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Safer Treatment of Bell’s Palsy

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Stroke strikes terror in the hearts and minds of sufferers and their families. So there is little wonder why panic sets in when one awakes to droopy facial features and discomfort. Thankfully, for many, symptoms of one-sided facial paralysis are from a far less serious disorder — Bell’s palsy.

Doctors often prescribe the anti-inflammatory corticosteroid prednisone for Bell’s palsy, but when questioned about the necessity of taking a steroid, many doctors concede that prednisone may merely help speed the reduction of the inflammation that occurs with Bell’s palsy. However, after six months, patients are generally in the same state of recovery with or without the prednisone.

My thinking: If you don’t truly need steroids why risk taking them, given that steroids, are powerful drugs with big-time side effects (headache, dizziness, mood changes, sleep difficulties, fatigue, slow healing of cuts and bruises, increased risk of osteoporosis, etc.)? For an expert opinion on the matter, I turned to Gary E. Cordingley, MD, PhD, clinical neurologist in private practice in Athens, Ohio. He confirmed that in numerous studies, steroids have shown minimal, if any, effect on the course of symptoms of Bell’s palsy. Until research proves otherwise, the best thing you can do is to take measures to lessen any discomforts and disease progression risks as the Bell’s palsy runs its course.

BELL’S PALSY — A PRIMER

Bell’s palsy develops as a result of damage or trauma to the facial nerves, likely from inflammation in response to a virus. Facial nerves lie on either side of the face, and typically Bell’s palsy affects only one side. Doctors suspect that most cases are caused by a viral infection such as herpes simplex (cold sore virus) or viral meningitis. Bell’s palsy has also been associated with influenza, Lyme disease, headaches, high blood pressure, chronic middle ear infection and trauma, and occurs more frequently in people with diabetes, pregnant women and elderly people with reduced immune function.

The symptoms of Bell’s palsy usually come on suddenly and peak within 48 hours. They range in severity from person to person, but can be painful and distressing. The eye on the affected side of the face cannot close completely, a corner of the mouth droops and there may be difficulties with simple everyday tasks such as speaking and eating. Similar to when you get procaine (Novocaine) at the dentist’s office, you may not be able to prevent yourself from drooling. Other symptoms include facial weakness, twitching, pain around the jaw or behind the ear, headache, loss of taste, ringing in one or both ears and sensitivity to sound on the affected side.

COPING WITH BELL’S PALSY

Some cases of Bell’s palsy are mild, and symptoms soon pass on their own without treatment. In fact, most people experience significant improvement within two weeks, and recover completely in three to six months. Frustratingly for sufferers, there is no specific laboratory test to diagnose Bell’s palsy and no standard course of treatment. However, Dr. Cordingley emphasizes that it is still important to see your physician in order to rule out other causes of facial paralysis. If you live in a part of the country where Lyme disease is common, you should get tested — and if necessary, treated for it.

Despite limited evidence of their utility, doctors’ current best guess for treatment of Bell’s palsy continues to be steroids along with the antiviral drug acyclovir. Dr. Cordingley acknowledges that theoretically these both make sense, since steroids help control inflammation and acyclovir fights certain viral infections. However, randomized, controlled trials of the drugs failed to show benefit for the treated groups, and then there are the side effects. I mentioned those of steroids already, and acyclovir is not much better. Its possible side effects include upset stomach, vomiting, diarrhea, dizziness, fatigue, agitation, hair loss and vision changes.

WHAT YOU CAN DO

To ease your discomfort and prevent complications of Bell’s palsy, there are a number of options beyond steroids…

* Protect the affected eye. According to Dr. Cordingley, this is the single most important thing you can do. When the eye cannot blink, it grows dry and irritated. To prevent infection, Dr. Cordingley recommends that you frequently moisten and clean the eye with over-the-counter, non-medicated, lubricating eye drops (artificial tears). At bedtime, he advises applying a thin line of eye ointment into the lower eyelid sac, and padding and taping the eyelid into a shut position overnight. During the day, if you have occasion to be in a dusty or sandy environment, wear an eye patch.

* Take a painkiller. Over-the-counter analgesics (acetaminophen, aspirin or ibuprofen) can provide pain relief, says Dr. Cordingley. Natural analgesics include meadowsweet and white willow bark.

* Consult a physical therapist. Some people find physical therapy beneficial to stimulate the facial nerve. PT, facial massage and exercise also may help maintain muscle tone and prevent shrinkage or shortening of the paralyzed muscles.

* Try a little do-it-yourself hydrotherapy. Moist heat provides pain relief. Daily Health News contributing editor Andrew L. Rubman, ND, recommends simply applying a hot Epsom salt compress to the affected side of the face. The magnesium salts help ease muscle contraction and pain. (To make this compress, wet a clean washcloth with comfortably hot water with 1 tablespoon of Epsom salts dissolved in 4 oz of water and wring it out.)

* Consider supplements. Ask your health-care professional to assess your B-12 level, recommends Dr. Rubman. Although it is often difficult to assess through lab tests, he finds that many Americans are functionally deficient in B-12, and this deficiency may contribute to neurological complications. If you have a clinical deficiency, B-12 (whether in injection or sublingual pill form) should be taken under a doctor’s supervision. Other potentially beneficial nutrients include vitamin B-6 and zinc.

* Look into other alternative therapies. According to the National Institute of Neurological Disorders and Stroke, other therapies that may be useful include relaxation techniques, acupuncture, electrical stimulation and biofeedback training. In addition, naturopathic physicians have in-depth training in other non-drug therapies that can help treat Bell’s palsy.

Of course, Dr. Cordingley says to bear in mind that the suggested use of physical therapy, vitamins and herbs are not based on large scientific studies, but rather on clinical judgment and experience. That said, before you turn to powerful drugs like steroids, keep in mind that with or without treatment, most people with Bell’s palsy recover completely within six months. In the meantime, consider safer and simpler measures to feel better and protect yourself from complications.

Safer Treatment Options for Bell’s Palsy

* Gary E. Cordingley, MD, PhD, clinical neurologist in private practice, Athens, Ohio.
* Andrew L. Rubman, ND, adjunct professor of clinical medicine, Florida College of Integrative Medicine, Orlando, and director, Southbury Clinic for Traditional Medicines, Southbury, Connecticut.
* National Institute of Neurological Disorders and Stroke, www.ninds.nih. gov

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