Bell's Palsy

Bell's Palsy: Overview

Bell's Palsy (BP) is the most common cause of facial paralysis worldwide.  Its incidence is about 20 cases per 100,000 persons.  Although not age-specific, it affects young and middle-aged adults most often.  There is no bias towards either sex.

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Right- and left-side facial palsy occurs equally.

Causes and Development

Climate is not a contributing factor.  BP does, however, have a higher prevalence among lower socioeconomic groups.  70% of patients with BP relate a previous upper respiratory infection, and 10% have a family incidence of the disorder.  During pregnancy or pregnancy-induced hypertension, the significant increase in vascular volume, particularly in the last trimester, triples the risk of facial neuropathy due to edema of the facial nerve and the resulting compression.

Its cause remains unknown but reactivated herpes simplex virus (HSV) heads the list as the most probable cause.  An acute inflammatory response results in swelling of the facial nerve within the myelin sheath, causes reduced circulation in the nerve.

Signs and Symptoms

The disorder usually progresses for 7 to 10 days, with sudden onset of facial weakness.  Symptoms of Bell's palsy include:

  • Sudden weakness or paralysis on one side of the face, causing it to droop.  This is the defining symptom, and may lead to difficulty closing the eye on that side of the face.
  • Drooling
  • Excessively dry or moist (tearing) eyes
  • Loss of ability to taste
  • Pain in or behind the ear
  • Numbness on the affected side of the face
  • Increased sensitivity to sound

Diagnosis and Tests

BP is a diagnosis of exclusion.  Nerve conduction does not become altered until about 3 days after degeneration has occurred.  These changes are then detected by observing a widened palpebral fissure (the space between the margins of the eyelids), reduced nasolabial fold (smile line), and drooping corner of the mouth.  A dry eye may result from reduced blinking.  Pain behind the ear is a common symptom, along with fever, tinnitus, and a mild hearing deficit.  A tumor should be suspected when there is (1) associated tics or spasms, (2) slow onset of paralysis, and (3) paralysis of isolated branches of the facial nerve.

Treatment and Prevention

The first priority in treating Bell's palsy or any type of facial paralysis is to eliminate the source of damage to the nerve as quickly as possible.  Minor compression for a short time period can result in mild and temporary damage.  As time goes on with constant or increasing compression, damage to the nerve can also increase.

Prognosis

Recovery from BP begins at 3 weeks for most (85%) patients, with a full recovery by 6 months.  Between 4 and 6% experience severe deformity with very little return to normal facial movement, and 10 to 15% will be bothered by asymmetrical movement of the facial muscles.  Recurrence may be on the same or opposite side.

Signs, symptoms & indicators of Bell's Palsy:

Symptoms - Head - Mouth/Oral

(Much) reduced sense of taste

The facial nerve also innervates some of the taste buds of the tongue, sometimes causing a reduction in the sense of taste.

Conditions that suggest Bell's Palsy:

Symptoms - Nervous

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Risk factors for Bell's Palsy:

Infections

Herpes Simplex Type I

The cause of Bell's palsy is not clear, but most cases are thought to be caused by the herpes virus that causes cold sores.

Lyme Disease

Bell's Palsy has been known to be both an early and late symptom of Lyme Disease.

Bell's Palsy suggests the following may be present:

Infections

Herpes Simplex Type I

The cause of Bell's palsy is not clear, but most cases are thought to be caused by the herpes virus that causes cold sores.

Recommendations for Bell's Palsy:

Drug

Conventional Drug Use

If you do decide to use conventional medications that may help relieve the compression, such as prednisone and antivirals, they should be started as quickly as possible.  The "window of opportunity" for starting these medications is thought to be 7 days from the onset of Bell's palsy.

Mineral

MSM (Methyl Sulfonyl Methane)

MSM, an organic form of sulfur, is reported to be of benefit in reducing pain associated with Bell's Palsy.

Physical Medicine

Hydrotherapy

The use of eye drops can be important in treating BP.  The 'dry eye' and associated problems are caused by a combination of things.  For some people the tear gland may not be producing moisture.  Blinking is the mechanism that protects the eye from external debris and spreads tears over the cornea.  Under normal circumstances we blink every 5-7 seconds and with every blink the eyelid spreads moisture over the cornea.  With facial paralysis the ability to blink may be disrupted; eyelid closure can be weak or the eye can be stuck wide open.  Take action if the eye feels uncomfortable.  Manually blink your eye using the back of your finger at regular intervals, especially when it feels dry.  A stinging or burning sensation can mean the eye is too dry, even if tears are apparent.  The 7th nerve does not control focus, so if you are experiencing blurred vision, don't ignore it.  It may be a warning of a dry cornea that needs to be protected.

Vitamins

Vitamin B12 (Cobalamine)

Methylcobalamin, a form of vitamin B12, was compared with steroids in a trial involving 60 patients with Bell's palsy.  The shortest time required for complete recovery of facial nerve function occurred in the group receiving Methylcobalamin alone.  A therapeutic dose would be a minimum of 1500mcg and a maximum of 6000mcg per day, by injection.  It was administered by intramuscular injection 3 times weekly for 8 weeks (or until recovery).  The results of this study have not been validated, and administration of methylcobalamin has not become a common treatment.

Cyanocobalamin is reported to have worked in a couple chronic cases at high doses also.  [J Indian Med Assoc 33: pp.129- 31, 1959]

Vitamin B3 (Niacin)

74 consecutive Bell's palsy patients were treated with niacin at a dose of 100-250mg with "excellent results" noted in all patients within 2 to 4 weeks.  [Arch Otolaryngol 68: pp.28-32, 1958]

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