Bell’s Palsy

Also indexed as: Facial Nerve Palsy, Facial Paralysis

Bell’s palsy is a disorder of the nerves that control the muscles of the face. People with Bell’s palsy lose control of some or all of the muscles on one half of the face; consequently, the face looks asymmetrical. Rarely are both sides of the face affected. The cause is unknown, and the disorder usually resolves without treatment within six to twelve months.

People with diabetes or hypertension have greater-than-average risk for Bell’s palsy.1 2 3 While no research has investigated whether better control of these conditions may help prevent Bell’s palsy, people with Bell’s palsy should be checked for diabetes and hypertension, especially if the palsy occurs repeatedly or affects both sides of the face,.

Checklist for Bell’s Palsy

Rating Nutritional Supplements Herbs
2Stars Vitamin B12 (injections)  
See also:  Homeopathic Remedies for Bell’s palsy
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

What are the symptoms of Bell’s palsy? Some common symptoms of Bell’s palsy include a rapid onset of weakness, numbness, heaviness, or paralysis of one side of the face. People with Bell’s palsy may also have symptoms of pain behind the ear, inability to completely close one eye, drooling, and speech difficulties.

How is it treated? Conventional therapy involves the use of natural tears (isotonic saline and methylcellulose drops), skin tape, or an eye patch to help the eye stay closed and lubricated. In difficult cases, surgery may be used to stitch the eyelids together. Steroids, such as prednisone, may also be recommended.

Nutritional supplements that may be helpful: Vitamin B12 deficiency can cause nerve degeneration,4 and both oral5 and injected6 7 vitamin B12 have been used to treat many types of nerve disorders.8 One older case report described successful treatment of chronic Bell’s palsy with vitamin B12 injections of 500 to 1,000 mcg given every one to two days.9 A more recent trial compared the effect of 500 mcg of injected vitamin B12 (in the form of methylcobalamin) given three times weekly for at least eight weeks—steroid medication, or both. Researchers found significantly faster recovery in the groups given B12 injections with or without steroids, compared to those given steroids alone.10 These findings agree with earlier reports on the effectiveness of methylcobalamin injections for Bell’s palsy.11 12 It is unlikely that oral vitamin B12 would be similarly effective. People seeking B12 injections should consult a physician.

Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions.

Other integrative approaches that may be helpful: Many reports claim that acupuncture speeds recovery from Bell’s palsy,13 14 15 16 but no controlled trials have been done to confirm this is neither a placebo effect nor the natural course of healing.

Hyperbaric oxygen therapy (HBT) is a procedure in which the patient breaths 100% oxygen at pressures up to three times greater than normal atmospheric pressure. A well controlled study of Bell’s palsy patients compared HBT plus a placebo tablet with fake oxygen therapy plus steroid medication.17 HBT produced significantly faster recovery (22 vs. 34 days) compared to the use of steroids.

Biofeedback techniques (using simple electronic devices to measure and report information about a person’s biological system) have been reported to help limit the deterioration of muscle function and speed recovery in Bell’s palsy.18 19 However, a controlled trial of patients with chronic facial paralysis (including some with Bell’s palsy) found that using a mirror as feedback was as effective as a mirror plus electrical biofeedback for improving facial symmetry and muscle function.20

References:

1. Adour K, Wingerd J, Doty HE. Prevalence of concurrent diabetes mellitus and idiopathic facial paralysis (Bell’s palsy). Diabetes 1975;24:449–51.

2. Yanagihara N, Hyodo M. Association of diabetes mellitus and hypertension with Bell’s palsy and Ramsay Hunt syndrome. Ann Otol Rhinol Laryngol Suppl 1988;137:5–7.

3. Brandenburg NA, Annegers JF. Incidence and risk factors for Bell’s palsy in Laredo, Texas: 1974–1982. Neuroepidemiology 1993;12:313–25.

4. Savage DG, Lindenbaum J. Neurological complications of acquired cobalamin deficiency: clinical aspects. Baillieres Clin Haematol 1995;8:657–78 [review].

5. Yaqub BA, Siddique A, Sulimani R. Effects of methylcobalamin on diabetic neuropathy. Clin Neurol Neurosurg 1992;94:105–11.

6. Ide H, Fujiya S, Asanuma Y, et al. Clinical usefulness of intrathecal injection of methylcobalamin in patients with diabetic neuropathy. Clin Ther 1987;9:183–92.

7. Kuwabara S, Nakazawa R, Azuma N, et al. Intravenous methylcobalamin treatment for uremic and diabetic neuropathy in chronic hemodialysis patients. Intern Med 1999;38:472–5.

8. Yamane K, Usui T, Yamamoto T, et al. Clinical efficacy of intravenous plus oral mecobalamin in patients with peripheral neuropathy using vibration perception thresholds as an indicator of improvement. Curr Ther Res 1995;56:656–70 [review].

9. Mitra M, Nandi AK. Cyanocobalamin in chronic Bell’s palsy. J Indian Med Assoc 1959;33:129–31.

10. Jalaludin MA. Methylcobalamin treatment of Bell’s palsy. Methods Find Exp Clin Pharmacol 1995;17:539–44.

11. Kobayashi H, Aoyagi M, Suzuki H, et al. The clinical effects of mecobalamin on peripheral facial palsy. Otolaryngology 1980;26:968–72.

12. Yagi N, Ishikawa Y, Fukazawa T. The effect of steroid and CH3 vitamin B12 on peripheral facial paralysis. Otologia Fukuoaka 1981;74:1613.

13. Zhang Y. Clinical experience in acupuncture treatment of facial paralysis. J Tradit Chin Med 1997;17:217–9.

14. He S, Zhang H, Liu R. Review on acupuncture treatment of peripheral facial paralysis during the past decade. J Tradit Chin Med 1995;15(1):63–7 [review].

15. Yuan H, Zhang J, Feng X, Lian Y. Observation on electromyogram changes in 93 cases of peripheral facial paralysis treated by point-through-point acupuncture. J Tradit Chin Med 1997;17:275–7.

16. Zang J. 80 cases of peripheral facial paralysis treated by acupuncture with vibrating shallow insertion. J Tradit Chin Med 1999;19:44–7.

17. Racic G, Denoble PJ, Sprem N, et al. Hyperbaric oxygen as a therapy of Bell’s palsy. Undersea Hyperb Med 1997;24:35–8.

18. Biedermann HJ, Inglis J. The restoration of control in facial muscles affected by Bell’s palsy. Int J Psychosom 1990;37:73–7.

19. Lobzin VS, Tsatskina ND. The adaptive biological control system with electromyographic feedback in the treatment of Bell’s palsy. Zh Nevropatol Psikhiatr Im S S Korsakova 1989;89(5):54–7 [in Russian].

20. Ross B, Nedzelski JM, McLean JA. Efficacy of feedback training in long-standing facial nerve paresis. Laryngoscope 1991;101:744–50.