of 10 days) plus placebo; 1000 mg valaciclovir three times per day for 7 days plus placebo; or prednisolone (10 days) plus valaciclovir (7 days). Follow-up was for 12 months. The primary outcome event was time to complete recovery of facial function, as assessed with a regional Sunnybrook scale score of 100 points. Analysis was by modified intention to treat. This study is registered with ClinicalTrials.gov, number NCT00510263. Of 839 patients who were randomly assigned, 829 were included in the modified intention-to-treat analysis: 206 received placebo plus placebo, 210 prednisolone plus placebo, 207 valaciclovir plus placebo, and 206 prednisolone plus valaciclovir. Time to recovery was significantly shorter in the 416 patients who received prednisolone compared with the 413 patients who did not (hazard ratio 1.40, 95% CI 1.18 to 1.64; p<0.0001). There was no difference in time to recovery between the 413 patients treated with valaciclovir and the 416 patients who did not receive valaciclovir (1.01, 0.85 to 1.19; p=0.90). The number of patients with adverse events was similar in all treatment arms. Prednisolone shortened the time to complete recovery in patients with Bell's palsy, whereas valaciclovir did not affect facial recovery.
    The Lancet Neurology 10/2008; 7(11):993-1000. · 23.92 Impact Factor
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    ABSTRACT: Finding human herpesvirus (HHV)-7 and dual HHV-6A and -6B DNA in cerebrospinal fluid (CSF) of two facial palsy (FP) patients is intriguing but does not allow etiologic conclusions as such. HHV-6 or -7 DNA was revealed in 10% of the CSF samples tested from 70 immunocompetent adolescents and adults; a highly unusual result. How these findings are associated with the diseases they accompany remains to be defined. To determine whether herpes simplex virus (HSV)-1 and -2, varicella-zoster virus (VZV), HHV-6A, -6B, and -7, Epstein-Barr virus (EBV), and cytomegalovirus (CMV) DNA could be found in CSF of FP patients or controls. In all, 33 peripheral FP patients (26 idiopathic, 5 with herpesvirus infection, 1 puerperal, 1 Melkersson-Rosenthal syndrome) (34 CSF samples) and 36 controls (16 nonidiopathic FP, 7 hearing loss, 6 vertigo, 5 headache, 2 other) previously tested for HSV-1, VZV, and HHV-6 DNA by polymerase chain reaction (PCR) were tested with highly sensitive multiplex-PCR and an oligonucleotide microarray method. One FP patient had HHV-7 DNA and another had HHV-6A and -6B DNA simultaneously. In the control group, one HHV-7, one HHV-6A, and three HHV-6B DNA-positive specimens were found.
    Acta Oto-Laryngologica 05/2008; 128(4):460-4. · 1.11 Impact Factor
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    ABSTRACT: To study characteristics of Melkersson-Rosenthal syndrome (MRS) patients with facial palsy (FP) and differences in patients treated at the Departments of Otorhinolaryngology and Dermatology. Clinical picture of MRS was studied from patient charts at two departments. Patients with FP received a questionnaire and were examined. Tissue biopsies were searched for non-necrotizing granulomatous infiltrations typical of MRS and blood DNA for UNC-93B1 gene mutations predisposing to herpesvirus infection. At the Department of Otorhinolaryngology, all 18 MRS patients had FP, 9 the triad form. Two patients revealed non-necrotizing granulomatous infiltrations during acute edema episodes; another two had association with uveitis. Edema was rarely persistent and did not dominate the clinical picture. No UNC-93B1 mutations were found. At the Department of Dermatology, 2 patients had triad MRS and 15 had monosymptomatic granulomatous cheilitis with persistent edema and typical MRS histology. The clinical picture of MRS with FP differed from the current knowledge of edema-dominated MRS. More studies focusing on MRS with FP would broaden our understanding of the syndrome.
    Otolaryngology Head and Neck Surgery 03/2008; 138(2):246-51. · 1.73 Impact Factor
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    ABSTRACT: Herpes simplex virus 1 (HSV-1) and varicella-zoster virus (VZV) DNA were not detected in the cerebrospinal fluid (CSF) of patients with acute idiopathic peripheral facial palsy (Bell's palsy). Our results indicate either the absence of these viruses or the presence of technical shortcomings. The role of human herpesvirus 6 (HHV-6) in this disorder and the significance of a positive HHV-6 DNA finding in the central nervous system need further investigation. Our goal was to determine whether DNA of HSV-1, VZV, or HHV-6 can be found by polymerase chain reaction (PCR) in the CSF of peripheral facial palsy patients. We used PCR to detect the presence of HSV-1, VZV, and HHV-6 DNA in CSF. This was a retrospective case control study with 33 peripheral facial palsy patients (34 CSF samples) in the study group (26 with Bell's palsy, 5 with simultaneously diagnosed herpesvirus infection, 1 with puerperal facial palsy, 1 with Melkersson-Rosenthal syndrome). The control group included 36 patients, most with diagnosed or suspected Borreliosis and facial palsy or sudden deafness. One patient with Bell's palsy had HHV-6 DNA in CSF. Neither HSV-1 nor VZV DNA was detected in patients or controls.
    Acta Oto-Laryngologica 08/2007; 127(7):775-9. · 1.11 Impact Factor
  • Otolaryngology Head and Neck Surgery 08/2007; 137(2). · 1.73 Impact Factor
  • Mervi Kanerva, Tuija Poussa, Anne Pitkäranta
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    ABSTRACT: To assess repeatability and agreement of the House-Brackmann (H-B FGS) and the Sunnybrook (SFGS) Facial Grading Systems. Eight video-recorded facial palsy patients were graded in 2 sittings by 28 doctors. Repeatability and agreement for SFGS were measured by intraclass correlation coefficient (ICC) and coefficient of repeatability (CR), and for H-B FGS by agreement percentage and kappa coefficients. Repeatability for SFGS was from good to excellent and for H-B FGS from fair to good. Agreement between doctors for SFGS was moderate by CR and nearly perfect by ICC. For H-B FGS, the agreement percentage was 50%, and generalized kappa indicated only fair agreement. SFGS was at least as good in repeatability as H-B FGS and showed more reliable results in agreement between doctors. While waiting for an ideal scale for facial grading, the usage of SFGS can be encouraged over H-B FGS.
    Otolaryngology Head and Neck Surgery 01/2007; 135(6):865-71. · 1.73 Impact Factor
  • Mervi Kanerva, Anne Pitkäranta
    Duodecim; lääketieteellinen aikakauskirja 01/2006; 122(18):2267-74.
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    ABSTRACT: In Europe, the day-case tonsillectomy rate in children is slowly increasing, but whether parents really want this rapid discharge of their child is questionable. The fear is that aftercare might fall solely on community care. The aim of this prospective study was to introduce pediatric day-case tonsillectomy to our hospital and to determine parents' attitudes to this procedure. The other interest centered on consultation rates within the 2-week recovery period. One hundred children aged 3-16 years had day-case tonsillectomy (38) or adenotonsillectomy (62). Peri-operative and post-operative complications were recorded. Parents were phoned the next day and 1-4 months after the operation. Parents' opinions of day-case surgery and consultations with healthcare professionals during the 2-week recovery period were recorded. Ninety children went home the day of the operation. Vomiting was the most frequent complication. No primary hemorrhages occurred. Called the next day, 100% of parents felt that their children were better served spending their first night at home as compared with staying in hospital. Called 1-4 months later, 94.5% of parents still thought this way. In the 2-week recovery period following the tonsillectomy, 13% of patients visited a physician and 17% called for information. These numbers include patients with secondary hemorrhage. If these are excluded, 5% of patients visited a physician and 13% called for advice. Children were taken back to hospital only due to secondary hemorrhage. Most parents considered day-case tonsillectomy to be suitable for their family. Consultation rates were low. Careful patient selection and adequate pre-operative information are prerequisites for day-case tonsillectomy.
    International Journal of Pediatric Otorhinolaryngology 08/2003; 67(7):777-84. · 1.35 Impact Factor
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    Mervi Kanerva
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    ABSTRACT: The objective of this study was to assess the utility of two subjective facial grading systems, to evaluate the etiologic role of human herpesviruses in peripheral facial palsy (FP), and to explore characteristics of Melkersson-Rosenthal syndrome (MRS). Intrarater repeatability and interrater agreement were assessed for Sunnybrook (SFGS) and House-Brackmann facial grading systems (H-B FGS). Eight video-recorded FP patients were graded in two sittings by 26 doctors. Repeatability for SFGS was from good to excellent and agreement between doctors from moderate to excellent by intraclass correlation coefficient and coefficient of repeatability. For H-B FGS, repeatability was from fair to good and agreement from poor to fair by agreement percentage and kappa coefficients. Because SFGS was at least as good in repeatability as H-B FGS and showed more reliable results in agreement between doctors, we encourage the use of SFGS over H-B FGS. Etiologic role of human herpesviruses in peripheral FP was studied by searching DNA of herpes simplex virus (HSV) -1 and -2, varicella-zoster virus (VZV), human herpesvirus (HHV) -6A, -6B, and -7, Epstein-Barr virus (EBV), and cytomegalovirus (CMV) by PCR/microarray methods in cerebrospinal fluid (CSF) of 33 peripheral FP patients and 36 controls. Three patients and five controls had HHV-6 or -7 DNA in CSF. No DNA of HSV-1 or -2, VZV, EBV, or CMV was found. Detecting HHV-7 and dual HHV-6A and -6B DNA in CSF of FP patients is intriguing, but does not allow etiologic conclusions as such. These DNA findings in association with FP and the other diseases that they accompanied require further exploration. MRS is classically defined as a triad of recurrent labial or oro-facial edema, recurrent peripheral FP, and plicated tongue. All three signs are present in the minority of patients. Edema-dominated forms are more common in the literature, while MRS with FP has received little attention. The etiology and true incidence of MRS are unknown. Characteristics of MRS were evaluated at the Departments of Otorhinolaryngology and Dermatology focusing on patients with FP. There were 35 MRS patients, 20 with FP and they were mailed a questionnaire (17 answered) and were clinically examined (14 patients). At the Department of Otorhinolaryngology, every MRS patient had FP and half had the triad form of MRS. Two patients, whose tissue biopsies were taken during an acute edema episode, revealed nonnecrotizing granulomatous findings typical for MRS, the other without persisting edema and with symptoms for less than a year. A peripheral blood DNA was searched for gene mutations leading to UNC-93B protein deficiency predisposing to HSV-1 infections; no gene mutations were found. Edema in most MRS FP patients did not dominate the clinical picture, and no progression of the disease was observed, contrary to existing knowledge. At the Department of Dermatology, two patients had triad MRS and 15 had monosymptomatic granulomatous cheilitis with frequent or persistent edema and typical MRS tissue histology. The clinical picture of MRS varied according to the department where the patient was treated. More studies from otorhinolaryngology departments and on patients with FP would clarify the actual incidence and clinical picture of the syndrome. Perifeerisessä kasvohalvauksessa kasvohermon toiminta on häiriintynyt osittain tai kokonaan. Yleisimmin oire on toispuoleinen. Otsan rypistyminen tai kulmakarvan kohottaminen on vajavaista. Silmää ei saa suljettua, eikä nenää nyrpistettyä. Suupieli ei nouse, eikä suuta saa supistettua. Lisäksi kasvohermo vastaa kyynel- ja syljenerityksestä ja kielen etuosan (2/3) makuaistista ja näissä toiminnoissa voi olla häiriöitä. Tämän väitöskirjatyön tavoitteena oli tutkia kahta kasvohalvauksen vaikeusasteen arvioinnissa käytettyä luokitusta, selvittää ihmisen herpesvirusten mahdollista etiologista osuutta kasvohalvauksessa ja kartoittaa Melkersson-Rosenthalin (MR) oireyhtymän taudinkuvaa. Kasvohalvauksen vaikeusastetta kuvaamaan on kehitetty monia luokituksia, mutta mitään niistä ei käytetä yhtenäisesti tai maailmanlaajuisesti. Sunnybrook ja House-Brackmann luokitusten toistettavuutta ja yhtäpitävyyttä arvioitiin 26 tutkijan ja kahdeksan videoidun kasvohalvauspotilaan avulla. Sunnybrook luokituksen toistettavuus oli vähintään yhtä hyvä kuin House-Brackmann luokituksella, ja tutkijoiden välinen yhtäpitävyys parempi, joten näistä kahdesta luokittelumenetelmästä suosittelemme Sunnybrookia kliiniseen käyttöön. Tavallisin perifeerinen kasvohalvaus on Bellin pareesi, äkillisesti alkava toispuoleinen halvaus, jonka syytä ei tiedetä. Aiheuttajaksi on epäilty herpesviruksia, etenkin herpes simplex-virus 1:tä (HSV-1) ja varicella-zostervirusta (VZV). Kasvohalvauspotilailta (33 potilasta, 34 näytettä) ja kontrolleilta (36 kontrollia) etsittiin PCR/mikrosirumenetelmällä selkäydinnesteestä kahdeksan ihmisen herpesviruksen (HHV) DNAta. Yhdeltä kasvohalvauspotilaalta löytyi HHV-6A ja -6B DNAta ja toiselta HHV-7 DNAta. Löydös on harvinainen, sillä merkkejä näistä viruksista löytyy harvoin selkäydinnesteestä lapsuusiän jälkeen tai ihmisiltä, joiden immuunipuolustusjärjestelmä on normaali. Koska myös viideltä kontrollipotilaalta, joilla ei ollut kasvohalvausta, löytyi HHV-6A, -6B ja -7 DNAta, löydösten ja tautien syy-yhteys vaatii jatkoselvittelyjä. HSV-1 tai VZV DNAta ei löytynyt. MR oireyhtymän klassisessa muodossa potilaalla on toistuvia kasvojen tai suun alueen turvotuksia, toistuvia kasvohalvauksia ja syväuurteinen kieli. Vain murto-osalla potilaista on kaikki kolme oiretta. Oireyhtymä on harvinainen ja sen syytä ei tiedetä. Tutkimuksessa selvitettiin taudinkuvaa niillä potilailla, joilla oli kasvohalvauksia, koska näitä potilaita on tutkittu erittäin vähän. Suurin osa julkaistuista tutkimuksista on yksioireisista MR potilaista, joilla on pelkkä turvotteluoire. HYKSin Korvaklinikalta löytyi 18 ja Ihotautiklinikalta kaksi MR potilasta, joilla oli ollut kasvohalvauksia. Lopuilla 15 Ihotautiklinikan MR potilaalla oli turvotusoireinen MR ilman halvauksia. Nykykäsitys taudista olettaa turvotuskohtausten pikkuhiljaa pahenevan ja turvotusten muuttuvan pysyviksi lähes kaikilla potilailla. Suurimmalla osalla kasvohalvausoireisista MR potilaista turvotuksia oli ollut harvakseltaan eivätkä ne olleet pahentuneet ajan myötä. Tutkimustulos vahvisti olettamuksen, että nykykäsitys taudinkuvasta voi olla vääristynyt, koska kasvohalvausoireisia MR potilaita on tutkittu vähän. MR oireyhtymälle tyypillisen kudoshistologian, ei-kaseoottisen granulomatoottisen infiltraation, on myös oletettu liittyvän pysyvään turvotukseen ja pitkäaikaiseen sairastamiseen. Me löysimme tällaisen kudoslöydöksen äkillisen turvotuskohtauksen aikana potilaalta, jolla oireita oli ollut alle vuoden ja turvotukset väliaikoina poissa. Herpesviruksia on epäilty myös MR oireyhtymän aiheuttajiksi. Verinäytteistä etsittiin UNC-93B1 geenimutaatiota, joka altistaa HSV-1 infektioille. Kenelläkään tutkituista ei ollut mutaatiota. Tutkimalla lisää eri erikoisaloilla hoidettavia MR potilaita saamme paremman kuvan oireyhtymän todellisesta taudinkuvasta, esiintyvyydestä ja mahdollisesti lisätietoja oireyhtymään syistä.

Publication Stats

158 Citations
68.28 Total Impact Points

Institutions

  • 2012–2013
    • University of Helsinki
      Helsinki, Southern Finland Province, Finland
  • 2003–2011
    • Helsinki University Central Hospital
      • Department of Otorhinolaryngology
      Helsinki, Province of Southern Finland, Finland
  • 2008
    • Uppsala University Hospital
      • Department of Otolaryngology - Head and Neck Surgery
      Uppsala, Uppsala, Sweden