Bells Palsy Thoughts and Considerations

A 1976 article by M.H. Weiss documents the use of the Myomonitor for the treatment of a Bell’s Palsy patient. The author concludes that since Bell’s Palsy is associated with the failure of the 7th motor nerve, the Myomonitor stimulus may have helped reactivate the affected nerve issue. The treatment in this case consisted of pulsing the patient for an hour on a daily basis for 11 days.

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There have been a number of neuromuscular doctors who reported effectiveness using the Myomonitor on cases with Bell’s Palsy. Dr. Bob Jankelson (a renowned neuromuscular pioneer and dentist, now retired) reported from his 30+ years of clinical experience treating a number of Bells patients. Here is a brief background he reported and once wrote.

“First, a little background on the epidemiology and pathogenesis of Bells Palsy. The incidence is about 23 cases per 100,000 adults per year. Not uncommon. (Ref. Hauser,WA et al 1971, Petersen, E 1982). The literature suggests 71% of the Bells patients will spontaneously remiss to normal without intervention. ( Ref. Jenkins, HA 1985). This leaves a significant 30% of the patients with residual effects without intervention.

DIAGNOSIS
Differential diagnosis should include possibility of Cerebral Vascular Accident, Central Nervous System lesion etc. Clinical onset is rapid with drooping of the corner of the mouth, ptosis of the eye, occasional numbness, and facial muscle motor dysfunction on the affected side. Always get physician evaluation to rule out CVA even though patient presents with classical Bells.

Many Bells patients will relate a history of sitting in a draft, cold wind or air conditioning prior to onset of the motor symptoms.

TREATMENT
The Standard of Care makes use of a Medrol Dosespan starting at 60mg prednisone for 10 days requisite. Conventional wisdom in the medical community is that resolution after 6-8 weeks is usually optimal and further improvement questionable. My clinical protocol since 1970 was immediate application of the ultra low frequency TENS (Myomonitor) daily 4-8 hours or more for a least two weeks or until symptoms ameliorate.

Electrode application is bilateral over the coronoid notches. You may have to move the balance control over to the affected side. Patient comfort is the guide. Prior to 1980 we did not use the prednisone and still had phenomenal success. Today, combine the prednisone with the TENS to fulfill Standard of Care. Remember, 70% of the cases will spontaneously remiss so you will not know you are successful until success rates soar to 90+ %.

There is no question that chronicity affects response. This is probably because histopathologic findings from biopsies in Bells patients reveal degeneration and demyelination of the nerve fibers and lymphocytic infiltration of the nerve. However, I have had patients symptoms improve or remiss in cases of several years duration after intensive TENS treatments.

MY CLINICAL IMPRESSIONS
My clinical impression through the years was that most of the Bell Palsy patients that I saw were suffering from COMPRESSION of the efferent motor fibers of the VII nerve. This can be inflammatory which can cause edema and compression, particularly in the facial canal or the narrow meatal foramen where the facial nerve emerges. The issue of sudden and severe muscle contraction associated with the frequent history of cold or draft is also possible. The rationale for prednisone therapy is based upon the inflammatory issue. However, ultra low frequency TENS helps pump out the lymphatics, restores blood supply and relaxes muscles in the area of the VII motor nerve. Makes sense. Also, if demyelination is an issue we know that the greatest consumer of oxygen in the body is myelin tissue. Makes sense to pump extra blood and oxygen into the area. Again, my clinical experience with many Bells patients suggests early and aggressive application of the Myomonitor (BNS-40 is most practical because of portability). Hope this gives some perspectives.” – Bob J.