Bell's palsy, or facial palsy, is a weakness or paralysis of the muscles that move either side of the face. Bell's palsy is a temporary neurological disorder that results from damage to one of a pair of facial nerves (usually the 7th cranial nerve) that runs beneath each ear to the muscles in the face. Facial nerves pass through the base of the skull connecting the brain to muscles of facial expression.
Damage to the facial nerves may result in a droopy appearance of the face. Although Bell's palsy is not a life-threatening condition, it can cause problems with self-esteem. Bell's palsy is the most common cause of facial paralysis worldwide.
Bell's palsy afflicts approximately 40,000 Americans each year. Bell's palsy affects men and women equally and can occur at any age, but it is less common before age 15 or after age 60. Bell's palsy occurs more often in pregnant women, in individuals with diabetes, upper respiratory ailments (such as the flu or a cold), and in individuals with conditions that compromise their immune systems, such as human immunodeficiency virus (HIV) and cancer.
For most individuals, Bell's palsy usually disappears on its own within weeks or months.
The incidence of Bell's palsy in the United States is approximately 23 cases per 100,000 persons. The condition affects approximately one person out of 65 in a lifetime. Worldwide, the incidence of Bell's palsy is similar to that in the United States. The condition is named for Sir Charles Bell, a Scottish surgeon who studied the nerve and its innervation of the facial muscles 200 years ago.
CAUSES AND RISK FACTORS
Bell's palsy occurs when the nerve that controls the facial muscles is swollen, inflamed, or compressed, resulting in facial weakness or paralysis.
The causes of Bell's palsy remains unclear, although blood vessel involvement, infections, genetic, and immunologic causes have all been considered. Individuals with other conditions, such as neurological conditions, sometimes develop peripheral facial nerve palsy, but these are not classified as Bell's palsy.
Ethnicity: Incidence of Bell's palsy appears to be slightly higher in persons of Japanese descent.
Gender: There seems to be no difference in sex distribution in patients with Bell's palsy.
Age: Age affects the incidence of developing Bell's palsy. The incidence is highest in persons aged 15-45 years. Bell's palsy is less common in those younger than 15 years and in those older than 60 years.
Viral infections: Scientists believe that Bell's palsy is caused by an infectious condition, which triggers an immunologic response, resulting in damage to the facial nerve. Infectious causes of Bell's palsy include herpes simplex virus type 1 (HSV-1), herpes simplex virus type 2 (HSV-2), human herpes virus (HHV), varicella zoster virus (VZV), Mycoplasma pneumoniae, Borrelia burgdorferi; influenza B, adenovirus, coxsackievirus, Ebstein-Barr virus, hepatitis A, B, and C, cytomegalovirus (CMV), and rubella virus.
Pregnancy: Although Bell's palsy is uncommon in pregnancy, the outcome is significantly worse in pregnant women with Bell's palsy than among non-pregnant women with the condition. The reasons include: a high fluid content in the tissues; viral inflammation, particularly herpes simplex; and a lowered immune system that occurs in the latter part of pregnancy.
SIGNS AND SYMPTOMS
Facial nerves are responsible for contraction of the muscles of the face, for production of tears from the lacrimal gland (located under the upper eyelid), and for conveying the sense of taste from the front part of the tongue. Therefore, damage to the nerve or a disruption in its function can lead to many health problems. Symptoms of Bell's palsy are due to damage to facial nerves. Symptoms vary from person to person and range in severity from mild weakness to total paralysis. They may include twitching, weakness, or paralysis on one or both sides of the face, drooping of the eyelid and corner of the mouth, headache, drooling, dryness of the eye or mouth, impairment of taste, and excessive tearing in one eye. However, these symptoms usually begin suddenly and reach their peak within 48 hours.
Other symptoms may include pain or discomfort around the jaw and behind the ear, ringing in one or both ears, headache, loss of taste, an increased sensitivity to sound on the affected side, impaired speech, dizziness, and difficulty eating or drinking.
Major complications of Bell's palsy are chronic loss of taste (ageusia), chronic facial spasm, and corneal (eye) infections. Bell's palsy can cause aesthetic, functional, and psychological disturbances in individuals who have reoccuring nerve dysfunction during their recovery phase or in patients with incomplete healing.
Another complication of Bell's palsy can occur during nerve re-growth. The nerve can be thought of as a bundle of smaller individual nerve connections that branch out to their proper destinations. During re-growth, nerves are generally able to function normally. However, some nerves may begin to function abnormally, leading to a condition known as synkinesis. Synkinesis refers to an involuntary contraction of multiple facial muscles in the process of one or more motions. For example, re-growth of nerves controlling muscles attached to the eye may sidetrack and also re-grow connections reaching the muscles of the mouth. In this way, movement of one also affects the other. When the individual closes the eye, the corner of the mouth will lift, or when smiling, the eye will close.
In addition, around 6% of individual's with Bell's palsy exhibit crocodile tear syndrome on recovery, where they will shed tears while eating. This is thought to be due to faulty regeneration of the facial nerve.
A doctor may be able to make a preliminary diagnosis of Bell's palsy by looking at the individual's face. The doctor will ask the individual to try to move the facial muscles and then will determine if nerve damage is present. Conditions, such as a stroke, infections, and tumors, also may cause facial muscle weakness, acting like Bell's palsy.
Imaging tests: Imaging tests, including computed tomography (CT scan), magnetic resonance imaging (MRI scan), and positron emission tomography (PET scan), may be used to detect nerve damage.
Other imaging tests: An electromyogram (EMG) may be performed. An EMG test is used to monitor electrical activity within the body and can help detect nerve and muscle disorders. EMG involves placing electrodes on the skin (surface EMG) or into the muscle (intramuscular EMG) to record electrical activity of the muscle.
Most individuals suffering from Bell's palsy recover fully with or without treatment. Courses of treatment may include steroid medications, antiviral medications, and massage.
Antiviral medications: Prescription antiviral medications, such as acyclovir (Zovirax©) and famciclovir (Famvir©), may limit or reduce damage to the nerve from some viral causes. Side effects of these medicines may include nausea, vomiting, and stomach upset.
Eye protection: Bell's palsy commonly affects the eyes. An important factor in treatment is eye protection. Bell's palsy can interrupt the eyelid's natural blinking ability, leaving the eye exposed to irritation and drying. Therefore, keeping the eye moist and protecting the eye from debris and injury, especially at night, is important. Lubricating eye drops, such as artificial tears or eye ointments or gels (including Visine Tears©, Artificial Tears©, and Lacri-lube©), and eye patches, which help protect the eye, are also effective.
Massage: Facial massage may help prevent permanent problems with paralyzed muscles before recovery takes place. Facial massages may help to relax facial muscles and help relax the individual. Individuals suffering the effects of Bell's Palsy need to be advised to relax more to relieve the stress that may cause this disease.
Steroid medications: A short course of prescription corticosteroid (steroid) medications, such as prednisone (Deltasone©), may reduce inflammation and swelling in the narrow, bony channel through which the facial nerve travels. Side effects of steroids include weight gain, edema (fluid buildup), and stomach upset.
Surgery: Surgical procedures to decompress and realign the facial nerve have been attempted, but have not been proven beneficial. There are serious risks involved with surgical procedures to the facial nerves. The most common complications are hearing loss and damage to the facial nerve, which can be permanent. On rare occasions, cosmetic or reconstructive surgery may be needed to reduce deformities and correct some damage, such as an eyelid that will not fully close or a crooked smile.
Other therapies: Other therapies that may be useful for some individuals include relaxation techniques, acupuncture, electrical stimulation, biofeedback training, and vitamin therapy (including vitamin B12, B6, and zinc), which may help nerve growth.
The outcome for individuals with Bell's palsy is generally very good. The extent of nerve damage determines the extent of recovery. Improvement is gradual and recovery times vary. With or without treatment, most individuals begin to get better within two weeks after the initial onset of symptoms and most recover completely, returning to normal function within three to six months. For some, however, the symptoms may last longer. In a few cases, the symptoms may never completely disappear. In rare cases, the disorder may recur, either on the same or the opposite side of the face.
Note: There is currently a lack of available scientific evidence on the use of integrative therapies for the treatment or prevention of Bell's palsy. The therapies listed below have been studied for the management of neurological disorders in general, should be used only under the supervision of a qualified healthcare provider, and should not be used in replacement of other proven therapies or preventive measures.
Strong scientific evidence:
Alpha-lipoic acid: Many studies have shown that alpha lipoic acid (ALA) is an effective treatment for neuropathy (nerve pain or damage) associated with diabetes or cancer treatment. Avoid if allergic to ALA. Use cautiously with diabetes and thyroid diseases. Avoid with thiamine deficiency or alcoholism. Avoid if pregnant or breastfeeding.
Good scientific evidence:
5-HTP: Cerebellar ataxia results from the failure of part of the brain to regulate body posture and limb movements. 5-HTP has been observed to have benefits in some people who have difficulty standing or walking because of cerebellar ataxia. Some research shows that 5-HTP may allow individuals with unsteady movements to stand alone without assistance, walk without aid, or improve coordination. Other research shows no benefit. Further research is needed before a conclusion can be drawn. 5-HTP may interact with other mood-altering medications, such as antidepressants and anti-anxiety drugs. Avoid 5-HTP if allergic or hypersensitive to it; signs of allergy to 5-HTP may include rash, itching or shortness of breath. Avoid with eosinophilia syndromes, Down's syndrome, and mitochondrial encephalomyopathy. Use cautiously with renal (kidney) insufficiency, HIV/AIDS- particularly HIV-1 infection, epilepsy, and/or with a history of mental disorders. Avoid if pregnant or breastfeeding.
Music therapy: Music therapy has been reported to improve symptoms in people with Parkinson's disease. Modest improvement in symptoms including motor coordination, speech intelligibility and vocal intensity, bradykinesia (slow movement), emotional functions, activities of daily living, and quality of life were seen. Music therapy is generally known to be safe.
Unclear or conflicting scientific evidence:
Acupressure, Shiatsu: The practice of applying finger pressure to specific acupoints (energy points) throughout the body has been used in China since 2000 B.C. Shiatsu technique involves finger pressure at acupoints and along body meridians (energy lines). It may incorporate palm pressure, stretching, massaging, and other manual techniques. Shiatsu practitioners commonly treat musculoskeletal, neurological and psychological conditions, including neck/shoulder and lower back problems, arthritis, depression, and anxiety. In preliminary clinical study, individuals with facial spasm reported improvement when using Shiatsu acupressure. Acupressure may also benefit several measures of severity of Parkinson's disease. Further study is needed before conclusions may be made.
With proper training, acupressure appears to be safe if self-administered or administered by an experienced therapist. No serious long-term complications have been reported, according to scientific data. Hand nerve injury and herpes zoster ("shingles") cases have been reported after shiatsu massage. Forceful acupressure may cause bruising.
Acupuncture: Acupuncture has been reported to help relieve symptoms of some neurological disorders including Bell's palsy, cerebral palsy, nerve damage, hemiplegia (full or partial paralysis of one side of the body due to disease, trauma or stroke), Parkinson's disease (characterized by fine muscle coordination and tremors), spinal cord injury, Tourette's syndrome (characterized by "tics"), and trigeminal neuralgia. There is currently insufficient evidence available from well-designed studies supporting use of acupuncture for these indications. Additional study is needed.
Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders or with drugs that increase the risk of bleeding (anticoagulants), medical conditions of unknown origin, and neurological disorders. Avoid on areas that have received radiation therapy and during pregnancy. Use cautiously with pulmonary disease (like asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics or with history of seizures. Avoid electroacupuncture with arrhythmia (irregular heartbeat) or in patients with pacemakers.
Alexander technique: The Alexander technique is an educational program that teaches movement patterns and postures, with an aim to improve coordination and balance, reduce tension, relieve pain, alleviate fatigue, improve various medical conditions, and promote well-being. Preliminary research suggests that Alexander technique instruction may improve fine and gross movements and reduce depression in patients with Parkinson's disease. Well-designed human trials are necessary. No serious side effects have been reported. It has been suggested that the technique may be less effective with learning disabilities or mental illnesses.
Arginine: Arginine, or L-arginine, is considered a semi-essential amino acid, because although it is normally synthesized in sufficient amounts by the body, supplementation is sometimes required. Adrenoleukodystrophy (ALD) is a rare inherited metabolic disorder characterized by the loss of fatty coverings (myelin sheaths) on nerve fibers in the brain, and progressive destruction of the adrenal gland. ALD is inherited as an x-linked genetic trait that results in dementia and adrenal failure. Injections of arginine have been proposed to help manage adrenoleukodystrophy, although most study results are inconclusive.
Avoid if allergic to arginine, with a history of stroke, liver or kidney disease. Avoid if pregnant or breastfeeding. Use caution if taking blood-thinning drugs (like warfarin or Coumadin©) and blood pressure drugs or herbs or supplements with similar effects. Check blood potassium levels. L-arginine may worsen symptoms of sickle cell disease. Caution is advised in patients taking prescription drugs to control sugar levels.
Ashwagandha: There is currently insufficient scientific evidence to recommend the use of ashwagandha in the management of Parkinson's disease. Avoid if allergic or hypersensitive to ashwagandha products or any of their ingredients. Dermatitis (allergic skin rash) was reported in three of 42 patients in one ashwagandha trial. There are few reports of adverse effects associated with ashwagandha, but there are few human trials using ashwagandha, and most do not report the doses or standardization/preparation used. Avoid with peptic ulcer disease. Ashwagandha may have cause abortions based on anecdotal reports. Avoid if pregnant or breastfeeding.
Ayurveda: There is evidence that the traditional herbal remedy Mucuna pruriens may improve symptoms in Parkinson's disease, and that it may offer advantages over conventional L-dopa preparations in the long-term management of the disorder. One study has suggested that symptoms of Parkinson's disease may be reduced with use of an Ayurvedic formula called HP-200, which is derived from Mucuna pruriens. More studies are needed to verify what can be expected from these treatments.
Ayurvedic herbs should be used cautiously because they are potent and some constituents can be potentially toxic if taken in large amounts or for a long time. Some herbs imported from India have been reported to contain high levels of toxic metals. Ayurvedic herbs may interact with other herbs, foods and drugs. A qualified healthcare professional should be consulted before taking.
Belladonna: The autonomic nervous system, which helps control basic body functions like sweating and blood flow, is affected in several disorders. To date, human studies have shown no benefit from belladonna in treating autonomic nervous system disorders. Avoid if allergic to belladonna or plants of the Solanaceae (nightshade) family (bell peppers, potatoes, eggplants). Avoid with a history of heart disease, high blood pressure, heart attack, abnormal heartbeat (arrhythmia), congestive heart failure, stomach ulcer, constipation, stomach acid reflux (serious heartburn), hiatal hernia, gastrointestinal disease, ileostomy, colostomy, fever, bowel obstruction, benign prostatic hypertrophy, urinary retention, glaucoma (narrow angle), psychotic illness, Sj©gren's syndrome, dry mouth (xerostomia or salivary gland disorders), neuromuscular disorders such as myasthenia gravis, or Down's syndrome. Avoid if pregnant or breastfeeding.
Chiropractic: Chiropractic is a healthcare discipline that focuses on the relationship between musculoskeletal structure (primarily the spine) and body function (as coordinated by the nervous system), and how this relationship affects the preservation and restoration of health. Although there is not enough reliable scientific evidence to conclude the effects of chiropractic techniques in the management of Parkinson's disease, anecdotal reports suggest a positive impact on fine muscle coordination in some individuals. More clinical research is necessary.
Use extra caution during cervical adjustments. Use cautiously with acute arthritis, conditions that cause decreased bone mineralization, brittle bone disease, bone softening conditions, bleeding disorders or migraines. Use cautiously with the risk of tumors or cancers. Avoid with symptoms of vertebrobasilar vascular insufficiency, aneurysms, unstable spondylolisthesis or arthritis. Avoid with agents that increase the risk of bleeding. Avoid in areas of para-spinal tissue after surgery. Avoid if pregnant or breastfeeding due to a lack of scientific data.
Choline: Data regarding efficacy of choline in the treatment of Parkinson's disease is conflicting and inconclusive. Avoid if allergic/hypersensitive to choline, lecithin, or phosphatidylcholine. Use cautiously with kidney or liver disorders or trimethylaminuria. Use cautiously with a history of depression. If pregnant or breastfeeding it seems generally safe to consume choline within the recommended adequate intake (AI) parameters; supplementation outside of dietary intake is usually not necessary if a healthy diet is consumed.
Chromium: Chromium has been studied for its protective benefits in Parkinson's disease and is included in antioxidant multivitamins. However, there is lack of scientific evidence in humans in this area. Additional study is needed. Trivalent chromium appears to be safe because side effects are rare or uncommon. However, hexavalent chromium may be poisonous. Avoid if allergic to chromium, chromate, or leather. Use cautiously with diabetes, liver problems, weakened immune systems (such as HIV/AIDS patients or organ transplant recipients), depression, Parkinson's disease, heart disease, and stroke and in patients who are taking medications for these conditions. Use cautiously if driving or operating machinery. Use cautiously if pregnant or breastfeeding.
Coenzyme Q10: Coenzyme Q10, or CoQ10, is produced by the human body and is necessary for the basic functioning of cells. There is promising early evidence to support the use of CoQ10 in the treatment of Friedrich's ataxia and Parkinson's disease. Better-designed trials are needed using CoQ10 for neurological conditions.
Allergy associated with Coenzyme Q10 supplements has not been reported, although rash and itching have been reported rarely. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk and do not use immediately after these procedures. Use cautiously with a history of blood clots, diabetes, high blood pressure, heart attack, or stroke, or with use of anticoagulants (blood thinners) or antiplatelet drugs (like aspirin and warfarin), or blood pressure, blood sugar, cholesterol, or thyroid drugs. Avoid if pregnant or breastfeeding.
Cowhage: Traditional Ayurvedic medicine and preliminary evidence suggests that cowhage (Mucuna pruriens) contains 3.6-4.2% levodopa, the same chemical used in several Parkinson's disease drugs. Cowhage treatments have yielded positive results in early studies. However, additional high quality clinical research is needed to confirm these results.
Avoid if allergic or hypersensitive to cowhage, its constituents, or members of the Fabaceae family. Use cautiously with Parkinson's disease and/or when taking levodopa, dopamine, dopamine agonists, dopamine antagonists, or dopamine reuptake inhibitors as cowhage seeds contain the dopamine precursor levodopa. Use cautiously if taking monoamine oxidase inhibitors (MAOIs) or other antidepressants. Use cautiously if taking anticoagulants (blood thinners) or with diabetes. Avoid with psychosis or schizophrenia. Avoid if pregnant or breastfeeding as cowhage may inhibit prolactin secretion.
Creatine: Numerous studies suggest that creatine may help treat various neuromuscular diseases and may delay the onset of symptoms when used with standard treatment. However, creatine ingestion does not appear to have a significant effect on muscle creatine stores or high-intensity exercise capacity in individuals with multiple sclerosis and supplementation does not seem to help people with tetraplegia. Although early studies were encouraging, recent research reports no beneficial effects on survival or disease progression. Additional studies are needed to provide clearer answers. There is also not enough scientific information to make a firm recommendation about the use of creatine in Huntington's disease. High-quality studies are needed to clarify this relationship.
Avoid if allergic to creatine or with diuretics (like hydrochlorothiazide, furosemide (Lasix©)). Use caution in asthma, diabetes, gout, kidney, liver or muscle problems, stroke or a history of these conditions. Avoid dehydration. Avoid if pregnant or breastfeeding.
DHEA: There is conflicting scientific evidence regarding the use of DHEA (dehydroepiandrosterone) supplements for myotonic dystrophy. Better research is necessary before a clear conclusion can be drawn. Avoid if allergic to DHEA. Avoid with a history of seizures. Use with caution in adrenal or thyroid disorders or anticoagulants, or drugs, herbs or supplements for diabetes, heart disease, seizure or stroke. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Avoid if pregnant or breastfeeding.
Dong quai: There is insufficient evidence to support the use of Dong quai as a treatment for nerve pain. High-quality human research is lacking. Although Dong quai is accepted as being safe as a food additive in the United States and Europe, its safety in medicinal doses is not known. Long-term studies of side effects are lacking. Avoid if allergic/hypersensitive to Dong quai or members of the Apiaceae / Umbelliferae family (like anise, caraway, carrot, celery, dill, parsley). Avoid prolonged exposure to sunlight or ultraviolet light. Use caution with bleeding disorders or if taking drugs that may increase the risk of bleeding. Use cautiously with diabetes, glucose intolerance or hormone sensitive conditions (like breast cancer, uterine cancer or ovarian cancer). Do not use before dental or surgical procedures. Avoid if pregnant or breastfeeding.
Feldenkrais Method©: There is not enough clinical evidence on the use of Feldenkrais for cerebral palsy. Patients who practice complementary alternative medicine methods have reported that the Feldenkrais Method©, as well as breathing therapy, massage, and relaxation techniques helped improve symptoms of dystonia. Further data are needed to form therapeutic recommendations. There is currently a lack of available scientific studies or reports of safety of the Feldenkrais Method©.
Ginseng: A clinical study found that patients with neurological disorders may improve when taking Asian ginseng (Panax ginseng). This supports research findings that report Panax ginseng improving cognitive function. More research is needed in this area. Avoid ginseng with a known allergy to plants in the Araliaceae family. There has been a report of a serious life-threatening skin reaction, possibly caused by contaminants in ginseng formulations.
Kava: There is unclear evidence for the use of kava for Parkinson's disease. Kava has been shown to increase 'off' periods in Parkinson's patients taking levodopa and can cause a semicomatose state when given with alprazolam.
Consult with a qualified healthcare professional before taking kava due to the risk of harmful side effects. Avoid if allergic to kava or kavapyrones. Avoid with liver disease, a history of medication-induced extrapyramidal (the motor system related to the basal ganglia) effects, and chronic lung disease. Avoid if taking medications for liver disease or CNS depressants such as alcohol or tranquilizers. Avoid while driving or operating heavy machinery (may cause drowsiness). Use cautiously with depression or if taking antidepressants. Avoid if pregnant or breastfeeding.
L-carnitine: Although used traditionally for the support of neurological conditions, one poorly designed preliminary clinical study reported that L-acetyl-carnitine (carnitine or L-carnitine) possesses neither efficacy nor toxicity towards patients with Huntington's disease. Further trials are required to determine if L-carnitine is beneficial in individuals with neurological disorders. Currently there is insufficient evidence to support the use of carnitine for peripheral neuropathy. Avoid with known allergy or hypersensitivity to carnitine. Use cautiously with peripheral vascular disease, hypertension (high blood pressure), alcohol-induced liver cirrhosis, and diabetes. Use cautiously in low birth weight infants and individuals on hemodialysis. Use cautiously if taking anticoagulants (blood thinners), beta-blockers, or calcium channel blockers. Avoid if pregnant or breastfeeding.
Massage: Early evidence suggests a possible benefit of calf massage for children with cerebral palsy. However, more study is needed. Early scientific evidence suggests that people with Parkinson's disease might have reduced symptoms after massage. More studies are needed in this area as well. Avoid with bleeding disorders, low platelet counts, or if on blood-thinning medications (such as heparin or warfarin/Coumadin©). Areas should not be massaged where there are fractures, weakened bones from osteoporosis or cancer, open/healing skin wounds, skin infections, recent surgery, or blood clots. Use cautiously with a history of physical abuse or if pregnant or breastfeeding. Massage should not be used as a substitute for more proven therapies for medical conditions. Massage should not cause pain to the client.
Melatonin: Melatonin is a naturally occurring hormone that helps regulate the sleep/wake cycles (circadian rhythm). Melatonin has been reported useful in neurological conditions including Parkinson's disease, periodic limb movement disorder, and tardive dyskinesia. The use of melatonin in these conditions, however, is not supported by rigorous scientific testing. Better-designed research is needed to determine if melatonin is beneficial in individuals with neurological disorders.
Melatonin supplementation should be avoided in women who are pregnant or attempting to become pregnant, based on possible hormonal effects, including alterations of pituitary-ovarian function and potential inhibition of ovulation or uterine contractions. High levels of melatonin during pregnancy may increase the risk of developmental disorders.
Moxibustion: Moxibustion uses the principle of heat to stimulate circulation and break up congestion or stagnation of blood and chi (energy). Early study reported treatment of trigeminal neuralgia with cupping to have a significant therapeutic effect. Additionally, limited available study suggests that acupuncture plus moxibustion, with or without conventional treatments for Bell's palsy, may have benefit. More studies are needed to verify these findings.
Use cautiously over large blood vessels and thin or weak skin. Avoid with aneurysms, any kind of "heat syndrome," cardiac disease, convulsions or cramps, diabetic neuropathy, extreme fatigue and/or anemia, fever, inflammatory conditions, allergic skin conditions, ulcerated sores, or skin adhesions. Avoid if pregnant or breastfeeding. Avoid areas with an inflamed organ, contraindicated acupuncture points, face, genitals, head, inflamed areas in general, nipples, and skin adhesions. Avoid in patients who have just finished exercising or taking a hot bath or shower. Use cautiously in elderly people with large vessels. It is considered not advisable to bathe or shower for up to 24 hours after a moxibustion treatment.
Omega-3 fatty acids: Omega-3 fatty acids are essential fatty acids found in cold water fish (including salmon, herring, and tuna) and other marine life (such as krill and algae). Omega-3 fatty acids can also be found in certain plants and nuts, including purslane and walnuts. Well-designed research is necessary before a clear conclusion can be reached regarding the effects of omega-3 fatty acids for infant eye/brain development. An investigational drug for the symptomatic treatment of the neurological condition Huntington's disease (HD) is ethyl-EPA (Miraxion©), a pharmaceutical drug based on a component of omega-3 fatty acids called eicosapentaenoic acid (EPA). Miraxion© seems to help decrease the chorea (involuntary movements) that can be debilitating in individuals with HD. More research should be performed for the use of Miraxion© in other neurological disorders.
Omega-3 fatty acid supplements (including fish oils) may cause an increase in bleeding in sensitive individuals, including those taking blood thinning drugs such as warfarin (Coumadin©) or those with bleeding disorders. Avoid if allergic or hypersensitive to fish, omega-3 fatty acid products that come from fish, nuts, linolenic acid or omega-3 fatty acid products that come from nuts. Use cautiously with diabetes, low blood pressure or drugs, herbs or supplements that treat these conditions. Use cautiously before surgery. The Environmental Protection Agency (EPA) recommends that intake be limited in pregnant/nursing women to a single 6-ounce meal per week, and in young children to less than 2 ounces per week. For farm-raised, imported, or marine fish, the U.S. Food and Drug Administration recommends that pregnant/nursing women and young children avoid eating types with higher levels of methylmercury and less than 12 ounces per week of other fish types. Women who might become pregnant are advised to eat 7 ounces or less per week of fish with higher levels of methylmercury or up to 14 ounces per week of fish types with about 0.5 parts per million (such as marlin, orange roughy, red snapper, or fresh tuna).
Physical therapy: There is limited study of physical therapy for the treatment of neurological disorders such as Guillain-Barre Syndrome and Parkinson's disease. Numerous physical therapy techniques have been used to treat movement/motor disorders associated with cerebral palsy, including hippotherapy (physical therapy utilizing the movement of a horse), sensory-perceptual-motor training, neurodevelopmental physical therapy, and functional physical therapy. Results are inconclusive and additional high-quality studies are needed.
Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with a qualified healthcare professional before beginning any treatments. Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the physical therapy literature although causality is unclear. Erectile dysfunction has also been reported. Physical therapy has been used in pregnancy and although reports of major adverse effects are lacking the available literature, caution is advised nonetheless. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
Qi gong: There is promising early evidence suggesting that internal Qi gong may help in the treatment of Parkinson's disease. However, the evidence is somewhat unclear, and further research is needed. Qi gong is generally considered to be safe in most people when learned from a qualified instructor. Use cautiously with psychiatric disorders.
Reiki: Reiki is a system of lying on of the hands that originated as a Buddhist practice approximately 2,500 years ago. Clinical study suggests that Reiki may have an effect on autonomic nervous system disorders by affecting heart rate, blood pressure, or breathing activity. Large, well-designed studies are needed before conclusions can be drawn.
Reiki is not recommended as the sole treatment approach for potentially serious medical conditions, and should not delay the time it takes to consult with a healthcare professional or to receive established therapies. Use cautiously with psychiatric illnesses.
Rolfing© Structural Integration: Rolfing© Structural Integration may improve movement slightly in cerebral palsy patients. More studies are needed to confirm these possible benefits.
Rolfing© Structural Integration should not be used as the sole therapeutic approach to disease, and it should not delay the time it takes to speak with a healthcare provider about a potentially severe condition. Rolfing© Structural Integration is generally believed to be safe in most people. Avoid in patients taking blood thinners and in patients with broken bones, severe osteoporosis, disease of the spine or vertebral disks, skin damage or wounds, bleeding disorders, blood clots, tooth abscesses, acute disc problems, aneurysm, fever, recent scar tissue, connective tissue disease, cancer, and in patients who have just received cortisone shots or who are on chronic cortisone therapy. Use cautiously in patients with varicose veins or phlebitis, joint diseases, psychosis or bipolar disorder, severe kidney, liver, or intestinal disease, diabetes, menstruation, infectious conditions, colostomies, high blood pressure, and stenoses or strictures.
Safflower: In clinical study, safflower (Carthamus tinctoria) decreased deterioration caused by Friedreich's ataxia. More high-quality studies with larger sample sizes are needed to establish safflower's effect on neurological conditions.
Avoid if allergic/hypersensitive to safflower, Carthamus tinctorius, safflower oil, daisies, ragweed, chrysanthemums, marigolds or any related constituents. Use parenteral safflower oil emulsions cautiously in newborns. Use cautiously if taking anticoagulants (blood thinners) or anti-platelet drugs, immunodepressants or pentobarbital. Use cautiously with diabetes, hypotension, inadequate liver function, hypercoagulability, and skin pigmentation conditions. Use cautiously if pregnant or breastfeeding.
Taurine: Taurine may affect cellular hyperexcitability by increasing membrane conductance to potassium and chloride ions, possibly by altering intracellular (within the cell) availability of calcium. Results from limited available clinical study suggest that taurine supplementation may result in improvements in myotonic dystrophy. Well designed clinical trials are needed.
Taurine is an amino acid and it is reportedly unlikely that there are allergies related to this constituent. However, allergies may occur from multi-ingredient products that contain taurine. Use cautiously in patients with high cholesterol, low blood pressure, coagulation disorders, potential for mania, or epilepsy. Avoid consumption of energy drinks containing taurine, caffeine, glucuronolactone, B vitamins, and other ingredients, then consuming alcohol or exercising. Use cautiously if pregnant or breastfeeding because taurine is a natural component of breast milk.
TENS: Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. Electrodes are temporarily attached with paste in various patterns, depending on the specific condition and treatment goals. Several case reports and a small number of controlled trials report improvements in pain symptoms in people with peripheral neuropathy or nerve damage. However, these studies have not been well designed or reported, and additional research is needed before a firm conclusion can be drawn about effectiveness. Several studies have reported benefits of TENS therapy in patients with trigeminal neuralgia (facial pain). However, these trials have been small without clear descriptions of design or results. A small clinical study also found TENS effective in decreasing symptoms associated with spinal cord injury. Therefore, additional research is needed before a firm conclusion can be drawn in the area of neurological disorders. Avoid with implantable devices, like defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps. Use cautiously with decreased sensation, like neuropathy, and with seizure disorders. Avoid if pregnant or breastfeeding.
Vitamin B6: Vitamin B6 (pyridoxine) is required for the synthesis of the neurotransmitters serotonin and norepinephrine, and for myelin formation. Pyridoxine deficiency in adults principally affects the peripheral nerves, skin, mucous membranes, and the blood cell system. In children, the central nervous system (CNS) is also affected. Major sources of vitamin B6 include: cereal grains, legumes, vegetables (carrots, spinach, and peas), potatoes, milk, cheese, eggs, fish, liver, meat, and flour. Some prescription drugs called neuroleptics, which are used in psychiatric conditions, may cause movement disorders as an unwanted side effect. Vitamin B6 has been studied for the treatment of acute neuroleptic-induced akathisia (NIA, a neuromuscular disorder characterized by a feeling of "inner restlessness," a constant urge to be moving) in schizophrenic and schizoaffective disorder patients. Preliminary results indicate that high doses of vitamin B6 may be useful additions to the available treatments for NIA, perhaps due to its combined effects on various neurotransmitter systems. Vitamin B6 may also have some antioxidant effects, which theoretically may benefit patients with tardive dyskinesia. Results from a small high-quality trial suggest a benefit of vitamin B6 on symptoms of tardive dyskinesia. Further research is needed to confirm these results.
Avoid if sensitive or allergic to any ingredients in vitamin B6 products. Some individuals seem to be particularly sensitive to vitamin B6 and may have problems at lower doses. Avoid excessive dosing. Vitamin B6 is likely safe when used orally in doses not exceeding the recommended dietary allowance (RDA). Use cautiously if pregnant or breastfeeding.
Vitamin E: Vitamin E has been studied in the management of tardive dyskinesia, and has been reported to significantly improve abnormal involuntary movements, although the results of existing studies are not conclusive enough to form a conclusion. The scientific evidence regarding Parkinson's disease is also inconclusive. Additional research is needed.
Avoid if allergic or hypersensitive to vitamin E. Avoid with retinitis pigmentosa (loss of peripheral vision). Use cautiously with bleeding disorders or if taking blood thinners. Avoid above the recommended daily level in pregnant women and breastfeeding women.
Yohimbe bark extract: It is theorized that yohimbine may improve orthostatic hypotension (lowering of blood pressure with standing) or other symptoms of autonomic nervous system dysfunction (autonomic failure). However, yohimbe bark extract may not contain significant amounts of yohimbine, and therefore may not have these proposed effects. More research is needed before a conclusion can be made.
Yohimbine is generally well tolerated in recommended doses. However, many side effects have been reported with yohimbine hydrochloride and may apply to yohimbe bark. Avoid if allergic to yohimbe, any of its components, or yohimbine-containing products. Use cautiously with peptic ulcer disease, kidney disease, high blood pressure, heart disease or if taking drugs that affect blood sugar levels. Avoid with benign prostate hypertrophy (enlarged prostate), anxiety, mania, depression, stress disorders, post-traumatic stress disorders, bipolar disorders or schizophrenia. Avoid use in children or if pregnant or breastfeeding.
Fair negative scientific evidence:
Choline: Choline is possibly ineffective when taken by mouth for treating cerebellar ataxia. Avoid if allergic/hypersensitive to choline, lecithin, or phosphatidylcholine. Use cautiously with kidney or liver disorders or trimethylaminuria. Use cautiously with a history of depression. If pregnant or breastfeeding it seems generally safe to consume choline within the recommended adequate intake (AI) parameters; supplementation outside of dietary intake is usually not necessary if a healthy diet is consumed.
Creatine: Overall, the evidence suggests that creatine supplementation does not offer benefit to individuals with amyotrophic lateral sclerosis (ALS). Avoid if allergic to creatine or with diuretics (like hydrochlorothiazide, furosemide (Lasix©)). Use caution in asthma, diabetes, gout, kidney, liver or muscle problems, stroke or a history of these conditions. Avoid dehydration. Avoid if pregnant or breastfeeding.
Octacosanol: Preliminary study does not show any evidence of benefit with use of octacosanol in neurologic (brain) or pulmonary (lung) symptoms of amyotropic lateral sclerosis (ALS) patients. Additional study is needed in this area. Avoid if allergic or hypersensitive to octacosanol or policosanol. Use cautiously in patients taking nitrates, lipid lowering drugs/herbs (such as acipimox, statins, bile acid sequestrants/resins), cholesterol absorption inhibitors (such as ezetimibe, fish oil, plant stanols/sterols, polyphenols), nutraceuticals (such as oat bran, psyllium, and soy proteins), aspirin, or agents that lower blood pressure. Avoid if pregnant or breastfeeding.
Diet: Nutritional changes along with the addition of supplements (vitamins, minerals, and herbs) may be effective in reducing symptoms associated with neurological disorders such as Bell's palsy. Positive changes in dietary habits are a lifelong goal and commitment.
It is best to avoid caffeine and other stimulants, alcohol, and smoking. All of these place stress on the body that can lead to symptoms of Bell's palsy in sensitive individuals.
It may be best to eliminate potential food allergens, including dairy (milk, cheese, and sour cream), eggs, nuts, shellfish, wheat (gluten), corn, preservatives, and food additives (such as dyes and fillers). Food allergies can be a contributing factor in neurological imbalance.
It may be best to avoid refined foods such as white breads, pastas, and sugar. Doughnuts, pastries, bread, candy, soft drinks, and foods with high sugar content may all contribute to worsening symptoms of neurological disorders.
Exercise: Maintaining physical fitness is important to those suffering from movement disorders. Those with movement disorders who exercise and keep active tend to do better, with less symptoms and a slower disease progression, than those who do not. A daily regimen of exercise can help the person feel better physically and mentally. Individuals should walk as much as possible, even if assistance is necessary. Talking with a healthcare provider about an exercise program is important.
Medications: Over-the-couther (OTC) medications such as acetaminophen (Tylenol©), ibuprofen (Advil©), or aspirin may help to alleviate inflammation and pain. The application of moist heat to the affected side of the face may also improve symptoms.
Other preventive measures: The individual will need to protect their eyes from damage to the outer layer (cornea) because of the absence of blinking on the side of the face with weakness. An excessively dry eye can result in clouding of the cornea and lead to a corneal ulcer, which can interfere with vision. Protect the eyes with artificial tears (such as Refresh P.M.© and Visine Tears©). Artificial tears are a special eye lubricant generally used at night. Also, an eye patch or a transparent eye shield attached to the face with tape can help. Eyes problems are a common complication of Bell's palsy.
This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
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