BELL’S PALSY & TRIGEMINAL NEURALGIA

Bell’s Palsy

Bell’s palsy is an inflammation of facial nerve and the most common type of facial paralysis, which is characteristic with the loss of voluntary muscle movement of one side of the face. 75% of cases of facial paralysis in adults are caused by Bell’s palsy. It is a rather common disorder, affecting 25 out of 100,000 individuals per year, and is more common in people with diabetes. It usually affects one side of the face (very rarely both sides at one time), with common symptoms as facial drooping and deviation, difficulty closing one eye, difficulty with fine facial movements, stiffness and/or numbness in face, drooling due to inability to control facial muscles, dry eye secondary to being unable to close eye properly. Some patients can also have impaired sense of taste, and sensitivity to sound (hyperacusis) on the affected side.

Bell’s palsy is an idiopathic “viral” attack on the facial nerve. The virus most commonly associated with Bell’s palsy is the Herpes Simplex-1 Virus (known as HS1). Recent studies show strong clinical evidence that HS1 is the primary cause of previously known idiopathic Bell’s palsy. Nearly 80% of all Bell’s palsy patients were found to have this virus present.

While the facial distortion usually improves over time, there may be some permanent deformity in 20% of individuals. Full recovery is less likely in older people, as well as those with hyperacusis, loss of taste, and severe paralysis.

In TCM, Bell’s palsy is caused by the invasion of wind cold or wind heat, which attacks the local meridians on the face, leading to obstruction of Qi and blood and poor nourishment of the muscles. Therefore, the treatment Principle would be dispelling wind, dredging meridians and collaterals, and promoting Qi and blood circulation.

Arguably acupuncture is one of the most effective treatments for Bell’s palsy. Clinical experience and studies from China and elsewhere have shown that the earlier to start acupuncture treatment the better. Although in some cases the facial deviation may get worse after the first one or two sessions of acupuncture, it is most certainly not caused by acupuncture but the condition itself still being in the developing stage. Some TCM practitioners may use other therapies such as tuina massage, moxibustion, or Chinese herbal medicine.

Trigeminal Neuralgia

Trigeminal neuralgia (TN), also known as tic douloureux, is characterized by sudden attacks of brief serious pain in the upper, middle and/or lower portions of the face, depending on which branch(es) of trigeminal nerve being involved.

The prevalence of TN is approximately 1-2%o, (100 to 200 people per 100,000), and new TN cases occur in 5 people per 100,000 each year. It is more common in elderly people, with the average age of onset being in the 50s-60s. Women are nearly twice as likely to suffer from TN comparing to men.

The cause of TN is still an area of discordance among the medical professionals. Most of them believe that the deterioration of the myelin (protective coating of the nerve) allows the transmission of abnormal messages of pain. The damage of the myelin sheath may be caused by pressure from blood vessels or arteries, tumours, multiple sclerosis, injury to the nerve, consequences of shingles, or just the aging process.

Clinical manifestations

TN is one of most painful neuralgia conditions. The typical attacks last only seconds to two minutes. These attacks are severe and described as intense, stabbing or electrical shock-like, usually occur on only one side. Each attack may come on spontaneously (without warning) or be triggered by some stimulation (even mild) in the affected areas of the face. Common triggers include touch, talking, eating, drinking, chewing, tooth brushing, hair combing, water from a shower and kissing.

During an attack, the sufferer will almost always remain still and refrain from speech or movement of the face, so as not to trigger further attacks of pain. The face may contort into a painful flinch. When painful attacks come on often and may be very difficult to control with medications. In typical TN, sufferers are free of pain between attacks. However, even during periods of remission, patients live in fear of their next flare-up. Over time the flare-ups become more frequent and more severe, while the remissions become shorter. Therefore, the need for more aggressive medical or surgical treatments increases as the disease progresses.

TCM Perspective

TCM takes the view that TN is mostly caused by wind cold or wind heat from exterior, or excessive heat from interior organs (live and stomach). Exogenous pathogenic wind cold or wind heat invading into the local meridians in the face will cause obstruction of Qi and blood, giving rise to pain. An upward attack of accumulated heat from liver or stomach can also impede the flow of Qi and blood, causing pain.

Acupuncture is commonly used by most TCM practitioners in treating this condition. The principle for the treatment is dredging the channels and collaterals, promoting Qi and blood circulation to relieve pain. A rather high percent of TN patients can receive a quick improvement from acupuncture. Some TCM practitioners may use other therapies such as tuina massage, moxibustion, or Chinese herbal medicine.