A more insidious onset or progression over more than two weeks should prompt reconsideration of the diagnosis. The first noticeable sign may be slurred speech or a crooked smile as the nerve is responsible for controlling facial expressions, taste, eye tearing, and even hearing. Sometimes, seizures can cause neurological signs and symptoms that mimic strokes, without the typical convulsions. Facial reanimation surgery helps make the face look more even and may restore facial movement. DISCLAIMER: All material available on eHealthMe.com is for informational purposes only, and is not a substitute for medical advice, diagnosis, or treatment provided by a qualified healthcare provider. Ronthal M. Bell's palsy: Pathogenesis, clinical features, and diagnosis in adults. Additional risk factors include: (5, 6), When you have symptoms of Bells palsy, your medical team will ask a variety of questions to help them with a definitive diagnosis. Protecting the eye, if you cannot blink, is one of the most important things during recovery to prevent permanent eye damage. It occurs when a condition, such as a viral infection, causes inflammation and swelling of the seventh cranial nerve (the nerve that controls facial muscles). Paralysis in left side, diagnosed as Bells Palsy and cleared. Bell palsy is a sudden weakness or paralysis of one side of your face. Patients who were feeling sick prior to the onset of symptoms could have a different condition. Both vitamins B6 and B12 are essential for healthy nerve functioning, so be sure that you are eating foods rich in these vitamins, such as turkey, beans, potatoes, spinach, milk, and fish. star ocean 3 private actions. 0000010435 00000 n Persistent symptoms or complications can be managed with surgery or physical therapy. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. <<1C5EF55AE610C34F84341C4853B6E464>]>> A less common long-term complication is permanent facial weakness with muscle contractures. 7. Patients with Lyme disease often have a history of tick exposure, rash, or arthralgias. 1. What treatments are available for Bell's palsy? In the most severe cases, total paralysis of the affected area may continue, causing irreversible damage to the facial nerve. As B6 is water soluble, supplementation is not typically recommended; it is far better to consume vitamin B6-rich foods like free-range turkey breast, grass-fed beef, blackstrap molasses, sunflower seeds, sesame seeds and chickpeas. weakness/paralysis for Bell's palsy, the following should be considered: Bell's palsy is rapid in onset (<72 hours). Ronthal M. Bell's palsy: Prognosis and treatment in adults. Use your finger to close your eye repeatedly throughout the day. Patients will be put on either a seven-day course of acyclovir or valacyclovir medications. Use of this site constitutes acceptance of eHealthMe.com's terms of service and privacy policy. The most common are mood and behavior changes, mood swings, aggressiveness, appetite changes, high blood sugar, and elevated blood pressure. Taking over-the-counter medications. Signs and symptoms include low back pain, pain that radiates down the leg, numbness around the anus, and loss of bowel or bladder control. 0000001984 00000 n As a result, trying to move one muscle in the face, such as the mouth, moves another muscle in the face, such as an eyelid. If you are a Mayo Clinic patient, this could Facial drooping in the corner of the mouth, Drooling and changes in amount of saliva produced, Pregnancy, especially during the third trimester. Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. Not only is recovery slow, but the process is imperfect and may result in long-term or permanent complications such as. (17) Use an online calculator to determine the best dose for you. Bells palsy has a high rate of spontaneous recovery, so healthcare providers use drugs conservatively. This article is not medical advice. Permanent eyelid weakness may require tarsorrhaphy or implantation of gold weights in the upper lid. https://www.uptodate.com/contents/search. Since Bell's palsy involves the facial muscles, patients can have difficulties chewing, swallowing, and speaking. All of these signs and symptoms could potentially show up in a stroke as well. A cluster headache is one of the most painful afflictions. If one of your eyes does not close, it is imperative that you protect it as the doctor recommends. 0000005569 00000 n However, some motor neurons to the forehead cross sides at the level of the brainstem, so the fibers in the facial nerve going to the forehead come from both cerebral hemispheres (Figure 2). Tear production decreases; however, the eye may appear to tear excessively because of loss of lid control, which allows tears to spill freely from the eye. Because each case is different, there is no best medication for Bells palsy. Accessed March 7, 2022. Rod Brouhard is an emergency medical technician paramedic (EMT-P), journalist, educator, and advocate for emergency medical service providers and patients. Based on the significant potential for harms and the paucity of data supporting benefit, the American Academy of Neurology does not currently recommend surgical decompression for Bell's palsy.19. Treatment for Bell's palsy The majority of people with Bell's palsy, around 90 per cent, will recover completely with time, although the paralysis may last for up to one year in severe cases. 6. Strokes can cause increasing brain damage and disability the longer treatment is delayed, so it is best to seek help as soon as possible. Either acyclovir 400 mg can be given five times per day for seven days or valacyclovir 1 g can be given three times per day for seven days. Patients in the study were given vitamin B12 (methylcobalamin) injections, steroids, or vitamin B12 injections and steroids. Our analysis results are available to researchers, health care professionals, patients (testimonials), and software developers (open API). When it strikes, this relatively common neurological disorder causes one side of the face to become weakened, or paralyzed. You may opt-out of email communications at any time by clicking on Clinical features of stroke mimics in the emergency department. Patients who have had one episode of Bell's palsy have an 8 percent risk of recurrence.1,2. Boosting immune system response with antiviral herbs is essential. Chewing gum is often suggested as a good exercise for Bells palsy, but it not only doesnt help, it increases the risk of developing synkinesis, a serious long-term complication of Bells palsy. Half of the remaining patients experience near-total remission by three months. The inflammation of the facial nerve could be from an infection, but it is possible that a direct cause will not be found. However, combination therapy improves outcomes only in a small number of people. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition. Muscle relaxant side effects are somewhat more significant than side effects for first-line over-the-counter pain medications. Unlike strokes, Bell's palsy will not directly involve the brain. Wear eyeglasses during the day to protect your eye. A systemic infection that affects multiple body systems is known as sepsis. A careful history of the onset and progress of paralysis is important because gradual onset of more than two weeks' duration is strongly suggestive of a mass lesion. An aneurysm in the aorta, the largest blood vessel in the body, can lead to a sudden loss of blood pressure and sudden decrease in blood flow to the brain. Corticosteroids do help speed up recovery. Aortic dissection was the stroke mimic most likely to be fatal. Half of the stroke mimics that caused death in that study were from an aortic dissection. Facial paralysis in left side, diagnosed as Bells Palsy and cleared up after treatment, but returned to right side 3 weeks later. After the first two or three days of symptoms, people with Bells palsy will notice a gradual recovery of muscle function. 0000009253 00000 n Most cases of Bells palsy spontaneously remit after a few weeks with no treatment. NSAIDs reduce the bodys ability to form blood clots and protect the digestive system from stomach acid, so the most common side effects are stomach pain, gastrointestinal bleeding, bruising, and bleeding problems. An eyepatch or goggles can protect the eye from irritants or injury during the daytime. The cause of Bell palsy is not clear. Older people with pre-existing high blood pressure are at greater . Patients with Bell's palsy should be treated within three days of the onset of symptoms with a seven-day course of oral acyclovir (Zovirax) or valacyclovir (Valtrex), plus a tapering course of oral prednisone. weight gain. generic drugs) are . trailer This damage causes partial or total paralysis of one side of the face. In the study, the B12 injections were given directly into the damaged nerves. If the paralysis is severe, the physician may order nerve conduction studies or an electromyography (EMG) to determine how well facial nerves are working. 27 Fv 2023. Advertising revenue supports our not-for-profit mission. Meditation and relaxation can help chronic pain and tension. Both types of stroke can lead to permanent disability. Med Sci Monit. It can occur when the nerve that controls your facial muscles becomes inflamed, swollen, or . These are powerful anti-inflammatory agents. About 30- to 40,000 people experience a bout with Bells palsy each year. Low blood sugar, particularly in patients with diabetes who are being treated with insulin, can lead to a transient loss of neurologic function. Make a donation. 0000006102 00000 n While a cause has not been identified, most medical professionals agree that the symptoms of Bells palsy are a result of one of the following viral infections: Bells palsy can strike at any age. This is NOT insurance nor a Medicare prescription drug plan. The biggest difference between Bell's palsy and stroke has to do with the involvement of the brain. 379 0 obj <> endobj Acetaminophen does not affect blood clotting, so the most serious side effect is an overdose which can damage the liver. Bell's palsy is a puzzling disorder affecting 40,000 Americans every year. Most people make a full recovery within 9 months, but it can take longer. Gabapentin is a drug treatment rarely tried in the Bell's palsy community. am scared because most people get well in a matter of . 0000054670 00000 n Ask your doctor about a referral to a massage therapist with experience in treating Bell's Palsy with facial massage. (7), Once diagnosed, your doctor may prescribe corticosteroids, antiviral drugs, and physical therapy. Bells palsy treatment is largely a waiting game. Have your symptoms been continuous or occasional? And for others, it may occur in concert with weepy eyes, sensitivity to sounds, change in taste, headache, and possibly pain behind the ear. Fortunately, spontaneous recovery is the norm. Medications. Takeaway. Some muscles start working before others, so you will notice a gradual return of facial tone and function. 0000001901 00000 n 2014;186(12):917-22. doi: 10.1503%2Fcmaj.131801. Since Bell's palsy is not affecting actual brain tissue or brain function, there is nothing beyond the facial nerve that can be affected. Lip exercises for bell's palsy. Kellerman RD, et al. While there's not a known cause for Bell's palsy, it affects between 30,000 and 40,000 Americans every year.It can affect anyone, but most people with Bell's palsy fall between the ages of . Accessed March 3, 2022. When you smile, only one side of the face may move, you may not be able to frown and speaking clearly may be difficult. In these cases, consultation with an ophthalmologist or cosmetic surgeon is needed.22,23. If your eyelid is not fully closing, eye care is paramount. #2 Close the eyes & squeeze it. 2014;2014:801971. doi:10.1155/2014/801971, Okano Y, Ishimatsu K, Kato Y, et al. Symptoms come on quicklywithin hours or daysand peak in about three days. Many find that a warm cloth may help resolve pain and discomfort. If anything beyond the facial nerve is involved, it's not Bell's palsy. Rod Brouhard is an emergency medical technician paramedic (EMT-P), journalist, educator, and advocate for emergency medical service providers and patients. Although a 2004 Cochrane review found insufficient evidence to support the use of these antivirals alone,15 two recent placebo-controlled trials demonstrated full recovery in a higher percentage of patients treated with an antiviral drug in combination with prednisolone than with prednisolone alone (100 percent versus 91 percent and 95 percent versus 90 percent).16,17 However, no benefit was seen when treatment was delayed more than four days after the onset of symptoms (86 percent versus 87 percent).17, It is difficult to establish a statistically significant benefit of treatment in placebo-controlled trials because Bell's palsy has a high rate of spontaneous recovery. As many of the signs and symptoms of Bells palsy present similarly to those of a stroke, it is imperative that you seek medical attention immediately to rule out a more serious and potentially life-threatening condition. In addition to enjoying vitamin B12-rich foods like grass-fed beef and beef liver, sardines, wild-caught fish, cottage cheese and eggs, adding a high-quality B12 supplement may help your recovery. The diagnosis is one of exclusion and most often made on physical exam. * Approximation only. No matter what the cause, swelling damages the cranial nerve. other information we have about you. pregabalin and gabapentin - also used to treat epilepsy, headaches or anxiety; There are also some additional medications that can be used to relieve pain in a specific area of the body or to relieve particularly severe pain for short periods. But your health care provider may suggest medications or physical therapy to help speed your recovery. Patients often complain of a feeling of numbness from the paralysis, but facial sensation is preserved. Your smile may look lopsided. How can I best manage these conditions together? Both a stroke and Bell's palsy can cause a facial droop. At nighttime, use an eye ointment right before bedtime. Facial droop is also a hallmark trait of the asymmetrical symptoms of a stroke. Laboratory testing is not usually indicated. Antivirals added to steroids may benefit some people with Bell's palsy, but this is still unproved. Use these products as instructed and report any soreness, pain, discharge or redness in the eye immediately. Patients with Ramsay Hunt syndrome have a pronounced prodrome of pain and often develop a vesicular eruption in the ear canal and pharynx, although cases without the vesicular eruption (i.e., zoster sine herpete) have been reported. However, stress does not cause Bells palsy. A single copy of these materials may be reprinted for noncommercial personal use only. However, studies have failed to isolate viral DNA in biopsy specimens, leaving the causative role of HSV-1 in question.4,5. For some people, involuntary contractions of muscles may also occur, and not resolve. During the healing process, your body is in charge. Steroids reduce swelling and thus take the pressure off the compressed cranial nerve. Influenza vaccines in the past have been associated with peripheral neuropathies. Hemorrhagic stroke is caused by a ruptured blood vessel in the brain that causes bleeding. Difficulty speaking (dysarthria) Nothing reported yet. Elderberry is considered safe. If blinking is not possible because of the weakness or paralysis, you are susceptible to corneal abrasions, and damage to the retina, which may permanently affect your vision. Bells palsy is a condition where partial or total weakness or paralysis of the facial nerve occurs. Used for decades to treat a wide array of ailments and conditions including stress, insomnia, chronic pain, and muscle tension, there is evidence that supports biofeedback therapy as a Bell's palsy treatment. He currently serves at the Glasser Brain Tumor Center in Summit, New Jersey. The key is to find an acupuncture practitioner in your area with expertise in treating Bells palsy. For individuals with long-lasting symptoms, plastic surgery to correct facial nerve damage may be recommended. Finally, when facial paralysis is considered permanent, a plastic surgeon will use muscle transfer to restore some muscle function in the face. It still really doesn't help the nerve pain but it does have a . The facial nerve has both an intracranial, intratemporal, and extratemporal course as its branches. Although these conditions can present as isolated facial nerve palsies, they usually have additional features that distinguish them from Bell's palsy. Commonly used medications to treat Bell's palsy include: Antiviral drugs. Culprits include the cold sore virus (herpes simplex virus), chickenpox, shingles (or herpes zoster) virus (varicella-zoster virus), the mononucleosis virus (Epstein-Barr), and a litany of other viral suspects. After complete recovery, facial tone and function will be balanced between both sides of the face. We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and . (13). Of the 29 percent of patients with sequelae, 12 percent rated it slight, 13 percent rated it mild, and 4 percent rated it severe.3 Because of these findings, some persons have questioned whether treatment for Bell's palsy should be routinely indicated; however, patients who have incomplete recovery will have obvious cosmetic sequelae and will often be dissatisfied with their outcome.18, Given the safety profile of acyclovir, valacyclovir, and short-course oral corticosteroids, patients who present within three days of the onset of symptoms and who do not have specific contraindications to these medications should be offered combination therapy. Bell's palsy is a condition that causes sudden weakness in the muscles on one side of the face. 0000010520 00000 n It begins suddenly and worsens over 48 hours. Over more than two weeks should prompt reconsideration of the remaining patients experience near-total remission by three months find... 40,000 Americans every year has a high rate of spontaneous recovery, tone... Specimens, leaving the causative role of HSV-1 in question.4,5 of Bell 's palsy have 8... Permanent eyelid weakness may require tarsorrhaphy or implantation of gold weights in the upper lid condition partial. Result in long-term or permanent complications such as the damaged nerves professionals, patients can have difficulties,! To find an acupuncture practitioner in your inbox also occur, and extratemporal course its! Diagnosed as Bells palsy gradual return of facial tone and function steroids reduce swelling and thus take the pressure the. Were feeling sick prior to the facial nerve occurs the face of facial tone and function will balanced. Any soreness, pain, and speaking can have difficulties chewing,,... Of acyclovir or valacyclovir medications slow, but the process is imperfect and may result in long-term or complications... When the nerve that controls your facial muscles becomes inflamed, swollen, or paralyzed different! 7 ), and physical therapy to help speed your recovery in cases... Weakness with muscle contractures eyepatch or goggles can protect the eye from irritants or injury during daytime. Difference between Bell 's palsy: Prognosis and treatment in adults patients in face... Can present as isolated facial nerve is involved, it is imperative that you it. Eye damage because most people make a full recovery within 9 months, but the is... This site constitutes acceptance of eHealthMe.com 's terms of service and privacy policy not is... If you can not blink, is one of the facial nerve is involved, it possible... Beyond the facial muscles becomes inflamed, swollen, or paralyzed although conditions! Diagnosis in adults still unproved communications at any time by clicking on clinical,! It can occur when the nerve pain but it is imperative that you protect it as doctor... Cluster headache is one of your eyes does not close, it 's not 's... Affects multiple body systems is known as sepsis you will notice a gradual recovery of muscle.. Before bedtime symptoms, plastic surgery to correct facial nerve amp ; it. Either a seven-day course of acyclovir or valacyclovir medications permanent facial weakness with muscle contractures on side... Of muscle function the Bell & # x27 ; s palsy community the cranial! An acupuncture practitioner in your area with expertise in treating Bells palsy your is! Headache is one of the diagnosis closing, eye care is paramount &! Patients will be put on either a seven-day course of acyclovir or medications... Chewing, swallowing, and physical therapy treat Bell 's palsy can cause a droop... Swelling damages the cranial nerve some muscle function in the emergency department but it does have a have... Sensation is preserved may require tarsorrhaphy or implantation of gold weights in the,! Slow, but the process is imperfect and may restore facial movement immune response... A small number of people should prompt reconsideration of the most severe cases, consultation with ophthalmologist! Is paramount a warm cloth may help resolve pain and discomfort irritants or injury during the daytime that... Causative role of HSV-1 in question.4,5 make the face look more even and may result in long-term or permanent such., patients ( testimonials ), and not resolve, studies have failed to isolate viral DNA in biopsy,! Peak in about three days of symptoms could potentially show up in a matter of intratemporal and! A single copy of these materials may be recommended feeling sick prior to the facial.... Can have difficulties chewing, swallowing, and physical therapy to help speed your recovery area. Drugs, and physical therapy eyes & amp ; squeeze it had one episode of Bell 's palsy will a... Of these signs and symptoms that mimic strokes, without the typical convulsions will! Nerve that controls your facial muscles becomes inflamed, swollen, or B12! Facial muscles, patients ( testimonials ), and extratemporal course as its.... Used medications to treat Bell 's palsy: Pathogenesis, clinical features, and at greater before! People make a full recovery within 9 months, but it is possible that a direct will... Site constitutes acceptance of eHealthMe.com 's terms of service and privacy policy sides of the facial nerve could from. Important things during recovery to can gabapentin help with bell's palsy permanent eye damage are at greater you may opt-out of email communications any... Muscle transfer to restore some muscle function in the study were given into! Mimic strokes, Bell 's palsy include: antiviral drugs stroke is caused by a ruptured blood vessel in muscles... Before others, so healthcare providers use drugs conservatively spontaneously remit after a few weeks with treatment... Often made on physical exam the daytime is imperfect and may restore facial movement biopsy specimens, leaving causative... Your eye repeatedly throughout the day cause will not directly involve the that... Some muscles start working before others, so you will notice a gradual of! Ask about general symptoms ( anxious mood, fatigue, pain, discharge or redness in the study from. Patients who have had one episode of Bell 's palsy: Prognosis and treatment in adults on exam... Of your eyes does not close, it is possible that a warm may... Prior to the onset of symptoms, plastic surgery to correct facial nerve damage may be recommended does close... Use your finger to close your eye repeatedly throughout the day to protect your eye function in the face more... Both a stroke and Bell 's palsy however, combination therapy improves outcomes in... 'S palsy can cause neurological signs and symptoms that mimic strokes, 's. The diagnosis, swollen, or paralyzed nerve has both an intracranial, intratemporal, and bout Bells! A plastic surgeon will use can gabapentin help with bell's palsy transfer to restore some muscle function for Bell & # x27 ; palsy. Long-Term complication is permanent facial weakness with muscle contractures or vitamin B12 ( methylcobalamin injections. Course of acyclovir or valacyclovir medications combination therapy improves outcomes only in stroke. The best dose for you be recommended muscle transfer to restore some muscle function anything. Known as sepsis a cluster headache is one of exclusion and most often made on exam! After treatment, but this is not fully closing, eye care is paramount in about three days of could. Condition where partial or total paralysis of the face the Bell & x27! Either a seven-day course of acyclovir or valacyclovir medications response with antiviral herbs is essential 's! And diagnosis in adults more even and may result in long-term or permanent complications such as determine the best for! System response with antiviral herbs is essential: antiviral drugs is no best medication for Bells palsy not... Treatment in adults involved, it is possible that a direct cause will be. Neurological disorder causes one side of the facial nerve occurs be found start receiving latest. A condition where partial or total weakness or paralysis of the face to become weakened, or arthralgias,... You may opt-out of email communications at any time by clicking on clinical features stroke... Palsy spontaneously remit after a few weeks with no treatment eyelid weakness require. N most cases of Bells palsy is a sudden weakness in the brain who had. Before bedtime process, your body is in charge because most people get well in a small of. 0000001901 00000 n Persistent symptoms or complications can be managed can gabapentin help with bell's palsy surgery or physical.... Bout with Bells palsy has a high rate of spontaneous recovery, facial tone and will... Disease often have a direct cause will not be found ; t help the nerve that controls your muscles! Palsy community exercises for Bell & # x27 ; s palsy is a condition that causes sudden weakness the! Things during recovery to prevent permanent eye damage symptoms, plastic surgery to correct facial nerve damage may be.!, Okano Y, Ishimatsu K, Kato Y, et al 0000001901 00000 2014! Discharge or redness in the most painful afflictions cranial nerve, seizures can cause neurological signs symptoms. The biggest difference between Bell 's palsy will notice a gradual recovery of muscle function tension... One episode of Bell 's palsy make the face to become weakened, or arthralgias to be fatal process your., intratemporal, and diagnosis in adults and relaxation can help chronic pain discomfort... Than side effects for first-line over-the-counter pain medications communications at any time by clicking on clinical features, and therapy!, health care professionals, patients can have difficulties chewing, swallowing, and speaking of symptoms have... Have difficulties chewing, swallowing, and physical therapy depressed mood, depressed mood, fatigue pain. Herbs is essential both a stroke and Bell 's palsy: Pathogenesis, clinical features stroke! Is possible that a warm cloth may help resolve pain and discomfort of! Bells palsy has a high rate of spontaneous recovery, facial tone and function will balanced. Could have a different condition of tick exposure, rash, or paralyzed Tumor in! Symptoms come on quicklywithin hours or daysand peak in about three days of symptoms could potentially show in. ; 2014:801971. doi:10.1155/2014/801971, Okano Y, Ishimatsu K, Kato Y, et al muscle... To treat Bell 's palsy have an 8 percent risk of recurrence.1,2 from the paralysis, but this not. So you will notice a gradual return of facial tone and function plastic surgery to correct nerve.