A case of Bell’s palsy successfully treated with homoeopathy

INTRODUCTION

The anatomy of the facial nerve and its association with unilateral facial palsy was first described by Sir Charles Bell in 1821.^[1] Bell’s palsy is defined as an idiopathic, unilateral and acute weakness of the face in a pattern consistent with peripheral nerve dysfunction, that may be partial or complete, occurring with equal frequency on either side of the face. Additional symptoms include mild pain in or behind the ear, oropharyngeal or facial numbness, impaired tolerance to ordinary levels of noise and disturbed taste on the anterior part of the tongue.^[2]

It affects both sexes equally and the incidence rates range from 11 to 40/1 lac population, with specific studies demonstrating similar annual incidences across the various parts of the globe and more common in people with diabetes.^[3,4]

The aetiology of Bell’s palsy is multifactorial, including physiological compression of the nerve due to arteriospasm, venous congestion, anatomical narrowing of the bony canal due to Congenital (genetic syndromes and birth trauma), developmental hypoplasia of the facial muscles, Infective in origin like varicella virus, herpes simplex virus I, tuberculosis, human immunodeficiency virus or traumatic, inflammatory, autoimmune, neoplastic or cerebrovascular diseases.^[5,6]

Several risk factors such as severe pre-eclampsia, pregnancy, obesity, diabetes mellitus, hypertension, migraine, radiation exposure, upper respiratory tract infection, exposure to extreme temperatures and psychological factors are also potential causative factors.^[6]

Clinical symptoms present with rapid and progressive onset, reaching peak severity within 72 h. The characteristic pattern of weakness is seen on one half of the face, with ocular features such as corneal exposure, dry eyes, lagophthalmos, brow droop, inability to close the eye with paralytic ectropion of the lower lid, difficulty in pursing the lips, loss of nasolabial fold, altered taste and hearing sensitivity/otalgia. Usually, partial or complete weakness of one side of the forehead is the key factor for diagnosis; if this is absent, a higher lesion should be investigated.^[7,8]

Clinical examination of Bell’s palsy includes complete head-and-neck examination, microscopic ear examination for cholesteatoma/middle ear effusions, detailed eye examination, with cranial nerve exam involving facial nerve and its branches for degree of weakness, synkinesis and spasticity. The clinical assessment is done using the House Brackmann scale.^[9] Investigations like electromyogram (EMG) and imaging techniques like computed tomography and MRI brain are highly essential in case of persistent and progressive facial palsy.^[10]

Many alternative methods of treatment are available for Bell’s Palsy and other neurological disorders. Homoeopathy originated by the end of 18^th century by ideas and experiments of Dr. Christian Friedrich Samuel Hahnemann.

The homoeopathic principle of similarity holds that a pathogenic substance administered in small doses may correct the physiological imbalance of a diseased organism producing symptoms similar to those that the same substance causes in healthy people in proving. The disturbed homoeostasis in a diseased individual needs an endogenous therapeutic reaction like homoeopathic remedy in small doses to restore the function back to normal state. Homoeopathy is more effective than complementary medicine in many neurological diseases.

Very few but significant clinical studies are available in homoeopathic literature to support efficacy of homoeopathy in neurological diseases. A study conducted on 103 facial nerve neuropathy cases treated with homoeopathy with infrared laser therapy showed an effective outcome.^[11]

CASE REPORT

RESULTS

Since few symptoms are available the causation, modalities and side affinities were taken into consideration and the medicines were prescribed, by choosing the appropriate rubrics from murphy repertory.

DISCUSSION

Facial expression is essential to every individual’s sense of well-being and ability to integrate into society. With facial asymmetry and decreased facial movements, patients with Bell’s palsy can experience deep social distress, impaired interpersonal relationships, social isolation and depression.

A study by Gantz BJ et al., found that patients with >90% electroneuronography (ENoG) degeneration in 14 days or less and no involuntary motor unit potentials on EMG had significantly better outcome when treated with surgical facial nerve decompression through the middle cranial fossa and shown 91% recovery rate than if treated with steroids alone which had only a 58% chance of recovery. Therefore, surgical management is highly recommended in patients with ENoG degeneration in 14 days or less and no voluntary unit potentials on EMG.^[13]

However, as surgical decompression has known side effects like irreversible facial palsy, all patients may not opt for it.^[14]

In a given case, the cause, its infinity of symptoms and susceptibility of the patient are all tributary for the successful application of the law of similar which helps in selection of similimum and successful outcome of the case.

In Aphorism 73, Dr. Hahnemann explains that the exciting causes could be any external impressions or emotions. Homoeopathic stalwarts like Boenninghausen emphasised on the circumstances that causes the symptoms and Dr. C. M. Boger proposed that causation is more reliable in individualisation and helps in selection of similimum. The homoeopathic remedies frequently indicated for Bell’s Palsy include Causticum, Rhus tox, Nux vomica and Graphites.

The above case of a 59-year-old woman with Bell’s palsy, who was relieved considerably within 6 months of homoeopathic treatment suggests that homoeopathic medicines when prescribed not only on the constitution but basing on the causation alone, also cures the case successfully.

CONCLUSION

Bell’s palsy is the most common affection of the facial nerve causing difficulty in daily activities and considerable social problems to those affected. Medical and surgical intervention has lifelong temporary/permanent disability of facial nerve functions. In contrast, homoeopathic medicines when prescribed on the basis of similarity of symptoms, either keynote/causation/totality of symptoms enable the patient with complete recovery of the Bell’s palsy without any adverse effects.