Bell's palsy not fatal but treatment a must

Donya Betancourt, Pediatrician, Sanur, Bali, drdonya@hotmail.com

Overexertion from too much physical activity and not enough rest can sometimes have a frightening side effect. I received word of such a case, concerning a young woman suffering stroke- like symptoms, via an e-mail from her family.

In the beginning, her story was one similar to those of many young people who make exercise a part of their regular routine: but that all changed when she unwittingly let her body get too weak and vulnerable to viral infection.

After a week of studies, this 19-year-old university student traveled home for the weekend. She went out with some friends before returning home to study. By 1.30 a.m. she had gone to sleep.

When she began brushing her teeth the next morning, she noticed something was clearly wrong. She felt a strange sensation of numbness on the right side of her face -- not unlike somebody with a stroke.

She couldn't smile on the left side of her face or blink or close her right eye when sleeping at night.

She cannot even feel it when the right side of her face is touched. Only her face is affected, however: her right arm and the rest of her right side function normally.

This is a classic example of the onset of Bell's palsy, also known as facial palsy.

What does it mean? Bell's palsy occurs when the nerve which controls most of the facial muscles, including the nerves, grow swollen and inflamed. The result is a paralysis of the facial nerve, which affects many facial movements and abilities.

There are varying degrees of Bell's palsy. It usually affects just one side of the face, though it can sometimes affect both sides. The paralysis produced by Bell's palsy may be temporary or permanent.

Most cases of the disorder take place over the age of 40. But it can strike at any time, even among children. As of yet, the cause remains unknown.

However, it may be caused by head injury, tumors, hypertension, or infarction.

It also has been associated with viral infections such as a flu-like illness called viral meningitis, as well as headaches, colds, chronic middle ear infection, high blood pressure and diabetes.

There are a wide variety of symptoms. They include sudden weakness of one or both sides of the face; the drooping of the eyelid and corner of the mouth; drooling after brushing the teeth or when drinking; excessive tearing in one eye and an inability to raise the eyebrow or close an eyelid, smile, show off teeth or puff out the cheeks and taste certain foods.

Symptoms usually develop quickly, most frequently over the course of one day, hitting their peak within 48 hours. Seventy- five percent of cases are preceded by an upper respiratory tract infection.

The goal of treatment is to relieve the symptoms.

Corticosteroids may reduce swelling and relieve pressure on the facial nerve for some people. Corticosteroids must be given early to be most effective -- preferably within 24 hours of the onset of paralysis.

Lubricating eye drops or ointments are recommended to protect the eye if it cannot close completely. The eye may also need to be covered with a patch during sleep to protect it from infection.

Surgical procedures that decompress the facial nerve have not been shown to benefit people with Bell's palsy.

Outcomes vary. Approximately 60 percent to 80 percent of cases have been known to resolve completely within a few weeks to several months. Other cases result in permanent changes.

The disorder is not life threatening, however.

While the sudden sight of a loved one in a state of semi- paralysis is disheartening, the biggest priority is to follow a physiotherapy program and consistently administer the medication.

No matter what the age, it is always important to remember to get plenty of rest so the body stays resistant against viral infection.