Robert Filice, M.D. - Dr. Bob's Newsletter

Bell's Palsy
The sudden appearance of facial asymmetry associated with inability to close the eye and disappearance of the creases on the forehead on the affected side are enough to scare anyone. The first thought, of course is that the person may have had a stroke. Stroke can mimic these symptoms, but the last two features detailed above illustrate weakness of the muscles of the upper face, and are strongly suggestive of a peripheral nerve (facial nerve) problem rather than a central nervous system problem like a stroke, which can affect the lower facial muscles. The most common cause of one sided facial weakness is Bells’ palsy. We are not sure yet what causes this sudden onset of muscular paralysis, but we do know that there is swelling of the facial nerve at a point in its course that creates a compression effect that is the immediate reason for the symptoms.

I have seen numerous cases of Bell’s palsy which appeared to be triggered after exposure to a cold or cool breeze, like an automobile air conditioner blowing on someone during a long road trip, or a fan directed at a person’s face. Surprisingly, the most common infection associated with Bell’s palsy is herpes virus type 1. The virus has been cultured from fluid taken from around the nerve during decompression surgery. Since we know that the herpes virus “hides” within cells of the nervous system, the thinking is that a reactivation of the latent virus by some stimulus impinging on the immune system is the cause of the condition in most patients. Lyme’s disease is also associated with the onset of Bell's palsy, and may act as a reactivation trigger. Thus anyone who has suffered with Bell’s palsy in the past should probably be tested for Lyme’s disease.

Although a short course of steroid medication can be helpful in reducing the duration of the usually self limited symptoms, there can be potential side effects, and steroids have an immunosuppressive effect. That is not a good thing in someone who just had a reactivation of a latent viral infection due to some assault on his immune system. I have had good results with daily vitamin B12 injections given at home, along with AMP. The B12 supports the nerve tissue while AMP has antiviral effects. Intravenous DMSO also helps because of its powerful effect in reducing tissue swelling. Oral antiviral drugs like acyclovir are probably worth trying. There is a therapeutic window of about two weeks before the compression causes permanent nerve damage. Fortunately nearly 90% of cases (with treatment) will recover completely.

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