Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: TUESDAY, August 3, 1993 TAG: 9308030200
SECTION: EXTRA PAGE: 6 EDITION: METRO
SOURCE: Jane Brody
DATELINE: LENGTH: Long
By the next day, when she saw a neurologist, her eye was tearing uncontrollably and one side of her face had begun to feel numb and to droop. When she tried to smile, she looked like a split-faced clown: happy on one side, sad on the other.
The neurologist did a series of tests to be sure something far more serious, like a brain tumor or stroke, was not the cause of Cathy's symptoms. Then he diagnosed Bell's palsy, an inflammation of a major facial nerve. A virus, probably Herpes simplex, which also causes cold sores, is strongly suspected as the cause of the inflammation.
Named for Sir Charles Bell, an early 19th-century Scottish physiologist who first described it, this frightening nerve ailment strikes some 40,000 Americans a year. One in 30 people develops it sometime over the course of a lifetime. And while 80 to 85 percent recover completely, 15 to 20 percent experience some degree of permanent nerve impairment. About 10 percent of all the victims suffer one or more recurrences.
Bell's palsy can strike almost anyone at any age. But it disproportionately attacks pregnant women and people who have diabetes, influenza, a cold or some other upper respiratory ailment. People with a family history of the inflammation run a higher than average risk of developing it. Most cases occur after the age of 40, and are about equally distributed between men and women.
Its cause has never been clearly established, although studies have strongly suggested a virus. Viruses in the herpes family have a predilection for invading nerves and dwelling there permanently, which makes herpes the prime suspect. In at least one study, which involved 41 victims, all of the people with Bell's palsy had developed antibodies to Herpes simplex.
What may trigger an attack of Bell's palsy is also not known. For most people, its symptoms develop with alarming speed. However, a significant minority of patients report that just before the attack, they had been exposed to a draft, perhaps from an air-conditioner or an open window near the bed. And often the draft was felt only on the affected side. For example, taxi drivers tend to get Bell's palsy on the left side of their faces, the side typically exposed to an open window.
For patients who are seriously debilitated by their condition or who fail to start recovering within months, neurologists may consider surgery to reduce the pressure on the nerve. However, this treatment also remains controversial and may not produce the desired result.
Even for those who recover fully, there remains the specter of a recurrence. For someone like Cathy, who, 19 months after her first attack, is concerned that she may never again have a completely normal face, there is a further concern that a subsequent pregnancy might trigger a second attack of the facial palsy.
Cathy's neurologist explained that for part of its route from the brain to the face, the involved nerve travels through a narrow, tortuous bony tunnel. If the nerve becomes inflamed and swollen, the pressure from its bony casing can cause it to stop functioning, and messages from the brain that control facial muscles no longer get through. Symptoms typically develop rapidly, and within 48 to 72 hours, half the face can become paralyzed.
This results in a dramatic distortion of the face. On the affected side, the eye tears and the mouth drools; the eye may not close, even during sleep; the nose cannot twitch; the tongue cannot taste, and the corner of the mouth cannot turn up. It is almost as if the whole side of the face had been numbed by a dental anesthetic. Sometimes sounds are especially loud to the ear on the affected side, and some patients have difficulty speaking and eating.
Given these symptoms, it is easy to see why people with Bell's palsy often feel, as Cathy did, that they would like to hide under a rock until it goes away. Cathy was so distressed by her appearance, especially when she tried to smile, that she refused to be photographed with her new baby.
There is no specific treatment for Bell's palsy, and the treatments that are used remain controversial. Some physicians prescribe a corticosteroid drug to reduce the inflammation and an analgesic to relieve the pain. But the steroid has never been proved to hasten recovery. Cathy, for one, was reluctant to take a steroid because she feared its possible effects on her unborn child.
With or without treatment, most patients begin to get significantly better within two weeks, and about 80 percent of patients recover completely within three months. However, the symptoms last much longer for some people, and, in a few cases - Cathy's might be among them - the symptoms may never completely disappear.
In patients whose eye muscles are affected, care must be taken to protect the delicate tissues of the eye against desiccation and debris. Outdoors, eyeglasses can help protect the eye from dust and particles. Artificial tears should be used repeatedly during the day, and an eye ointment should be used at night to prevent undue dryness, which could result in corneal ulcers. At night the eyelid may have to be manually or mechanically closed with tape or covered with a patch.
Physical therapy is often prescribed to stimulate the nerve and maintain tone in the affected muscles while the nerve is healing. Cathy, for example, was told to practice wiggling her nose, grinning and pouting with her mouth, raising her brow and blowing out her cheek; even when nothing seemed to be happening, the effort was thought to aid the muscles. Applications of heat for two five-minute periods a day followed by a gentle five-minute facial massage are sometimes helpful.
Some physical therapists suggest electrostimulation of the affected nerve. That approach has not been proved beneficial but, as Cathy put it, "at least it gives patients the feeling that something is being done to help." The New York Times
Jane Brody writes about health issues for The New York Times.
by CNB