Idiopathic Facial Paralysis (Bell’s Palsy): Symptoms, Causes, Diagnosis & Treatment

Idiopathic facial paralysis (Bell’s palsy): Symptoms, Causes, Diagnosis & Treatment

Bell’s palsy, also known as idiopathic facial paralysis is a type of facial paralysis that results in an inability to control the facial muscles on one half of the face.

Idiopathic facial paralysis normally gets better by itself with most achieving normal or near-normal function. Signs of improvement often begin within 14 days, with complete recovery within six months while few may not recover completely or have a recurrence of symptoms.

Idiopathic facial paralysis is the most common cause of one-sided facial nerve paralysis and it occurs in 1 to 4 per 10,000 people per year.Fewer than 1 million cases are reported in India per year. Bell’s palsy most commonly occurs in people between ages 15 and 60. Males and females are equally affected.

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How does Bell’s palsy affect your body?

Bell’s palsy is temporary, but sometimes its effects on the body are long-lasting or even permanent. Bell’s palsy cause sudden weakness or paralysis on one side of the face. People with idiopathic facial paralysis may find their sense of taste dull and sounds may be very loud in the ear on the affected portion of their face. Bell’s palsy patients find it difficult to blink or close their eye on the affected side. Eye dryness can be painful and if left untreated can lead to eye damage. Some people may experience facial twitching or problems with drooping or contracted muscles even after other symptoms have disappeared.

What are the causes of Bell’s palsy?

Some viruses can cause a persistent infection without symptoms, e.g., the varicella-zoster virus and Epstein–Barr viruses, both of the herpes family. Reactivation of a dormant viral infection has been suggested as a cause of acute Bell’s palsy. Reactivation could be preceded by trauma, environmental factors and metabolic or emotional disorders.

Genetic inheritance has been found to be the cause in 4–14% of cases. Bell’s palsy is three times more likely to occur in pregnant women and is also considered to be four times more likely to occur in diabetics.

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What are the risk factors of Bell’s palsy?

  • Pregnant women especially during the third trimester or in the first week after giving birth are at risk of Bell’s palsy.
  • Having an upper respiratory infection, such as the flu or a cold also increases the risk.
  • Diabetic patients can also get Bell’s palsy and their chances of getting it are higher than non-diabetic patients.

What are the symptoms of Bell’s palsy?

  • Idiopathic facial paralysis is characterized by a one-sided facial droop that comes on within 72 hours.
  • Bell’s palsy may present with loss of taste sensation in the anterior part (2/3rd) of the tongue on the affected side. This happens because facial nerve carries taste sensations from the anterior two-thirds of the tongue.
  • Sound sensitivity, causing normal sounds to be perceived as loud, and dysacusis are possible.
  • Myriad neurological symptoms including facial tingling, moderate or severe headache/neck pain, memory problems, balance problems, ipsilateral limb paresthesia, ipsilateral limb weakness, and a sense of clumsiness.
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How is Bell’s palsy diagnosed?

There’s no specific test for Bell’s palsy and is usually diagnosed by closely observing movement of facial muscles while closing eyes, lifting brow, showing teeth and frowning, among other movements.

Certain medical conditions such as a stroke, infections, Lyme disease and tumors can also cause facial muscle weakness, mimicking Bell’s palsy. If the cause of symptoms isn’t clear, certain other tests may be performed:

Electromyography (EMG) –EMG can confirm the presence of nerve damage and determine its severity. Electromyography measures the electrical activity of a muscle in response to stimulation and the nature and speed of the conduction of electrical impulses along a nerve.

Imaging scans– Magnetic resonance imaging (MRI) or computerized tomography (CT) to rule out other possible sources of pressure on the facial nerve, such as a tumor or skull fracture.

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How to prevent & control Bell’s palsy?

  • Follow a healthy diet that includes vitamin and mineral supplements.
  • Avoid caffeine and other stimulants like alcohol and cigarettes, which produce stress that can lead to Bell’s palsy in certain individuals.
  • Avoid potential food allergens and refined foods.
  • People who suffer from movement disorders should exercise,as this can help slow disease progression.

Treatment of Bell’s Palsy- Allopathic Treatment

Physiotherapy– Physiotherapy can be beneficial to some as it helps to maintain muscle tone of the affected facial muscles and stimulate the facial nerve.

Surgery– This may be able to improve outcomes in facial nerve palsy that has not recovered. However, it is not known if early surgery is beneficial or harmful.

Medications:

  • Steroids– Corticosteroid such as prednisone improve recovery at 6 months and is thus recommended whereas early treatment within 3 days after the onset gives benefit with a 14% greater probability of recovery.
  • Antivirals– Antivirals such as acyclovir, are commonly prescribed due to a link between Bell’s palsy and the herpes simplex and varicella zoster virus.

Treatment of Bell’s Palsy- Homeopathic Treatment

  • Aconite– Aconite is prescribed in the initial stages of Bell’s palsy especially if paralysis seems to have set in after exposure to a cold draft.
  • Causticum-This is prescribed to treat chronic cases of facial paralysis.
  • Hypericum– This is for paralysis caused due to injury to a nerve. In addition to the common symptoms of Bell’s palsy, the patient may also complain of tingling or numbing sensation and burning sensation on the affected side of the face.
  • Ignatia– Ignatia is recommended for Bell’s palsy triggered by grief.
  • Cadmium Sulph– This is prescribed forBell’s palsy that develops as a result of a sudden haemorrhagic condition.
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Bell’s Palsy- Lifestyle Tips

  • Using lubricating eye drops during the day and an eye ointment at night will help keep the eye moist and it will be easy to close them.
  • Wearing glasses or goggles during the day and an eye patch at night can protect the eye from getting poked or scratched.
  • Facial exercises and massage may help relax facial muscles.

What are recommended exercise for person with Bell’s palsy?

  • Basic movement exercises such as the forehead wrinkle, eye closure, smiling, snarling and lip pucker at varying speeds and intensity for 10 to 15 minutes, 4 to 5 times a day.
  • Lip closure exercises involving filling the cheeks with differing amounts of air, along with eating and drinking exercises while keeping the eye open.
  • Expression exercises like to recreate common facial expressions, such as anger and astonishment.

Bell’s palsy& pregnancy- Things to know

  • Pregnant women are estimated to be affected by Bell’s palsy three times more than non-pregnant women. Most cases occur in the third trimester and early post-partum period.
  • Preeclampsia or high blood pressure during pregnancy, may be the cause of Bell’s palsy.
  • According to a study, pregnant women’s altered susceptibility to herpes simplex viral reactivation may also be the reason.
  • Pregnant women with Bell’s palsy can have pre-term delivery and the child born may have low-birth weight.
  • During pregnancy, treatment with steroids is not advisable due to potential harm of the developing fetus.

Common complications related to Bell’s palsy

  • Irreversible damage to facial nerve.
  • Abnormal re-growth of nerve fibers, resulting in involuntary contraction of certain muscles (synkinesis).
  • Partial or complete blindness of the eye.
  • Problem closing the eye due to excessive dryness and scratching of cornea

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