Facial paralysis

18-year-old Priya Gopal woke up in the morning with watery eyes and a sensation of acute pain on one side of her face. Believing it to be an eye infection, she went to an ophthalmologist, who gave her some eye drops. But these made no difference: The symptoms increased, and her facial muscles felt looser. It was only after consulting a dentist and a physician that Priya ended up at a neurologist's office. Here she was shocked to hear that she had the symptoms of facial nerve paralysis or Bell's Palsy, in which the ability to control facial muscles on the affected side is temporarily lost. Which of us would imagine that pain or twitching on the face indicates facial paralysis? "The symptoms of Bell's Palsy, which is the most common cause of facial paralysis, usually show up on one side of the face. There could be a loss of taste on the front of the tongue and an increase in the perception of sound in the ear on the affected side of the face. If the symptoms occur on the both sides of the face, this is usually due to other generalised nerve or muscle disorder such as Sarcoidosis," says Dr Praveen Gupta, consultant neurologist, Artemis Health Institute. Facial paralysis can rob a person of the ability to smile, blink eyes, express emotions, hear or taste. This happens due to the inflammation of facial nerves or when regions within the brain through which the facial nerve passes are affected. A complete or partial loss of voluntary facial movements may occur, depending on the cause. "The doctor usually determines whether the nerves in the forehead are involved in the facial paralysis to determine if the lesion is in the upper motor neuron component of the facial nerve, or the lower one," says Dr Renu Achtani, senior consultant, neurology, Fortis Hospital. MANY CAUSES THOUGH there are a number of serious causes which can lead to facial paralysis such as stroke, Moebius syndrome or Myasthenia Gravis. Occasionally, however, something as simple as an ear infection can also affect the facial nerves. "Chronic ear infection may sometimes result from an infection of the mastoid bone, which is located in the inner ear. At times this may lead to facial paralysis. The problem can be taken care of by controlling the infection," says Dr Ashish Srivastava, consultant neurologist, Rockland Hospital. Apart from this, infections in the brain or in the parotid glands (key pathways for the facial nerve, located in the upper part of each cheek) can also lead to facial paralysis. However, the most common cause of facial paralysis remains Bell's Palsy, which affect two in 10,000 people. The only reassuring fact about Bell's Palsy is that it is a temporary paralysis and most patients recover in a few weeks or a month unless the symptoms are severe or the treatment is delayed. Though many blame herpes simplex virus for causing Bell's Palsy, there has been no established clinical study to prove this connection. Other common causes of facial paralysis are stroke, brain tumour and trauma. Unlike in Bell's Palsy, in facial paralysis caused by a stroke the eye on the affected side can be closed and the forehead can be wrinkled. The severity of facial paralysis caused by a stroke depends on whether there is a blockage of an artery to the brain or whether the vessels of the brain have haemorrhaged. "In facial paralysis caused by a stroke, it's the speech and the face that gets affected. It's important to rush a person who has suffered the stroke to the hospital within 4 hours so that the part of the brain where the blood flow is interrupted can be restored by the treatment," says Dr Gupta. A tumour is one of the serious causes of facial paralysis. It develops gradually with symptoms such as headaches, hearing loss and seizures. "Sometimes the facial nerves get entangled into the tumour and are damaged permanently during the attempt to excise the tumour surgically," says Dr Achtani. The severity of damage to the nerves depends on the size of the tumour and the stage of diagnosis. Trauma can also cause injury to the facial nerve in many ways. In case of serious brain injury, the facial nerve fibers can be affected as they course through the brain and brain stem. A fracture through the temporal bone, the bone which houses the middle and inner ear, can also fracture the bony canal of the facial nerve. TREATMENT IS EFFECTIVE Don't get scared by the word steroids if you have been struck by Bell's Palsy. Steroids tablet will help you recover completely without any long-term problems with facial muscles. According to the research done at the University of Toronto in Canada and published in the Journal of the American Medical Association in 2009, taking steroid tablets improves the chances of having a complete recovery from Bell's Palsy, whether the symptoms are moderate or severe, as it reduces inflammation and protect the nerves and muscles from further damage. Taking antiviral drugs as well may help as they work against the virus which possibly causes the infection. "The treatment of Bell's Palsy can be very effective if administered within a few days of occurrence, so it is very important to consult the doctor in time. Usually, 70 to 80 percent of the patients respond well to the treatment which include steroids, anti- viral, galvanic stimulation and physiotherapy," says Dr Srivastava. Since in Bell's Palsy the eye doesn't shut, complications such as corneal ulcers and infections may occur. "It's important to take good care of the eye and put the eye drops regularly as they control the dryness of eyes," emphasises Dr Srivastava. In case of trauma or stroke the treatment usually depends on the region of the brain which has been affected. Physiotherapy also plays a vital role in the treatment of facial paralysis. While medicines may control the symptoms in the beginning, physiotherapy strengthens the muscles and brings back the lost mobility. "In the beginning the stimulation to the face is given by the machine so that it doesn't sag but the patient has to be very proactive and do the exercises at home till the time the facial nerves work finely," says Dr Renu.