Bell's Palsy

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

Bell's Palsy, or idiopathic facial paralysis, is diagnosed 40,000 times per year in the United States, and is thought to affect approximately 1 person in 65 during a lifetime. The term idiopathic means that no objective known cause of the pathology is apparent. This disease is characterized by a sudden onset of facial paralysis on one side of the face, affecting mainly the Facial Nerve, or Cranial Nerve 7. The disease strikes mainly healthy individuals, of any age, and has a wide variety of degrees of severity and manifestation of symptoms. The Facial Nerve branches into 3 distinct pathways, and Bell's Palsy often affects all three, the forehead and eyelid, the cheek, and the mouth, tongue and sometimes the throat. The origin of the facial nerve is the brainstem, and the emergence of this cranial nerve is near the mastoid protuberance behind the ear. The facial nerve travels through two distinct narrow foramens, at the mastoid in the temporal bone, and in the fallopian tube (drainage from the inner ear). It is believed that swelling and compression at these sites of narrow passage of the facial nerve are responsible for the dysfunction and paralysis. The facial nerve has both motor and sensory aspects, and parasympathetic fibers to the tear glands in the eyes, to the nose, and to the mouth, account for symptoms of excess tearing or dryness as well.

Arterial blood vessels that travel alongside the facial nerve may also be implicated in the nerve irritation, and many experts think that a combination of vascular ischemia and inflammatory swelling cause the nerve irritation and damage. In the first few days of onset, the symptoms of facial sensory and motor dysfunction may change and worsen, and many patients report an initial pain near the mastoid or ear preceding sensory dysesthesia, and then rapidly progressive facial paralysis or paresis (partial paralysis) during the next 48 hours. In the past, cold exposure was considered the only trigger to Bell's Palsy, since the majority of patients report unusual exposure to cold wind, sleeping near window air conditioners, or driving in cold weather with the window down. Since then, though, a percentage of patients studied did not have exposure to cold air preceding the onset. Sudden or unusual cold, especially at night, when the immune system is more interior in response, would contribute much to vascular ischemia, though, and perhaps to an unusual sudden immune reaction, allowing latent viruses or low-grade bacterial infections to cause the sudden inflammatory reaction. A variety of symptoms beside facial hemiparalysis, or more rarely, bilateral facial paralysis, may be seen in Bell's Palsy. The mastoid pain and dryness to the eyes, nose and mouth have already been mentioned. Taste disturbances, and hyperacusis, or auditory sensitivity to certain frequency ranges, is also sometimes noted. Facial numbness is a common sensory symptom, and pain on the side of the face opposite to the paresis is sometimes noticed as well.

Even among the young healthy population, Bell's Palsy has a rate of incidence similar to the general population. A study by the U.S. Armed Services in 1999 found that the incidence among this healthy young population was about 43 per 100,000 person-years, and incidence rates increased with age and was higher among females, Blacks, Hispanics, and married persons (KE Campbell, JF Brundage: Am J Epidemiol 2002;156:32-9). Incidence was also increased in persons in a cold and/or dry climate, and is thought to occur in the diabetic population four times as much as the non-diabetic population. Theories related to such studies, and confirmed with modern testing, support the hypotheses that various viral and retroviral pathogens are related to the onset of Bell's Palsy. The array of identified viruses and pathogens include Herpes simplex (HSV-1), Herpes Zoster, HHV-6 (Human Herpes virus 6a or 6b), Epstein-Barr, cytomegolvirus, rubella, mumps, and HIV. Bacterial pathogens have also been identified in specific cases, and may have caused the disease, such as Typhus (usually spread by fleas and lice), Borrelia burgdorferi (Lyme's disease - tic bites), Moraxella catarrhalis, Haemophilus influenzae, and Streptococcus pneumoniae (causes of middle ear infections). Unfortunately, no single pathogen has been found in a majority of cases studied. Therefore, no single antiviral or antibacterial medicine, synthetic or herbal, is guaranteed to benefit the individual patient. A more thorough holistic approach to treatment is needed.

While approximately 65 percent of cases are self-limiting, meaning that the person affected, even receiving no therapy that is considered effective (such as synthetic corticosteroids and acyclovir) will recover completely within about 12 weeks to a year (and many in 3-6 weeks), about 35% of patients are left with a partial paresis of the facial muscles, and about 20% are left with serious consequences, including severe paroxysmal facial pain in a small percent of patients, and permanent facial paresis and dyskinesia in about 5%. About 80% are left with either no symptoms, or mild motor dysfunction, often not too noticeable, at one year. The goal in therapy should be to speed the recovery and increase the chances of a full recovery. No pharmaceutical medication has been proven effective in the treatment of Bell's Palsy (see additional information below). A protocol of Prednisone (synthetic corticosteroid), acyclovir (Herpes medication), and Vitamin B12 injection (to aid nerve repair and regeneration) is routinely prescribed as a potential aid to the patient recovery, but many studies have shown that acyclovir is ineffective, except for types of facial palsy clearly associated with a Herpes virus, usually starting with an inner ear infection. The proof that Prednisone is effective, or that benefits outweigh risks of adverse effects is also in question. The considerations by the patient afflicted with this disease are 1) what if I am in the approximately 35% that don't spontaneously recover, and 2) what can I do to hasten recovery and decrease the risks of permanent neurological deficit and facial paresis. This is the role of Integrative and Complementary Medicine, providing the patient with the most reliable information and holistic protocol to achieve the best outcome, and utilizing a comprehensive treatment protocol that shows no evidence of any adverse effects. Of course, utilizing Complementary Medicine, in the form of acupuncture, herbal and nutrient medicine, is best started as soon as possible, but even patients with long-term symptoms can benefit from these treatments.

Bell's Palsy, or Idiopathic Facial Paralysis, is currently a diagnosis of exclusion (no other cause is objectively found) and is still a poorly understood disease, despite a wealth of research around the world for the last 100 years. The obvious reason for this is that the underlying causes must be multifactorial and more complex than science had hoped for. Currently, no pharmaceutical medicine is proven effective, although there is weak evidence that an early injection of a synthetic corticosteroid (Prednisone) may alter the course of the disease. Bell's Palsy has been a consistent disease across time and population, though, and a number of traditional therapies have been utilized, refined, and proven effective with clinical observation for centuries. In China, almost all cases are treated in the hospital and clinic with acupuncture, and appropriate use of moxibustion stimulation, electrical stimulation, and herbal and nutrient medicine are well known to increase the degree of success when combined with acupuncture. In the United States, the National Institute of Neurological Disorders and Stroke has stated that treatments with some proof of benefit are limited to corticosteroid prednisone and perhaps acyclovir early in the course of the disease, as well as acupuncture, electrical stimulation, nutrient medicine, and biofeedback training to help restore nerve function.

In countries where acupuncture and professional herbal medicine are an established (and paid for) part of the standard medical establishment, such as Japan, Korea and China, these therapies are accepted as the only known effective and proven treatment for Bell's Palsy, and are routinely prescribed, along with medications that may help the course of the disease. Medical doctors in the United States are still not referring patients with Bell's Palsy for a short course of acupuncture and related therapies, despite having no effective treatment to offer themselves. While standard medicine in the United States points out that no large randomized placebo-controlled human clinical trials of acupuncture have proven this course of therapy to be effective, the patient must fully realize what this actually means. As you will see from the evidence on this website and links to studies, while we are still waiting for the long process of large randomized controlled human clinical trials in the United States, the proof of efficacy from decades, and even centuries, of clinical practice, is ample, as well as the proof of specific benefits from many herbal and nutrient chemicals, as well as self-administered therapies that the patient needs instruction to perform at home.

While the standard medical business in the United States likes to state that there is no proof that acupuncture works, intelligent patients are starting to realize what this really means. Number one, no randomized placebo-controlled human clinical trials have clearly demonstrated effectiveness of any therapy, pharmaceutical or other, in the treatment of Bell's Palsy, in the United States. Numerous studies now prove that the standard acupuncture therapy does effect both the central and peripheral nervous system related to the face, and does improve regrowth of the facial nerves and nerves sheaths. You may go to the section of this article entitled Additional Information to access these studies. Currently, the difficulty with designing randomized controlled human clinical trials with acupuncture for Bell's Palsy are being overcome and large, high-quality trials are underway. With CIM/TCM acupuncture stimulation is just one of the synergistic treatment protocols that are used, though, and integration of all effective therapies, in an individualized and staged protocol, is important.

When examining proof of efficacy with acupuncture and TCM therapy, one must keep in mind the difficulty with study design of manual therapies, of which almost none, including surgery, are actually proven effective with the standard randomized, placebo-controlled human clinical trial system. Many human clinical trials in China have established the efficacy of acupuncture and related therapies in the treatment of Bell's Palsy, as well as other diseases and injuries causing facial paralysis, but most have not been accepted as high quality RCTs. There are no large human studies with acupuncture that utilize a placebo, or no treatment, as a control in the study for this disease, mainly due to the fact that no patients want to have no treatment or a placebo treatment when their face is paralyzed, understandably. Placebo acupuncture is also very difficult to achieve, especially when treating the face. A fake sticking of a needle into the face is really not practical. Clinical studies also show that the best effects of acupuncture occur when the needles are manipulated and a sensation is achieved (de qi), when the acupuncture point prescription is somewhat varied, and when modalities such as moxibustion, Chinese herbal medicine, and electroacupuncture are used appropriately in the course of the disease. Continued studies in Chinese, Japanese and Korean medical schools and research hospitals help us understand which specific treatments in TCM should be used for each individual and each stage of the recovery. Such variance as this is not allowed in randomized placebo-controlled human clinical trials, making accurate design of large randomized controlled human clinical trials difficult as well.

Another problem with these human placebo-controlled trials of acupuncture, or any other treatment for that matter, is that a disease that is so variable, with a high rate of spontaneous recovery, even without any treatment, and a wide variety of disease courses and manifestations, is almost impossible to statistically evaluate. While designing and implementing a large randomized controlled human clinical trial for a pill is simple, albeit expensive, this same process for the evaluation of acupuncture to treat Bell's Palsy is difficult, and hence we still have no large trials. Also, there is no pressing need for such expensive and difficult to design trials, because the treatment is already known to be effective and there are absolutely no concerns for patient safety or adverse effects. The statement that acupuncture is not a proven treatment for Bell's Palsy by standard medicine in the United States is more of a competitive discouragement, and a philosophical, or sociopolitical statement, than it is a real concern for the welfare of the patient. Much of this is driven by the insurance industry, which largely determines treatment guidelines and decisions in the United States, rather than public health experts. The patient population today wants an integration of useful treatment expertise, and MDs need to find a competent Licensed Acupuncturist to whom referrals can be made.

Is there really no scientific proof that acupuncture and TCM therapy works to encourage improved recovery from Bell's Palsy? Currently, there are large randomized human controlled trials of acupuncture for the treatment of Bell's palsy, designed to overcome the problems mentioned above. The U.S. National Institutes of Health are sponsoring such trials, indicating that medical experts in the U.S. find that acupuncture appears to be a viable treatment option. In China, a large multicenter randomized controlled trial was conducted, comparing acupuncture to either standard therapy with prednisone, dibazole (an immune stimulant), and periodic B12 injections, or a combination of this standard therapy combined with the acupuncture (see additional information below). In both situations, acupuncture compared to standard therapy, and acupuncture combined with standard therapy, the acupuncture group had significantly better outcomes than standard therapy alone. Despite these large peer-reviewed studies by medical doctors in China, the medical doctors in the U.S. are still trying to suggest that there is not sufficient evidence to support this widely accepted therapy, utilized successfully for centuries, for Bell's Palsy. This type of game playing only hurts the patient population, and eventually, the standard medical profession is faced with an embarassing situation. They are not supporting real evidence-based medicine. They are only being motivated by economic and philosophical considerations.

By 2014, we see new therapeutic devices invented and marketed for the treatment of those 20 percent of patients left with chronic facial paresis, pain and sometimes dyskinesia. These new therapies focus on direct nerve stimulation with implants, especially with microscopic electrodes implanted and the use of nanotechnology. So far, these new and expensive therapies are unproven and some proof exists for the potential of adverse outcomes. Nevertheless, these are now being used extensively in standard medicine. At the same time, published stories are now implying that there are potential risks with electrical stimulation, and not clarifying what type of electrical stimulation they are talking about. There is ample proof that no adverse effects have been attributed to microcurrent electroacupuncture stimulation, despite its wide use to treat Bell's Palsy, and there is a clear difference between this type of indirect microcurrent stimulation and the various electrical implants and use of technology typically used for nerve cauterization and EMG. These newer electrical technologies are also used only when the patient is clearly left with chronic severe facial paresis, pain and dyskinesia, while the mild electroacupuncture stimulation is typically used for a short course early in the disease recovery.

The patients most at risk for a poor long term outcome with Bell's Palsy

The patients that should worry the most about long-term problems are those that are over age 60, have significant pain in the first week of onset, have all three areas of the face affected substantially (40% of patients with complete palsy are left with permanent paresis or paralysis), have diabetes or high blood pressure, are pregnant, have a worsening of symptoms after the first 10 days, have inner ear pain as well (Ramsay Hunt Syndrome), don't start to recover by week six, or are tested and found to have severe injury to the facial nerve. Many patients are given either injection or pills with Prednisone, or other corticosteroid, and acyclovir (just in case the Herpes virus is present), and told to go home and hope for the best. Patients with the inability to close the eyelid are given a lubricant and tape to protect the eye at night. Many intelligent patients then seek out a competent and experienced Licensed Acupuncturist to provide more therapy to insure a better and quicker outcome. In standard medicine, if you don't recover in 12 weeks to a year, or if the symptoms worsen and you are left with facial pain or an eyelid that doesn't fully close at night, or problems eating and swallowing, then a surgical evaluation is performed, and the possibility of severing a nerve permanently is discussed.

The first question of almost every patient that seeks acupuncture and related therapies for Bell's Palsy is will this work. The truth is that no therapy for any condition is guaranteed to work 100% of the time. The success with a proper protocol and technique in acupuncture and TCM medicine is very high, though. The disease may resolve on its own, so the exact evaluation of whether the acupuncture and other therapies resolved the condition, or whether it resolved on its own, can never be fully answered in each case. The point to keep in mind is that acupuncture works by stimulating the body to heal itself better. The patient is utilizing the best therapy that is known, with success documented over thousands of years, and confirmed with modern study, as much as can be accomplished in this realm. The patient is utilizing the best available medical approach to minimize the chances of a bad outcome, and to speed recovery. The therapy is usually relatively inexpensive. Even a short course of acupuncture and herbal medicine, followed by a high dosage of sublingual B12 and other B vitamins, is a smart choice, and can be very inexpensive. Waiting to see if you lose the lottery may not be the best choice.

Many scientific studies have created a sense of outrage at the standard treatment protocol for Bell's Palsy. No proof that prednisone produces a better long-term outcome exists, and many studies cited the frequently noted false sense of euphoria induced by this synthetic corticosteroid hormone, giving patients in the first week the impression that they were feeling better (see the study cited below). Electromyographic studies did not show any actual improvement with this corticosteroid therapy. Acyclovir, a drug that may inhibit expression of the herpes virus, but has a questionable level of actual efficacy, may help a small number of patients, especially those with an inner ear pain or blistering, or blisters evident on the tongue. Concurrent use of bitter melon extract is proven to enhance the effectiveness of acyclovir. Studies have shown that the prescence of a latent or active Herpes virus is not apparent, though, in a majority of cases. A more comprehensive herbal formula may address low grade infection from a variety of pathogens. A B12 injection may help substantially in the period of nerve sheath recovery and repair, but not in the first 2 weeks. Subsequent B12 injections with patients experiencing some nerve recovery down the road, say in the second or fifth month, may also be helpful. Because there is no actual proven therapy in standard medicine, many MDs around the world are now expressing concern that standard medicine perhaps should not discourage the treatment with acupuncture and herbal/nutrient medicine. This therapy is inexpensive, harmless, and proven effective in so many diseases and injuries, including nerve injuries, and proven to stimulate increased immune responses.

Of course, each patient must make the choice of what type of therapy is going to potentially help them. Patients more at risk may have a greater concern about the outcome. I hope this article elucidates the question of utilizing acupuncture and TCM therapies, and that many more patients are helped by Licensed Acupuncturists in the future. In my practice, I have seen an almost 100% benefit with proper treatment. Of course, some patients have only come to seek this therapy after being left with permanent pain and dysfunction, but even in these cases, I have seen considerable success with therapy. The patient that seeks therapy within the first 2 weeks have shown the best outcome, with a rapid and full recovery and no relapse in almost every case. It is gratifying to see the rapid recovery of this disease, which presents so much stress to the individual with the embarrassment of facial distortion, poor sleep, and often difficulty with chewing and swallowing food. The benefits of treatment in acupuncture and Traditional Chinese Medicine (CIM/TCM) provide more than just the relief of symptoms, and always deliver potentially improved health in many ways, and potentially decreased risk of future health problems, making it one of the most effective preventive medicines on the planet.

The diagnosis of Bell's Palsy, first ruling out other causes

Bell's Palsy, or idiopathic facial paralysis, is a diagnosis of exclusion, meaning that all other causes and diseases must be first ruled out when a patient is evaluated. Approximately two thirds to three fourths of all cases of facial paralysis are attributed to Bell's Palsy each year. The other one third to one fourth of cases are caused by trauma, herpes zoster (Ramsay Hunt syndrome), Lyme disease, sarcoidosis parotid tumors, Sjogren's autoimmune disease or syndrome, amyloidosis, or are related to diabetes mellitus, pregnancy, intranasal flu vaccine, or Guillain-Barre viral syndrome. It is rare that a stroke will cause facial hemiparesis alone. Almost always, facial droop in stroke patients is accompanied by upper or lower extremity weakness, as well as aphasia, and visual field deficits, as well as confusion. If the patient reports a gradual onset of facial paralysis, weakness of the opposite side of the face as well, or a history of recent infection or facial or head trauma, other causes must be strongly considered and tests and exams performed. If the facial paralysis on the same side of the face is recurrent, evaluation for a tumor is necessary. Some insurance companies now will only acknowledge a diagnosis of Bell's Palsy if a positive blink reflex test is positive. This may be performed in a lab with equipment, or in the doctor's office with a simple neurological exam, usually a light touch stimulating a blink reflex, with each side compared.

Types of trauma that would cause facial palsy include fractures to the petrous bone along the nose, although other head trauma, and a basilar fracture could damage the facial nerve. Ramsay Hunt syndrome type 2 is also known as herpes zoster oticus (of the ear), and usually other symptoms besides facial palsy are seen, such as pain in the ear, taste loss on the front two thirds of the tongue, dry mouth and eyes, and a red rash in the ear canal and on the tongue or hard palate, with small blisters. When just the facial paralysis is seen, this is diagnosed as a Bell's Palsy. Lyme's disease causing only facial paralysis is somewhat rare, but would be diagnosed with a spinal tap analysis and brain CT or MRI scan. The spinal fluid and blood would show antibodies to the Borrelia burgdorferi. Sarcoidosis is a disease in which small clumps of inflammatory cells accumulate mainly in the lymph nodes, eyes, skin and lungs, and results from an abnormal immune response. Sarcoidosis is not fully understood, and the symptom presentation and course is highly variable. It is difficult to diagnose, but X-ray and CT scans may reveal the clumps of inflammatory cells, and blood tests and kidney function are analyzed, as well as lung function tests. If swollen lymph nodes, parotid gland, or skin accumulations are noted in physical exam, these can also be biopsied.

Sjogren's Syndrome, a now common autoimmune disease syndrome, will generally show as dry eyes and mouth with facial paralysis symptoms. An array of tests will be analyzed to confirm a diagnosis, including blood test that include rheumatoid factor, antinnuclear antibodies, Sjogren's antibodies, antithyroid antibodies, and immunoglobulins. A salivary gland biopsy is the best way to diagnose Sjogren's Syndrome in relation to dry mouth. Symptom presentation in Sjogren's Syndrome is variable, though, and specific symptoms do not always present concurrently. It is also a slowly progressive disease that can be secondary to another autoimmune disease. The presentation of facial hemiparesis alone is very uncommon. The most typical symptoms seen are lack of fluid in the eyes and mouth (keratoconjunctivities sicca and xerostomia), and parotid gland enlargement (a large gland near the temporomandibular joint).

Amyloidosis is a very complex disease of protein abnormalities. Amyloid deposits can accumulate in many organs and tissues of the body. Salivary gland amyloidosis may be associated with facial hemiparesis, and a biopsy of the salivary glands confirms this. Urine or blood samples may reveal altered proteins related to amyloidosis as well. Guillaine'-Barre syndrome is an inflammatory demyelinating neuropathy, acutely caused by an abnormal immune reactivity to various foreign antigens, the most common being Campylobacter jejuni, but in most cases the infectious agent is not identified, and thought to be a virus, with many viruses implicated. Guillaine'-Barre Syndrome is a somewhat rare side effect of flu vaccines as well. It is reported as a side effect of flu vaccines at the rate of 1 per million, but this is considered underreported. The manifestation of Guillaine'-Barre Syndrome, though, is typically a progressive bilateral symmetrical neuropathy, starting in the legs and advancing upward. Diagnosis usually involves a cerebral spinal fluid analysis and electrodiagnostics of muscle weakness. Sometimes the neural symptoms are not dramatic, though, and often Guillaine'-Barre affects the facial nerve. This facial paralysis would almost always be affecting both sides of the face symmetrically, though. Bell's palsy may affect both sides of the face as well, though. About 23% of bilateral facial paralysis ends up diagnosed as Bell's Palsy.

Diabetic patients are four times as likely to have Bell's Palsy than nondiabetic patients, and 30% more likely to have only partial recovery. Recurrence of Bell's Palsy is also more common among diabetics. Diabetes mellitus alone is not a significant cause of facial paralysis. Since diabetes mellitus is highly associated with neuropathy, the diabetic person is more prone to chronic neural degeneration or recurrent facial paresis in Bell's Palsy. Patients with onset of Bell's Palsy, or idiopathic facial paresis or paralysis, should seek treatment as early as possible to improve outcomes. Complementary Medicine, in the form of professional medical care from a Licensed Acupuncturist and herbalist, may improve the chances of full recovery dramatically.

Utilizing acupuncture, herbal and nutrient medicine, as well as physiotherapy, to aid peripheral nerve regeneration in cases of chronic facial paresis

In recent years, a number of large and extensive scientific studies have confirmed that regeneration of peripheral nerves is common, yet restoration of function after this peripheral nerve regeneration is a problem. One of the problems discovered is that these new nerve fibers may not regenerate in the correct endoneurial tubes to direct them back to target muscles and organs. A 2013 review of scientific study by Dr. Wale Sulaiman MD and Tessa Gordon PhD from the University of Queensland School of Medicine, Ochsner Clinic Foundation, New Orleans, Louisiana, U.S.A. and the University of Toronto, Canada, found that gradual but extensive nerve regeneration after either complete axonal injury, or partial degeneration of the peripheral nerve, is common, albeit slow, at the rate of about 1-3 mm/day, corresponding to the slow rate of transport of nutrients to the neural pathways (see study link below in Additional Information). The damaged or degenerated nerve cell produces many new axons, most of which die off as the most successful axons find the correct pathway in the neural tube. Further elongation of the peripheral nerve through the distal nerve stump are dependent on a growth-supportive environment provided by the support cells, or Schwann cells. Providing a better environment for regrowth and stimulation of target muscles and neural pathways is essential to this process. Obviously, electroacupuncture stimulation and herbal and nutrient medicine is applicable to this treatment protocol.

These scientists found that immediately after nerve injury or degeneration, the loss of nerve conduction feedback triggers a complex pattern in the genes to switch from supporting myelinated conduction to a highly proliferative non-myelinating growth-supportive process. Various growth factors and adhesion molecules are naturally generated when the nerve conduction is disrupted, and even partially injured nerves show a switch in genetic expression to proteins that are important in the rebuilding process. After 6 months, though, most of these genetic rebuilding expressions are downregulated in laboratory animals, strongly suggesting that there is a window of opportunity for patients with poor recovery from Bell's Palsy to aid the successful nerve regeneration. Since this process of peripheral nerve regeneration is programmed into the human physiology, the task at hand is providing the right environment and stimulation for successful regrowth to the target muscles and organs.

These researchers noted that erroneous information on peripheral nerve regrowth continues to be repeated even today, despite definitive studies that demonstrate that successful neural regrowth is common and will be successful if the right environment for this regrowth and stimulation of target muscles is accomplished. Drs. Sulaiman and Gordon wrote that the common belief that atrophied muscles prevented restoration of function in paralysis and paresis stemmed from studies conducted during World War II, and this belief persisted for decades without much scientific study to confirm or deny this belief. Likewise, there persisted for many decades, until recently, a belief that neurons in the central nervous system did not regrow, that pancreatic beta cells did not regrow, and that certain types of cells in the heart did not regrow. All of these almost religious beliefs in modern medical science have been proved wrong. In peripheral nerves, there are just a few causes for the poor return of motor function, and muscle atrophy is not one of them.

One problem with functional restoration of the peripheral nerves after the nerves have been injured or degenerated is the slow rate of growth of the axons and nerve fibers. Of course, the facial innervation is fairly close to the nerve cells themselves, and this is good news for patients with prolonged facial paresis or paralysis. With Bell's Palsy, the initial inflammation and swelling around the nerve may have to be resolved, and then the immune system may need to clear the damaged cells and tissues to provide for regrowth. If the nerve axons themselves are injured or degenerated, there will be a period of time before these plentiful new axon growths find the neuronal tubes to begin the slow daily growth to the target cells. Studies in the laboratory noted that facial nerves that regenerated often did not end up innervating the same motor cells in the muscles that they originally innervated, so a period of retraining would be necessary to restore control of motor function as well, and dyskinesia (dysfunctional motor effects) is expected during this period of nerve regrowth in the first 6 months of the disease course. Since our muscles rely on opposing muscles being able to relax to allow specific muscle contractions, misdirection of innervation to these antagonistic muscles must also be retrained. A step-by-step protocol over a prolonged period of time may be necessary to fully restore motor function after peripheral nerve degeneration or injury. Unfortunately, there is no magic switch that will suddenly turn the motor and sensory nerve functions on, only a prolonged gradual process of restoration.

In summary, scientific study is definitive that clearing and regrowth of peripheral nerves will occur in all cases, a process that is strongly programmed into our genes, but that supplying of key nutrients, aiding the immune functions and tissue clearing, maintaining good circulation to the area, and finally stimulating the target muscles to both promote functional firing of regrown peripheral nerves, and reeducation of the motor function and control, is very important. The vitamins B12, B2 and B3 may be very beneficial to this process, as well as essential fatty acids, and various Chinese herbs have been proven to promote regrowth of peripheral nerves and Schwann cell migration (see studies in Additional Information). Studies have shown that active metabolites of acetyl L-carnitine and uridine, as well as active chemicals in Gotu kola and Gingko biloba stimulate greater nerve growth and repair. A number of studies have measured the effects of acupuncture stimulation on nerve growth factors, as well as the regulation of migration of Schwann cells in remyelination. A growing body of scientific studies, both with laboratory animals, and in human clinical trials, provide sound guidelines for treatment with acupuncture and electroacupuncture for the various stages of recovery as well. The combination of acupuncture, electroacupuncture, herbal and nutrient medicine, and neuromuscular retraining will obviously provide the best chance for recovery, and will act symbiotically to provide the array of important factors needed for successful peripheral nerve regrowth and restoration of neuromuscular function.

Clarifying the term Electrical Stimulation in the treatment of Bell's Palsy

There are a number of types of electrical stimulation utilized in the treatment of Bell's Palsy, and newer types of electrical implants being developed. Understanding the effects and purpose of these various electrical stimulation treatments helps clarify both the proof of efficacy as well as the potential adverse effects that may occur. Electroacupuncture, or the stimulation of the needles at the trigger point with microcurrent stimulation, is well studied and used extensively for the treatment of Bell's Palsy, especially in China, South Korea and Japan. No serious adverse effects have been noted in the use of electroacupuncture, and the array of beneficial effects include stimulation of endorphins, dynorphins, growth factors and the formation and migration of new cells. To refine the use of electroacupuncture, University Medical Schools in China have measured the specific effects and refined the types of microcurrent frequencies, effects at specific acupuncture points, and the effective duration of treatment. Such studies are presented below in Additional Information. Electroacupuncture as an electrical stimulation is distinct from other types of electrical stimulation increasingly used in standard medicine.

In standard medicine, the use of surface electrodes, or transcutaneous electrical nerve stimulation (TENS) is used to both decrease the pain signal and to stimulate muscle activity. A 2006 study at the University of Buffalo, Department of Rehabilitative Science, reviewed all published studies of the use of TENS to treat Bell's Palsy, and found only a few studies that were of high quality, randomized and controlled. In these studies TENS, performed for 6 months, initially applied daily during the first 2 weeks of the disease, and later 3 times per week, showed neither significantly measurable benefit nor harm (Patricia J Ohtake et al, Physical Therapy, Nov. 2006; Vol 86(11): 1558-64). These researchers noted that transcutaneous electrical stimulation stimulates muscle activity in unaffected muscles, but not in denervated muscles. The benefits noted in the studies were attributed to neuromuscular retraining and massage, and potential benefits of TENS stimulation were attributed to enhancing the patient's capacity to voluntarily activate involved muscles during recovery that were partially denervated. The recommendation by these experts at the University of Buffalo, in New York, USA, was to defer utilization of TENS stimulation, if desired by the patient, until 3 months after onset, and use this type of transcutaneous electrical stimulation to enhance neuromuscular reeducation performed by the patient.

A number of new technologies of electrical stimulation are being developed and utilized in recent years, including the use of tiny implanted electrodes in the nerves themselves, but it may be some years before studies of these treatments confirms efficacy or rules out the potential for adverse effects. Implantation of bioelectrical interfaces, direct nerve stimulation enhanced by nanotechnology, interferential stimulation, H-wave stimulation, intramuscular stimulation, and other technologies are being utilized, but guidelines currently recommend these treatments for chronic facial paresis only. There is some concern for the potential of these direct nerve stimulations and implants to result in adverse effects, particularly during the acute course of the disease. Use of electrical stimulation in neurolysis has long been a treatment of last resort when Bell's Palsy or other types of facial paresis has left the patient with problematic nerve pain or dysfunction. These types of new technologies are distinct from electroacupuncture, yet many studies and articles do not distinguish the various treatments, instead lumping them under the title of just electrical stimulation.

The study of microcurrent electrical stimulation on the acupuncture needles, or electroacupuncture, has been used extensively for decades, has been thoroughly studied, refined, and proven both effective and safe, especially in the acute and early stage of the disease. The effects of electroacupuncture are not limited to muscle activation like TENS, and are not a direct stimulation of the nerve, as is seen in new technologies with implants, interfaces, direct stimulation, and nanotechnology. The purpose of the electroacupuncture is to promote normal biological processes by specific and sustained trigger point activation, and to promote healthy regrowth of the nerves and tissues with a number of proven effects. Despite decades of extensive use of electroacupuncture, there is no evidence of adverse effects, although guidelines in China do recommend, as is usual in Traditional Chinese Medicine, the most cautious approach, and utilization of a short course of electroacupuncture, for 3 weeks at the most in the early phase of the disease, or during the regrowth window of 6 months from onset. Use of the electroacupuncture for chronic disability could be used for longer periods of time.

Information Resources and Additional Information with Links to Scientific Studies

  1. A 2010 analysis Bell's Palsy research in South Korea describes the current knowledge of this difficult disease and points to the findings of new pathogenic causes each year. Predominant known causes include Herpes viruses (HSV-1 and Zoster), but association of the disease with HIV vaccine, diabetes mellitus, Lyme disease, hypertension, HIV infection, sarcoidosis and amyloidosis, as well as a number of low grade viral and bacterial infections, indicate that a complexity to the etiopathogenesis may be the reason that this is still a poorly understood disease:
  2. A 2013 meta-review of scientific study of Bell's palsy and other causes of peripheral facial paresis, or weakness, by the Sestre Milosrdnice University Hospital Center in Zagred, Croatia, provides a succinct and revealing summary of current scientific findings: 1) about 80 percent of peripheral facial paresis is primary and idiopathic, which is called Bell's Palsy, a poorly understood disorder, but about 20 percent is due secondary to other health problems, including systemic viral infections, adverse effects of facial surgery, drugs, immune disorders, and neurological degenerative diseases; 2) diagnosis should include blood tests, cerebrospinal fluid investigations, nerve conduction studies, and neuroimaging, all of which are currently seldom performed; 3) treatment of Bell's Palsy is controversial as no definitive scientific studies confirm the efficacy of standard treatment, which consists of steroids and antivirals; and 4) additional treatments supported by the evidence include acupuncture, physiotherapy, palliative and protective therapy for the eyes when the eyelid doesn't fully close, and botox:
  3. A study of the electrical potential in the facial muscles of 87 randomly chosen patients with Bell's Palsy found that 36 had a full recovery within a short period (unspecified), while the others showed an abscence of electrical activity in 10% of the facial muscles in the first 2 weeks, and denervation of the facial nerve was seen in 38% of the patients at 2 months. Even in patients with some motor activity, increased denervation was measured in the second month, particularly affecting the frontalis and depressor labii inferioris muscles, which lifts the eyebrow and lowers the bottom lip. Marked denervation was noted in the second to third month. Patients with long term deficits and poor recovery showed marked degeneration of the Facial nerve after the second week, indicating that early treatment of Bell's Palsy, within the first 2 weeks of onset, may insure a much better outcome:
  4. A study of 2500 cases of Bell's Palsy in 2002 in Denmark found that initially 70% had a complete palsy (all 3 branches of the Facial nerve), and that in the 71% of patient that recovered, sufficient function of facial muscles returned for 85% of these patients in 3 weeks, and by the fifth month in the other 15%. About 30% did not recover normal facial motor function, and 29% experienced various degress of sequelae, with about 17% left with varying presentations of facial pain and contracture, and about 16% with abnormal facial movements, such as twitch and tic. No treatment in standard medicine, including prednisone, was found to give any better prognosis than no treatment. As the study pointed out, many MDs and health authorities question the use of prednisone in therapy, as it has shown no benefit, has significant risk of side effect and long-term harm, and induces a false sense of euphoria that gives the patient a false feeling of benefit in the crucial first 2 weeks. :
  5. A 2010 interview with a renowned physician acupuncturist, Xiaoming Tian, L.Ac., C.M.D., who received his medical degree from Beijing Medical University in China, and now is the director of the Academy of Acupuncture and Chinese Medicine in Bethesda, Maryland, and an adjunct professor of preventive medicine at the Uniformed Services University of Health Sciences (training military doctors and nurses), states in an interview that in his private practice at Wildwood Center in Bethesda, Maryland, that treatment of Bell's Palsy is the tenth most commonly treated disease or injury at his clinic:
  6. The success of acupuncture therapy for Bell's Palsy has long been acknowledged by American physicians. This 1999 review of the success rates with acupuncture by Dr. David P. Sniezek, M.D. of Washington, DC, shows that an almost 100% success rate is seen with patients seeking acupuncture therapy within the first 4 days of onset, and even with patients that sought treatment with acupuncture only after chronic nerve demyelination had occurred at 2 months or later after onset, and in severe cases, 80% of patients still were either cured or had excellent outcomes. :
  7. A 2004 multicenter human randomized controlled clinical trial with acupuncture and moxibustion sponsored by the Chengdu University in China, found that a statistically significant benefit was found with the use of acupuncture and moxibustion in the treatment of Bell's Palsy, both as an adjunct to standard treatment with prednisone, dibazole and B12 injections, and alone, compared to this standard treatment. 439 patients completed these studies, and 314 evaluated at 3 months post-treatment, and 207 at 6 months post-treatment. A number of variables were measured in these trials: http:/
  8. A 2013 randomized controlled human clinical trial of acupuncture treatment for Bell's Palsy, at Huazhong University in Hubei, China, Tongji Medical College, found that acupuncture therapy utilizing needle manipulation that elicited sensation or reaction, traditionally called de qi, or obtaining qi, had a much greater therapeutic effect than acupuncture without stimulation. All patients received the standard short course of prednisone, and the outcomes were measured were measured at 6 months, with facial nerve function and quality of life. In the United States, avoidance of momentary pain or discomfort from needle stimulation is common, but this study proves that the classic method, using needle manipulation to elicit such reactions, is more effective :
  9. A good description of the above 2013 Hubei study, which utilized neurologists to measure facial nerve function who were blinded to the groups who received classic needling with strong elicitation of sensation, or de qi, which means literally to obtain qi, which in this context means an active reaction to the needle stimulation (qi has no specific definition outside of a context), is available from this article on Reuters news. As the Chinese expert reveals to the journalist, the quantification of de qi in scientific study is difficult, because each patient may feel different sensations from the stimulation, even from one treatment to the next, and some Chinese schools of acupuncture put more emphasis on the sensations felt by the physician performing the needling than that reported by the patient, creating some debate on how best to judge needle stimulation. The most skilled acupuncturists will be able to both elicit needle sensations felt by the patient, and also feel sensation through his fingers as well when the body reacts. Often in the United States, though, the obtaining of strong sensation is not elicited because the patients have been taught to expect no pain, and to fear the needle sensations, which is a mistake:
  10. A 2015 randomized controlled human clinical study at the China Academy of Medical Sciences in Beijing, China, showed that indeed, the main points used to treat facial pathology and Bell's palsy, LI4 and ST6, stimulated areas of the brain related to the facial nerves, proven with fMRI analysis, and that the areas stimulated by these 2 points overlapped and were adjacent on the face:
  11. A 2012 study of the effects of daily electroacupuncture stimulation on structural changes of the facial nerves and support cells, at Chengdu University of Chinese Medicine, Chengdu, China, found that in the acute stage of facial nerve injury or degeneration, that daily electroacupuncture during the first week significantly improved the nerve fiber thickness in the facial nerves, the health of Schwann cells which provide regrowth of the nerve fibers, and more abundant organelles in the nerve cells. This benefit decreased after the first week of daily treatment, and benefits continued during the second week of daily treatments, but electroacupuncture daily for more than 3 weeks showed the possibility of overstimulation and worsening of the structural restoration. This study demonstrates a definite guideline for care in the acute stage of Bell's Palsy, and does not relate to long-term chronic effects, though:
  12. A 2007 study with BOLD fMRI of the effects of electroacupuncture stimulation at the point LI4, a primary headache point, at the Huazhong University of Science and Technology, in Wuhan, China, showed that this stimulation not only affected the limbic system to treat pain perception, but modulated the left central anterior gyrus and cerebellum to directly treat the facial palsy and facial muscle spasm:
  13. A 2014 study at Chengdu University, and the Sichuan Academy of Medical Sciences and Provincial People's Hospital, Chengdu, China, found that electroacupuncture for Bell's Palsy not only alleviated symptoms and improved outcomes, but facilitated nerve recovery and promoted a reduction of Herpes Simplex Virus Type 1 in the nerve tissues, as measured in laboratory animals undergoing electroacupuncture. We see from such study that proven measurable benefits of electroacupuncture, and the study showed no measurable adverse effects:
  14. A 2013 randomized controlled human clinical trial of electroacupuncture for the treatment of Bell's Palsy, involving 102 patients, at Qingdao Hiser Medical Center and the TCM Hospital of Zhangdian District of Zibo City, in Qingdao, China, found that combining electroacupuncture with standard acupuncture techniques significantly improved outcome measures and reduced the occurrence of complications in the course of the disease, and showed absolutely no side effects:
  15. A 2013 study at the Institute of Translational Pharmacology, sponsored by the National Research Council of Rome, Italy, found that the effects of acupuncture include stimulation of nerve regrowth, via neurotrophin expression:
  16. A 2013 study at Kyung Hee University, in Seoul, South Korea, also confirmed that acupuncture stimulation promoted nerve regrowth via upregulation of neurotrophic factor and other growth factors. These researchers noted that the common acupuncture points ST36 and DU20 were proven effective to accomplish this task:
  17. A 2011 study at China Medical University, Taichung, Taiwan, found that the Chinese herbal chemical quercetin has significant nerve growth-promoting effects on peripheral nerves:
  18. A 2011 study at China Medical University, Taichung, Taiwan, found that the Chinese herbal chemical puerarin (Pueraria lobata, or Ge gen, commonly called Kudzu) has significant nerve growth-promoting effects on peripheral nerves:
  19. A 2011 study at China Medical University, Taichung, Taiwan, found that the Chinese herbal chemicals in Di Long (a species of earthworm that is dried and processed in Traditional Chinese Medicine) has significant effects on growth factors and migration of Schwann cells on peripheral nerves, promoting peripheral nerve regeneration:
  20. A 2009 study at Taipei Physical Education College, Graduate Institute of Chinese Medical Science, in Taipei, Taiwan, found that the common Chinese herb Astagalus (Huang qi) exerted significant effects to aid peripheral nerve regeneration:
  21. A 2013 review of over 15 years of laboratory study of peripheral nerve growth and restoration of function, by experts at the University of Queensland School of Medicine in New Orleans, Louisiana, U.S.A. and the University of Toronto, Canada, shows that regrowth of peripheral nerves is a certain and dynamic process programmed into our genes, but that the rate of regrowth is slow, and often the new nerve fibers do not grow into the same neural tubes, or pathways to target cells, that they occupied before, requiring stimulation and neuromuscular retraining. A 6 month window or vigorous regrowth is consistently shown, and past notions that muscle atrophy would prevent the restoration of function were proved wrong :
  22. A 2012 study at Wellesley College, in Wellesley, Massachusetts, U.S.A. clearly shows that the nutrient medicine acetyl-L-carnitine (ALC) provides significant benefit in treatment of, and promotion of regrowth of peripheral nerve pathologies, with a regaining of motor function, as well as central nervous system benefits, regaining cognitive function. Here, the rare disorder called Rett's Syndrome is studied, but the treatment is applicable to any neural damage or degeneration :
  23. A 2010 study at the University of Manchester, in Manchester, England, U.K. shows that the nutrient medicine acetyl-L-carnitine (ALCAR) significantly improves regrowth of peripheral nerves. Such studies show that axons, dendrites and myelin sheaths all regrow at a faster rate with this simple nutrient medicine. Such research is used to create formulas to improve nerve regrowth and function in Bell's Palsy, such as the medicine Neuron Growth Factors from Vitamin Research Products:
  24. A 2005 study at Oregon Health Sciences University, in Portland, Oregon, U.S.A. found that the Chinese herb Gotu kola was effective to stimulate nerve regrowth. The studied effects was dose-dependent and in the form of an alcohol extract - combining an alcohol tincture of Gotu kola and Gingko biloba with the standardized extracts found in the neuron growth formulas may help to achieve the goal better:
  25. A 2012 study at the Hong Kong University of Science and Technology, in China, found that one of the active chemicals in Gingko biloba effectively stimulated nerve growth factor (NGF), explaining how this flavonoid has been found so beneficial for so many neurological degenerative conditions :
  26. A 2014 study at the International University of Catalonia, in San Kugat de Valle, Spain, and the Institute for Biomedical Research, in Barcelona, Spain, found that the nutritional medicine uridine significantly aided neural repair from damage: