TREATMENT OF BELL'S PALSY: A CASE REPORT
David P. Sniezek, D.C., M.D., Washington,
A 56-year-old white female presented
with a 3-month history of severe right facial pain, weakness,
and paralysis. This patient was referred to an otolaryngologist
and a neurologist at Johns Hopkins, but did not achieve symptomatic
relief. After 15 acupuncture treatments over an 8-week period,
the patient had nearly complete resolution.
Bell's Palsy, Acupuncture, Electroacupuncture, Wiad and Cold,
The patient's right facial paralysis
developed overnight. Associated symptoms included pain in her
face, difficulty speaking clearly, aud hypersensitivity to sound
in the right ear. She was unable to close her right eyelid, and
experienced difficulty with drinking and mastication. She was
evaluated and treated by an otolaryngologist, and placed on a
steroid taper and acyclovir; symptomatic improvement in facial
muscle strength did not occur. Her facial disfigurement and difficulty
speaking impacted on her occupation (restaurant owner and operator).
She developed mild depression and a secluded behavior.
Prednisolone, Premarin, Acyclovir, DHEA,
vitamins, minerals, and a natural Synthroid substitute.
Autoimmune and serology were negative.
Lyme titer was negative. Thyroid function tests indicated that
she was euthyroid with a slightly decreased TSH level.
This patient had a history of exposure
to shingles (sister) several years prior. She denied a history
of chicken pox or cold sores. She had osteonecrosis of the right
hip that required surgery, pseudotumor of the left orbit, obesity
secondary to long-term steroid use, left knee surgery, abdominal
hysterectomy, tonsillectomy, and appendectomy.
Neck pain, lower back pain, joint pain,
depression, right facial pain and sensitivity to sounds in the
right ear, with difficulty speaking clearly.
Chinese medicine attributes this condition
to Wind and Cold of external origin which invade the meridians
traversing the face and disrupt the flow of Qi and Blood, preventing
the vessels and muscles from receiving the necessary nourishment.
Treatment is directed toward spreading the Qi through the meridians
of the face (1).
The patient was treated with an integrated
approach of acupuncture models. Points from a neuroanatomical
model, or for classical indications, were included at each treatment
and primarily used unilaterally. Other points utilized the energetic
approach, and were treated bilaterally.
The following acupuncture points were
used without electrical stimulation. The local points were treated
only on the right side, while the distal points were needled bilaterally.
The principal points included GB 20 (Fengchi), GB 14 (Yangbai),
ST 4 (Dicang), ST 2 (Sibai), and LI 4 (Hegu). The supplemental
points included GV 26 (Renzhong), M-HN 18 [Jiachengjiang] (1),
M-HN 9 (Taiyang), ST 7 (Ziagnuan), ST 36 (Zusanli), ST 44 (Neiting),
and LI 19 (Heliao).
(Editor's Note: The M-HN points
referred to are "miscellaneous head and face points," according
to O'Connor and Bensky's Acupuncture: A Comprehensive Text; see
reference 1 .)
ST 2 (Sibai) was needled with a straight
insertion, while G B 14 (Yangbai) was joined to M-HN 6 [Yuyao]
(2). These two points may be procured with one needle, or connected
together with an alligator clip during electro-stimulation. ST4
(Dicang) and ST6 (Jiache) were treated independently. Because
of the weakness in the orbicularis oris, GV 26 (Renzhong) and
LI 19 (Heliao) were added. M-HN 9 (Taiyang) may be joined to ST
6 (Jiache). However, in this case, the points were treated independently.
The other points can be added in rotation; the best method is
a mixture of close points on the face, and distant points on the
limbs. Superficial insertion of the needles with moderate stimulation
is recommended, and was done in this case. Treatment was carried
out on alternating days. Points were treated on the affected side
only, except for LI 4 (Hegu), which was treated bilaterally.
The facial points are in muscles supplied
by the facial nerve. Treating these points helps to spread Qi
through the channels of the face. GB 20 (Fengchi) disperses Wind
and Cold. Stomach and Large Intestine meridians pass through the
face. Treating L14(Hegu), ST44 (Neiting), and ST 36 (Zusanli)
on these meridians opens them to the circulation of Qi.
can be used to intensify the effect of needling;
however, electroacupuncture is ordinarily
reserved until after the first or second week
of treatment. This can be accomplished with
low frequencies of 3-10 Hz (3), for 20 minutes
(ITC elec-toacupuncture stimulator, lC 1107),
using GB 14 (++) and LI 4 (- -). More rapid
results may be obtained when acupuncture is
combined with manipulation, hot compresses,
or Chinese and Western oral medication.
The patient was initially graded with
a House-Brackmann grade 5 paralysis in the right facial muscles
(4). After 10 acupuncture treatments over a 4-week period, she
showed significant motion in her forehead and had total closure
of her eye with maximal effort. However, with normal effort, she
had 1 to 2 mm of scleral fill with good protection of her cornea.
She also had good buccal movement and increased movement in the
muscles supplied by the mandibular branch of her facial nerve.
After a total of 15 acupuncture treatments over an 8-week period,
she exhibited normal upper division motion and intact tone in
the lower division, with only a mild decrease in motor strength
in this division. Her strength was graded at approximately a House-Brackmann
2. She had full eye closure, and intact conjunctivae with slight
Bell's Palsy is the most common disease
of the facial nerve. It is presumably due to an inflammatory reaction
in or around the facial nerve near the stylomastoid foramen. According
to Liu (1995), when acupuncture was initiated within three days
post-onset in 684 cases of facial nerve paralysis, 100 percent
of the patients were cured or there was a marked improvement (5).
Other studies (Gao, Chen, 1991) revealed that 80% of cases that
were treated at more than 2 months post-onset, and 83 percent
of severe cases, were cured or had excellent effect (6). Treatment,
as with this patient, may include numerous diagnostic procedures,
different classes of medications, lifestyle alterations, and still,
continued suffering. Acupuncture may often lead to significant
clinical improvement (7).
1. O'Connor J, Bensky D. Acupuncture a comprehensive text. Seattle:
Eastland Press 1981; 367-372.
2. Ibid, 609-610.
3. Stux G, Pomeranz B. Acupuncture textbook and atlas. Berlin:
Springer-Verlag 1987; 296.
4. Evans RA, Hames ML, Baguley DM, Moffat DA. Reliability of the
House and Brackmann grading system for facial palsy. J Laryngol
Otol Nov 1989; 103(11): 1045.
5. Liu YT. A new classification system and combined treatment
method for idiopathic facial nerve paralysis: report of 718 cases.
Am JAcup 1995; 23(3),205-210.
6. Gao HB, Chen D. Clinical observation on 60 cases of peripheral
facial paralysis treated with acupointure penetration needling.
Int J Clin Acup 1991; 2(1),25-28.
7. NIH Consensus Development Conference on Acupuncture, National
Institutes of Health, Bethesda MD, Nov 1997; 93-109.
Dr. David P. Sniezek
is in solo private practice specializing in Medical Acupuncture,
Pain Management, and Physical Medicine and Rehabilitation in Washington,
D.C. He is a member of the American Academy of Medical Acupuncture.
David P. Sniezek, DC, M.D.
2021 K Street, NW #710
Washington, DC 20006
Phone: 202-296~3555 · Fax: 202-296-0214
· Email: Sniezek@aol.com
to Top AAMA
of Contents Journal