Q:Are there any effective treatments or remedies I could employ to prevent a recurrence of two attacks of Bell's palsy I have suffered in the past two years?
My first attack, which paralyzed the left side of my face, occurred in July 1992, and the second attack, which paralyzed the right side, took place in April 1994. Both attacks lasted about three weeks, although it took a further week of slowly returning muscle power before I fully recovered.
On both occasions I couldn't close the lid of the eye on the affected side (making it impossible for me to read or write for any length of time as the eye was continually weeping and hurting), or eat or drink properly, owing to the loss of muscle control of my mouth on that side. It is a most distressing and disabling affliction, and I certainly want to avoid any further attacks.
My doctor dealt with both attacks by putting me on a course of cortisone, in order, he explained, to reduce the inflammation of the nerve in question, the seventh nerve from the brain, which controls the facial muscles. It is the inflammation of this nerve brought about by a virus, which is in turn excited by a chill which causes the disease. At least, this is the standard medical explanation and is as much as the medical profession knows about the condition, according to my doctor. Prescribing cortisone, he explained, is the classical medical treatment of Bell's palsy, as cortisone is the most powerful anti-inflammatory drug on the market.
I normally never touch drugs under any circumstances as I have been living according to naturopathic principles since I took up Hatha Yoga at the age of 22 (I'm now 67), and have always enjoyed excellent health. But I took the cortisone treatment for both attacks, as I felt I really had no alternative if I was going to put myself in the hands of my doctor, who is sympathetic to naturopathic practice.
Nevertheless, taking this drug runs counter to my naturopathic beliefs which would have simply indicated a three-day water-only fast and I desperately want to avoid the dilemma of having to decide whether or not to take a further course of cortisone, should I have the misfortune to suffer any more attacks in future. L C B, Luxembourg....
A:As you note, doctors don't really know a great deal about Bell's palsy, or facial paralysis. What they do know is that it has to do with the seventh cranial nerve, as you say, and may have to do with edema (swelling) of the nerve at the base of the skull, possibly as the after-effect of a virus. It strikes at any age, but can also be brought on (very rarely) by pregnancy.
The main symptoms are paralysis of all the muscles of one side of the face, including those of the eyelid and the forehead. During the attack, it's difficult to speak or eat, but the most troublesome aspect is usually the inability to blink, with its effect on the eye. The attack usually lasts about three weeks, and three-quarters or more of people completely recover after a few months, although the rest are left with a slight weakness (or facial "droop) and some wasting.
Because medicine is really grappling in the dark here, all they can offer is steroids, in hopes that it reduces the inflammation, and some measures to make sure the cornea of the eye isn't damaged because you are unable to close the lid. Some doctors also inject adrenocorticotrophic hormone (ACTH), in order to kickstart your own adrenal glands into working harder. According to Stephen Gascoigne (The Manual of Conventional Medicine for Alternative Practitioners, II, Jigme Press, Dorking, Surrey, 1994), doctors even resort to plastic surgery with those people with persistent paralysis, attempting to reactivate the damaged nerves by attaching them to a normal one.
According to Gascoigne, the condition is common in China during the spring winds, which howl at that time of year. Many sufferers report that their palsy arose after they'd been caught in a draught. In Gascoigne's experience (as a practitioner of traditional Chinese medicine), these cases usually are characterized, in TCM terms, as a "WindCold Invasion" affecting the channels of the face. He also finds that it is common to see problems of facial pain in people with digestive (Stomach or Spleen) weakness.
If you wish to pursue the alternative route, you may wish to find a highly trained TCM acupuncturist and herbalist, who can work on strengthening your inherent weaknesses in these areas. But do make sure to find a practitioner who is highly experienced, particularly in treating Westerners with Chinese herbs. Christine Steward, vice president of the National Institute of Medical Herbalists in Exeter, who writes in our letters column (see Letters, page 8), warns that, generally speaking, Westerners can only tolerate dosages of Chinese herbs that are considerably lower than those prescribed in China. That means it's a good idea to check that the practitioner you intend to go to has had some sort of training in the West.
Besides Eastern preventive medicine, you may also try strengthening your nutritional levels. Many sorts of neuropathy (disorders of the nervous system) have to do with low intake of, or poor absorption of, the B vitamins, particularly vitamin B12. Two cases of long-term Bell's palsy (one lasting a year and a half, the other four years) completely cleared up after the patients were given mega-doses (500-1000 ug) of cyanocobalamin, a form of B12, daily and then every other day for a total of 1000-20,000 ugs (J Indian Medical Assoc, 1959; 33: 129-31). Our panelist Dr Melvyn Werbach recommends that you take 1000 ug daily as needed.
Sometimes the problem can be poor absorption of B12, in which case you need to take the vitamins by injection. For anyone else, the culprit is often orthodox drugs, such as neomycin, cholesterol-lowering drugs, potassium chloride and drugs for diabetes.
You should also make sure to be taking adequate amounts of the other B vitamins, including folic acid and thiamine, since deficiencies of both often bring on nervous-system disorders.
For acute cases of Bell's palsy, our Alternatives columnist, Harald Gaier, says that he has great success with auricular (ear) acupuncture. With the patient lying on the couch, he prods sensitive points in the right ear while monitoring the pulse of the left hand.
If a point produces a "hump", or extra wave or slight contraction on the pulse, that's the acupuncture point with the problem and should be needled.
Once again, before you embark on this route, make sure you find a practitioner who is qualified and highly experienced in this form of acupuncture, which is very popular in France.