DEAR DR. GOTT: I recently met with a friend I hadn’t seen for a few weeks. She has Bell’s palsy. I didn’t know what to say or do. Are there any new medications or alternative treatments that I can pass on to her? She is a senior citizen and has frozen face muscles, her vision is affected and is also experiencing leg pain. Thanks for any information.
DEAR READER: Bell’s palsy, also known as facial palsy, is a symptom, not a disease; however, in many cases the exact cause cannot be found. The condition is characterized by a sudden weakness or paralysis of the muscle of half the face, although very rarely, the condition can affect both sides. Between 30,000 and 40,000 people are diagnosed each year.
Currently, it is believed that Bell’s palsy is the result of swelling and inflammation of one of the seventh cranial nerves which controls the muscles of half the face. It is believed to be a reaction that occurs following infection, especially those viral in nature although another big culprit is Lyme disease (which is bacterial). It has also been associated with HIV, herpes zoster and simplex, influenza B, middle ear infections, the mumps virus, adenovirus, Epstein-Barr, coxsackievirus, and more.
Symptoms can vary dramatically from patient to patient. Some may only experience mild weakness, slight drooping of one eye and/or the corner of the mouth (on the same side), while others may have more severe drooping, an inability to completely close the eye, and muscle paralysis. Others symptoms may include a decreased ability to taste, altered tear and saliva production, headache, increased sensitivity to sound on the affected side, pain behind the ear, and jaw pain.
The good news for many individuals with Bell’s palsy is that it is temporary in the majority of cases, with improvement seen within a few weeks and complete recovery in about six months. If total paralysis doesn’t occur and symptoms improve within the first three weeks, it is highly likely that all function will be regained. In more severe cases, some residual weakness, eyelid or muscle spasms, and long-term taste changes may remain.
As for treatment, there is no tried and true method. If an underlying cause such as infection can be found, treatment with antibiotics or antiviral drugs may help. Physical therapy and massage can also reduce muscle loss and possibly speed healing. Corticosteroids, if started within the first 48-72 hours after weakness/paralysis is noticed, may reduce the severity and duration. If the eye doesn’t close completely, eye drops, ointments or an eye patch may be necessary to prevent drying and damage to the eyeball.
I am not aware of any proven alternative treatments but, by far, the most commonly recommended by my readers is vitamin B12 injections. Speech therapy may also be beneficial.
The best advice that I can give you is to treat your friend exactly as you have always. Bell’s palsy can look alarming, but treating her differently, staring, or behaving otherwise oddly will likely hurt her feelings. Emotional complications from having any condition – be it permanent or temporary – that affects appearance, especially of the face, are common so do your best to ignore them unless she specifically asks for your input/opinion on the matter.
