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Serum and CSF cytokine profile in patients with facial palsy (Bell's palsy): a pilot study
Alexander Ustinov1,2, Josef Georg Heckmann3,4, Vijay Singh5
1Department of Neurology, Medical Campus Lower Bavaria, Hospital Landshut, Robert-Koch Str. 1, 84024, Landshut, Germany.
Background And Purpose:
Facial nerve palsy is the most common cranial nerve disorder, and over 60% are idiopathic (Bell's palsy, BP). An inflammatory process is discussed as a causative factor. The aim of this study was to search for changes in various cytokine concentrations in serum and cerebrospinal fluid (CSF) in patients with facial nerve palsy.
Methods:
In this prospective study, 47 patients with peripheral facial nerve palsy were included. Of these, 40 patients were diagnosed as BP and seven patients as non-idiopathic peripheral facial palsy (nipFP). Seventeen cytokines, including IL-1A, IL-5, IL-9, granulocyte colony-stimulating factor (G-CSF), CXCL-13, granulocyte-macrophage-colony-stimulating factor (GM-CSF), tumor necrosis factor-SF13 (TNFSF13), IL-8, IL-1ß, CXCL-10, fractalkine (Fract), monocyte chemotactic protein (MCP-1), IFN-y, IL-4, IL-17A, tumor necrosis factor (TNF), and Granzyme, were measured in the serum and CSF. For comparison, sera from 10 healthy individuals were used.
Results:
In serum, the levels of cytokines G-CSF, CXCL13, TNFSF13, and Granzyme were statistically significantly higher in patients with BP and nipFP compared to healthy individuals (p < 0.05). Cytokine IL-1ß was significantly higher in nipFP patients compared to healthy individuals and patients with BP (p < 0.05). Cytokine IL-8 was significantly lower in both patient groups than in healthy individuals (p < 0.05). In CSF, G-CSF, CXCL13, TNFSF13, IL-8, IL-1ß, and IL-17A were statistically significantly higher in patients with nipFP compared to patients with BP (p < 0.05). In addition, patients with BP also showed a clustering of cytokine elevation. For differentiating nipFP from BP, serum G-CSF and IL1ß indicated a certain discrimination (AUC 0.643; 0.614). Patients with severe facial palsy revealed higher CSF TNFSF13 (p = 0.02), and clinical outcome after 3 months was less favorable at higher CSF Fractalkine (p = 0.025). Elevated CSF cell count was associated with elevated CXCL13, IL-8, IL-1ß, IP-10, IFNa and granzyme in the CSF (r = 0.32-0.57; p < 0.05).
Conclusion:
Compared to healthy individuals, our study revealed an altered cytokine profile in patients with BP that resembles patients with nipFP. In CSF, a subset of cytokines was identified in patients with BP, but higher levels were found in patients with nipFP, suggesting a graduated inflammatory process.
Study Registration:
The study "Serum and CSF cytokine profile in patients with facial palsy (Bell´s palsy)" has been officially registered at the German Clinical Trials Register (DRKS00037815).
