szmtag In Reply (06.03.2020)
LNSLNS

We thank both correspondents for their contributions.

Of course, borrelia infection will have to be ruled out before corticosteroid treatment is given, as Beutner mentions. In our article we do not address this aspect directly, but we did emphasize that neuroborreliosis and herpes zoster oticus are the most common causes with a defined etiology and should be referred to diagnosis-specific treatment in the decision pathway (1).

Whether steroid administration at the recommended dosages generally brings neuroborreliosis to an “explosion” should be considered a clinical observation by our correspondent. In the individual case, antibiotic treatment is combined with steroid and cyclophosphamide administration in vasculitis associated with borreliosis (2). Regarding electrotherapy, the most recent meta-analysis does not confirm any scientific evidence for its use. Its prescription lies with the individual physician, according to the rules of drug prescription. Similarly, the literature does not provide evidence supporting facial exercises (3), even though these make sense psychologically speaking. In this context, we support the idea for patients to undertake such exercises three times daily in front of the mirror. The comment that if the paresis recedes very slowly or persists, ultrasound scanning of the parotid region should be undertaken, is very important and commendable.

Regarding symptomatic treatment in lagophthalmos, we personally are in receipt of a letter from an ophthalmologist, who recommends occlusion by means of an adhesive dressing as an alternative to the nocturnal moisture-retaining eye shield. In his view, patients experience this as less disruptive and are able to conceal the dressing by wearing sunglasses during daytime. In the author’s experience, such dressings are less stigmatizing than a moisture-retaining eye shield.

Maire mentions the importance of VZV-IgA antibodies and the parameter “VZV-specific CD-4-T-cells,” which to date is experimental. VZV-IgA can be of great importance in routine clinical practice and possibly even close a diagnostic gap in cases of zoster sine herpete

DOI: 10.3238/arztebl.2020.0175c

Prof. Dr. med. Josef G. Heckmann
Neurologische Klinik, Klinikum Landshut gGmbH
josef.heckmann@klinikum-landshut.de

Prof. Dr. med. Peter Paul Urban
Neurologische Klinik, Asklepios Klinik Barmbek, Hamburg

Prof. Dr. med. Susanne Pitz
Orbitazentrum, Bürgerhospital, Frankfurt

Prof. Dr. med. Orlando Guntinas-Lichius
HNO-Klinik, Universitätsklinikum Jena

Prof. Dr. med. Ildikό Gágyor
Institut für Allgemeinmedizin, Universität Würzburg

Conflict of interest statement

The authors of all contributions declare that no conflict of interest exists.

1.
Heckmann JG, Urban PP, Pitz S, Guntinas-Lichius O, Gágyor I: The diagnosis and treatment of idiopathic facial paresis (Bell´s palsy). Dtsch Arztebl Int 2019; 116: 692–702 VOLLTEXT
2.
Komdeur R, Zijlstra JG, van der Werf TS, Ligtenberg JJM, Tulleken JE: Immunosuppressive treatment for vasculitis associated with Lyme borreliosis. Ann Rheum Dis 2001; 60: 721 CrossRef MEDLINE PubMed Central
3.
Teixeira LJ, Valbuza JS, Prado GF: Physical therapy for Bell´s palsy (idiopathic facial paralysis). Cochrane Database Syst Rev 2011: CD006283 CrossRef MEDLINE
1.Heckmann JG, Urban PP, Pitz S, Guntinas-Lichius O, Gágyor I: The diagnosis and treatment of idiopathic facial paresis (Bell´s palsy). Dtsch Arztebl Int 2019; 116: 692–702 VOLLTEXT
2.Komdeur R, Zijlstra JG, van der Werf TS, Ligtenberg JJM, Tulleken JE: Immunosuppressive treatment for vasculitis associated with Lyme borreliosis. Ann Rheum Dis 2001; 60: 721 CrossRef MEDLINE PubMed Central
3.Teixeira LJ, Valbuza JS, Prado GF: Physical therapy for Bell´s palsy (idiopathic facial paralysis). Cochrane Database Syst Rev 2011: CD006283 CrossRef MEDLINE

Info

Specialities