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Bell's Palsy a common condition, usually treatable

Dr. Sandra Ruby is a neurologist at Carroll Health Group Neurology.
Dr. Sandra Ruby is a neurologist at Carroll Health Group Neurology. (Carroll Hospital Center)

Bell's palsy is often mistaken for a stroke, but it's usually a lot less scary. The condition, a form of temporary facial paralysis, is a common affliction that usually resolves itself over time. In a July interview with Vanity Fair, actress Angelina Jolie revealed that she recently suffered from the malady and recovered with the help of acupuncture, though some experts say there isn't enough evidence that it works to recommend it as a treatment. Dr. Sandra Ruby, a neurologist at Carroll Health Group Neurology, says anyone with symptoms should seek medical attention to rule out more serious conditions, get a proper diagnosis, and understand treatment options.

What is Bell's palsy and who typically gets it?

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Bell's palsy indicates facial weakness, usually only on one side of the face due to damage or dysfunction of the facial nerve, one of the cranial nerves of the body. Most common causes include idiopathic (unknown), infection, pregnancy, diabetes. Bell's palsy can occur in children or adults and is relatively common.

What are the symptoms and how fast do they come on?

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Bell's palsy usually causes facial weakness with difficulty raising the eyebrow, closing the eye, or smiling on the affected side. It is usually unilateral (one side of the face) but can be bilateral (both sides). Some patients notice ear pain before the onset of facial weakness. Bell's palsy can be associated with loss of taste sensation on the affected side of the tongue. There is no weakness in the arm or leg and no numbness on exam, as can be seen in a diagnosis of stroke. Onset of symptoms is usually over one to two days

Is medical treatment necessary, or only to rule out something more serious?

Medical evaluation is needed for Bell's palsy to make the diagnosis and to rule out other causes of facial weakness such as stroke. Once the diagnosis of Bell's palsy is made, I would recommend a Lyme test for individuals living in Lyme-endemic areas to rule out Lyme disease, which is a frequent cause of Bell's palsy. Sometimes other testing is needed to rule out more serious conditions, such as imaging studies and a spinal tap. Treatment usually involves oral steroids, sometimes antiviral medications. As Bell's palsy affects the ability to close one's eye, many patients require eye lubricant and covering the eye at night to prevent drying of the eye with ophthalmology follow up.

How long does it typically take to recover, and do most people fully recover?

Most patients do recover from Bell's palsy. The majority of patients begin noticing recovery within the first month, but it can take up to six months for recovery from Bell's palsy. Unfortunately, not all patients reach full recovery of facial function. Usually the severity of the initial weakness is associated with prognosis for recovery, with more severe initial weakness associated with less chance for recovery. In addition, no improvement in facial weakness at one month is associated with less chance of recovery. Sometimes electrodiagnostic testing is used to help give prognosis for recovery.

Can it strike more than once?

Yes, Bell's palsy can recur but usually only once and only in about 7 percent of cases.

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