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Case Report
6 (
2
); 61-66
doi:
10.25259/JISH_11_2023

A case of Bell’s palsy successfully treated with homoeopathy

Department of Practice of Medicine, National Homoeopathy Research Institute in Mental Health, Kottayam, Kerala, India
Corresponding author: Dr. Srigiri G. S. Chakravarthy, Department of Practice of Medicine, National Homoeopathy Research Institute in Mental Health, Kottayam, Kerala, India. sgschakravarthy@gmail.com
Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Chakravarthy SG. A case of Bell’s palsy successfully treated with homoeopathy. J Intgr Stand Homoeopathy 2023;6:61-6.

Abstract

Bell’s palsy is an acute unilateral facial palsy of the lower motor neuron type predominantly affecting middle aged men. Although exact aetiology is unknown, but probable causes include entrapment of the nerve at the mental foramen and vasospasm due to external factors. Surgical management along with medical management provides an assuring relief for the Bell’s palsy sufferers, may produce adverse effects such as facial nerve palsy or post-surgical synkinesis. Homoeopathic medicines, when selected based on signs and symptoms, act on the vital force dynamically and gently restore the nerve functioning to normal. Here, we present a case of left-sided Bell’s palsy recovered with homoeopathic medicines prescribed on the basis of causation and side affinity. The recovery was assessed by the House Brackmann scale and the quality of life was assessed using the modified Naranjo criteria.

Keywords

Bell’s palsy
Causticum
Homeopathy

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 18th 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

Patient information

A 59-year-old female patient, visited the out patient department with complaints of weakness of the left side of the face with inability to puff out the cheeks, inability to raise the eyebrows, twitching of the left eye with inability to close the left eye properly associated with dryness of eyes since 45 days. The symptoms had started suddenly without any prior health issues. She reported sitting under a high-speed fan in an air-conditioned room after a head bath the day before she developed these symptoms.

She denied any other physical or emotional disturbances. She reported a similar instance of left-sided Bell’s palsy 6 years prior, which had been triggered by exposure to cold air during a train journey. She underwent allopathic treatment for 2 months, which relieved her symptoms without any persisting weakness of the facial muscles. Her present episode had not responded to allopathic treatment. She had been prescribed Aspirin, Clopidogrel, Vit. B complex tablets, Aciclovir as per the standard treatment protocol, but since no relief was observed in her complaints she sought homoeopathic treatment.

Medical history

She is a known diabetic since 2–1/2 years and is on metformin 500 mg twice daily. She also had pain in the left upper molars for 1 week. No other major illness in the past.

Personal history

Desire: Sweets, Ice creams, Cold Juices; Appetite: Good; Thirst: Good; Bowels: Regular; Desires cold weather and cold bathing, but all complaints are aggravated on exposure to cold. Motion sickness only on traveling for long distances.

Menstrual history

Menarche at 13 years; regular cycles; Menopause at 48 years.

Obstetric history

G2P1L1A1; FTND.

Family history

Father diabetic and hypertensive; mother diabetic.

Mentals

Easily angered, outbursts of anger at trifles; least contradiction affects her; fear of thunderstorm.

Systemic examination

CVS: No abnormality detected

Respiratory system: No abnormality detected

Locomotor system: No abnormality detected

GIT: No abnormality detected

CNS: Higher functions normal

Cranial Nerves: Facial Nerve – Sensations (pain, touch, and thermal sensations) are intact bilaterally. Motor Functions: Wrinkling of forehead absent on left side; Eyes closure movement impaired on the left side; on puffing up of cheeks air escaping from the left side; angle of mouth deviated to the right and food/water escaping from the left corner of mouth.

Difficulty in talking, twitching of left upper eyelid, and not maintaining eye contact as she is feeling conscious about her condition. On assessment, it was GRADE IV on House Brackmann grading of Bell’s palsy Scale.

House Brackmann scale for grading of Bell’s palsy

Grade Characteristics
Normal Normal facial function in all areas
Mild dysfunction Gross: Slight weakness noticeable on close inspection, May have very slight weakness, normal symmetry, and tone.
Motion: Forehead: Moderate to good function Eye: complete closure with minimal effort Mouth: slight asymmetry
Moderate dysfunction Gross: Obvious, but not disfiguring difference between the two sides. Noticeable but not severe synkinesis, contracture, or hemifacial spasm. At rest normal symmetry and tone.
Motion: Forehead: moderate-to-moderate dysfunction.
Eye: Complete closure with effect.
Mouth: slightly weak with maximum effort.
Moderately severe dysfunction Gross: Obvious weakness with and/or disfiguring asymmetry. At rest normal symmetry and tone.
Motion: Forehead – None
Eye: Incomplete closure
Mouth asymmetric with maximum effort.
Severe dysfunction Gross: Only barely perceptible motion
At rest: ASymmetry.
Motion: Forehead – None
Eye: Incomplete closure
Mouth: Slight movement.
Total paralysis No movement

Miasmatic Predominance: Psora with Syphilis.[12]

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.

First prescription

Iven on 11/08/2020 - Rhus Tox 200C 8 doses (2 doses weekly on same day) Each dose consists of 6 pills of 30.no. size and Placebo 6 pills of 30 Size daily twice (morning and night) for 1 month. The remedy was selected based on keynote symptoms like causation (ailments after exposure to cold air) and side affinity and since the case improved well, the same medicine was repeated without any further repertorisation.

Follow-up and outcome

After the homoeopathic Intervention, the follow up of improvement of the case was taken and shown as under in the Followup Table 1 and also overall improvement by Modified Naranjo criteria as follows.

Table 1: Follow-up and outcome of the case after homoeopathic intervention.
Date Progress Prescription Reason
8 September 2020 Slightly better. Numbness of the left side of face improved slightly. Able to raise the eyebrow. Closing the eye difficult. Drooling of saliva unchanged. Angle of mouth deviated as it is. Twitching of eyelid better Rhus Tox 1M 8 doses – weekly two doses (on same day); Placebo 6pills of 30 size. daily twice for 1 month Improvement was very less and hence Potency was raised to 1M in frequent doses.
6 October 2020 Speech improved, able to close mouth properly. Smile better, drooling of saliva better; chewing – better. Twitching of eyelid – better. Rhus Tox 10M 1 dose and placebo twice daily for 1 month. Since No marked improvement the potency was raised to 10M and in awaited.
30 October 2020 Speech improved; drooling of saliva reduced. Underwent cataract surgery and lachrymation of the left eye was present. On and off pain in the left side of jaw. Sleep: good; Generals: good. Twitching of eyelid – relieved. Rhus Tox 10M 1 dose and placebo twice daily for 1 month. As Rhus Tox is a short-acting remedy, it was repeated.
4 December 2020 Speech improved; drooling of saliva reduced. Pain in left side of jaw reduced. Eye Closure – Can tightly close. Can raise the eyebrows; Sleep: Good; Generals: Good. Rhus Tox 50M 1 dose and placebo twice daily for 1 month. Potency was raised to 50M as improvement is for a shorter duration.
15 January 2020 Facial movements significantly improved; Eye closure normal; Smile normal; Chewing movements good; Stiffness of right shoulder since few days. Placebo twice a day for 1 month. Before going for the next potency, a wait-and-watch policy was followed for a month
9 February 2021; Eye closure normal; Smile normal; Chewing movements good; Stiffness of the right shoulder persists; Rhus Tox 0/3 in aqua doses once daily for 1 month. Placebo twice daily for 1 month. To avoid aggravation due to constant repetition of medicine and considering the appearance of new complaint (stiffness of the right shoulder joint), Rhus Tox was prescribed in the 50 Millesimal potency to enable frequent repetition.
5 March 2021 On and off pain in the left temple and twitching of left eyelid.
Stiffness in the right shoulder persists. Patient did not come as she felt much better.
Rhus Tox 0/3 -Once daily in aqua for 1 month. Placebo twice daily for 1 month. Since complaints persisted, the prescription was repeated.
28 December 2021 Due to exposure to cold air in winter, complaints reappeared with weakness of the left side of face. Associated symptoms: pain in the left temple, Pain right shoulder. Rhus Tox 1M 2 doses – One dose once in 15 days.
Placebo twice daily for 1 month.
After a gap of 8 months, since the patient’s symptoms recurred and she had been relieved with the previous prescription, the same Rhus tox 1M was prescribed.
21 January 2022 Complaints are not much improved and there is dizziness after exertion. Placebo twice daily for 1 month. New symptoms are appearing, and old symptoms have not totally recovered. So waited for further recovery.
18 January 2022 Complaints persist, left-sided facial movements moderately improved; on and off numbness of the right hand after cold air exposure. Causticum 200C – 2 doses one dose (6 pills) in 15 days.
Placebo twice daily for 1 month.
Since Rhus Tox provided partial relief, and the patient had an episode of Numbness from cold air exposure, (General – Dry cold air agg; [Env – Chapter]
Paralysis – cold wind or draft after/paralysis wet, after getting) – in Murphy Repertory and hence, the remedy was changed to Causticum.
8 March 2022 Complaints reduced.
Left-sided facial movements much improved. Smile returned to normal. Numbness of the right hand reduced even after exposure to cold air. Stiffness of the right shoulder persists.
Causticum 200C – 2 doses – one dose (6pills) in 15 days
Placebo twice daily for 1 month.
Complaints persisting, so prescription was repeated.
22 April 2022 Complaints are totally relieved. Raising of eyebrows better; Smiling better, but chewing slightly difficult. Stiffness of the right shoulder much better. Causticum 1M 1 dose. Placebo twice daily for 1 month. Since partial recovery was seen, the potency was raised to 1M.
24 June 2022 All complaints relieved. Placebo twice daily for 1 month. As recovery was ongoing, no medicine was prescribed.
29 July 2022 Left-sided facial movement restored.
Stiffness of shoulder and Numbness of the right hand reduced.
Causticum 0/4
8 doses (weekly two doses). Placebo twice daily for 1 month.
Since LM potency usually does not aggravate symptoms, it was prescribed. The patient did not visited again for further follow-up and telecommunicated that her complaints were totally relieved.

Case improvement of the case as per modified naranjo criteria

Item Yes No Not sure Case
Was there any improvement in the main +2 −1 0 Yes
symptom for which the homoeopathic
medicine was prescribed
Did the clinical improvement occur +1 −2 0 Yes
within a plausible time frame relative to
the medicine intake
Was there any Homoeopathic +1 0 0 No
aggravation of symptoms
Did the effect encompass more than the +1 0 0 Yes
main symptom or conditions I.e were
the other symptoms not related to the
main presenting complaint improved or
changed
Did overall well-being improve? +1 - 0 Yes
Direction of Cure: +1 0 0 Not
Did some symptoms improve in the sure
opposite order of the development of
symptoms of disease
Direction of cure +1 0 0 Not
Did at least one of the following sure
symptoms aspects apply to the order of
improvement of symptoms
From organs of less importance to those
of more importance
From deeper to more superficial aspects
of the individual
Form the top downward
Did old symptoms reappear during the +1 0 0 Not
course of improvement sure
Are there alternative causes that with −3 +1 0 Not
a high probability could have caused sure
improvement
Was the health improvement caused by +2 0 0 Yes
objective evidence
Did repeat doing if conducted create +1 -0 0 Yes
similar clinical improvement

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.

Scope and limitations of the case

The above case of Bell’s palsy recovered within a span of a few months and the follow-up was assessed with the House Brackmann scale. While the treatment had a positive outcome, the case needs to be followed up for a longer duration to collect more data. However, as the patient did not revisit the OPD after recovery, this case may provide minimal supporting evidence for the action of homoeopathic medicines on acute neurological disorders such as Bell’s palsy. A greater number of cases with longer duration of follow-up are highly recommended for stronger evidence.

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.

Declaration of patient consent

Patient’s consent not required as patient’s identity is not disclosed or compromised.

Conflicts of interest

There are no conflicts of interest.

Financial support and sponsorship

Nil.

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