A Brief Bell’s Palsy

I was chatting to my friend on the phone recently and to my surprise, he told me he had been diagnosed with Bell’s Palsy. I had no idea what this condition was and scrutinised him. Apparently the condition has left him with a droopy eye (to which I suggested he get a pirate patch) and bit of Frankenstein face (probably an improvement – no offense mate).  In all seriousness, the conditions symptoms could indicate a patient had suffered a stroke, for this reason NHS direct sent an ambulance to him. 

The condition itself is rare and is diagnosed through confirming that the paralysis is caused by a unilateral, lower motor neuron lesion. This seems to be true in my friend's case due to his ‘pirate’ eye but a thorough examination is necessary to rule out Lyme’s disease (bacterial infection) or Ramsey Hunt syndrome (caused by herpes zoster virus).  

The prognosis of the condition is good with 85% of patients making a full recovery in nine months (Sullivan et al. 2007). The eye should be appropriately lubricated so eye drops/ointment might be necessary for patients. (DTB, 2006).  Micropore tape could be used to close the eye at night however I think the pirate patch would be more appropriate for Andrew.

Treatment consists of prednisolone 25mg twice a day for 10 days. Aciclovir should not be used due to the outcome of the Sullivan et al (2007) randomised controlled trial which concluded no evidence of benefit.

Hopefully he should return to his normal beautiful self but it is sobering to think that not all patients recover. Maybe future genomic personalised medicine might be able to crack this idiopathic condition. 

References

DTB (2006) Managing Bell's palsy. Drug and Therapeutics Bulletin 44(7), p49-53.

Sullivan, F.M., Swan, I.R., Donnan, P.T. et al. (2007) Early treatment with prednisolone or acyclovir in Bell's palsy.New England Journal of Medicine 357(16), p1598-1607