J Ayub Med Coll Abbottabad 2010;22(4)

ORIGINAL ARTICLE
ACUPUNCTURE TREATMENT OF FACIAL PALSY
Syed Zahid Hussain Bokhari, Syeda Samina Zahid*
Pain and Plegia Centre, Dabgari Gardens Peshawar, *Khyber Girls Medical College Hayatabad Peshawar, Pakistan

Background: Bell’s palsy is an idiopathic, acute peripheral-nerve palsy involving the facial nerve
which supplies all the muscles of facial expression. This study was conducted to evaluate the
effects of Electro-Acupuncture on patients with Facial Palsy. Methods: This study was conducted
on patients with facial palsy at a private clinic at Peshawar during 1999–2009, and 49 cases were
included in the study. All those cases that were within first two weeks of illness or who had related
history of stroke or they had upper motor neuron lesion were not included in the study. Electro-
acupuncture was used as the main therapeutic technique to treat these cases. Patients were
subjected to acupuncture treatment at four major points on the face for 20–25 minutes everyday
for 10 days. Specific points were used for nasolabial fold and watering of the eye. After rest for a
week patients were again evaluated and another course of treatment comprising of 5–10 days was
sufficient in most cases. Frequency of electro-acupuncture is kept at 60–80 cycles per minute.
Results: Total number of patients studied was 49 with duration of illness as early as 3 weeks to a
year and above. Cases with duration of illness from 3 weeks onward showed rapid recovery of
palsy symptoms with electro-acupuncture. All cases showed recovery. Palsy of the angle of the
mouth did not recover completely. Conclusion: Electro-acupuncture is effective in treating facial
palsy cases.
Keywords: Facial palsy, Bell’s palsy, Electro-acupuncture
INTRODUCTION Approximately 70–80% of patients will
recover spontaneously; however, treatment with a 7-day
Bell’s palsy is an idiopathic, acute peripheral-nerve
course of acyclovir or Val-acyclovir along with
palsy involving the facial nerve which supplies all the
prednisone typically prescribed in a 10-day tapering
muscles of facial expression. Bell’s palsy is named
course starting at 60 mg per day, initiated within 3 days
after Sir Charles Bell (1774–1842), who first
of the onset of symptoms, is recommended to reduce the
described the syndrome along with the anatomy and
time to full recovery and increase the likelihood of
function of the facial nerve. Affected patients
complete recuperation.2 The incidence of Bell’s palsy is
develop unilateral facial paralysis over 1–3 days with
15–30 per 100,000 persons, with equal numbers of men
forehead involvement and no other neurologic
and women affected. There is no predilection for either
abnormalities. Patients with Bell’s palsy typically
side of the face. Patients who have had one episode of
complain of weakness or complete paralysis of all the
Bell’s palsy have an 8% risk of recurrence.3,4
muscles on one side of the face. The facial creases
Patients with Bell’s palsy usually progress
and nasolabial fold disappear, the forehead
from onset of symptoms to maximal weakness within 3
unfurrows, and the corner of the mouth droops. The
days and almost always within one week. Left
eyelids will not close and the lower lid sags. On
untreated, 85% of patients will show at least partial
attempted closure, the eye rolls upward (Bell’s
recovery within 3 weeks of onset.5 Bell’s palsy is
phenomenon). Eye irritation often results from lack
believed to be caused by inflammation of the facial
of lubrication and constant exposure. Tear production
nerve at the geniculate ganglion, which leads to
decreases, however, the eye may appear to tear
compression and possible ischemia and demyelination.
excessively because of loss of lid control, which
In upper motor neuron lesion affecting the facial nerve
allows tears to spill freely from the eye. Food and
causing facial palsy will not paralyse the forehead on the
saliva can pool in the affected side of the mouth and
affected side, resulting in a unilateral facial paralysis
may spill out from the corner.1
with forehead sparing.
Symptoms typically peak in the first week
Acupuncture is a technique that has proved
and then gradually resolve over 3 weeks to 3 months.
effective in treating palsy cases. In WHO’s
Bell’s palsy has been traditionally defined as
recommendations facial palsy is a diseases in which
idiopathic; however, one possible aetiology is
acupuncture form of treatment is effective. It is an
infection with herpes simplex virus type-1. A
old technique of traditional Chinese medicine that is
common short-term complication of Bell’s palsy is
now being vastly studied in the western world in the
incomplete eyelid closure with resultant dry eye. A
medical sectors as alternative medicine and has been
less common long-term complication is permanent
introduced as alternative treatment in many diseases.6
facial weakness with muscle contractures.
Fine filiform needles are used at acupuncture points

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that are explained on different parts of body. In old ranging from 5–10 days was then given in the light of
traditional technique hand stimulation was used to residual disability. In most of the cases this treatment
achieve the desired effects. regimen was sufficient. These patients were
Electro-acupuncture is a relative modern prescribed methylcobalamin one injection daily for
innovation. In electro-acupuncture stimulators are five days at the commencement of treatment.
used to give pulsatile stimulation parting passive
contractions to muscles/group of muscles. Electro
acupuncture achieves early results in certain
conditions and is specifically indicated in treatment
of palsies and in pain management.7,8 TENS is
innovation from principles of acupuncture. This
technique is crude with compromised results and thus
has limited application.
MATERIAL AND METHODS
Majority of cases that reported to us had been
diagnosed as Bell’s palsy cases by their physicians.
They had already undergone conventional treatment
of steroids and had been subjected to varied durations
of physiotherapy. Most of them had passed the acute
stage and had partial recovery of different symptoms.
These were those leftover cases in which recovery
had standstill or was very slow. Few cases found
their way to our clinic in early stage of disease.
(Table-1)
Figure-1: Needle insertion shown at the
Table-1: Total number of cases and duration of acupuncture points
illness (Adopted from American Family Physician Vol: 76, No. 7)
Total 3–4 5–30 31–45 1 year
Cases weeks weeks weeks and above RESULTS
49 18 25 4 2
All the 49 cases treated had satisfactory recovery within
The cases diagnosed as Bell’s palsy by a very short time span of two weeks. Long standing
physicians and treated on conventional methods but cases in which recovery had virtually stopped or was
without recovery were included in this study. Cases very slow, in them recovery was expedited and was
with unilateral facial palsy were included. Only those satisfactorily completed in two weeks (Table-2).
cases that had passed into 3rd week of illness and had In the recovery phase, the symptoms of
not shown signs of recovery were included in this collection of food underneath the effected cheek
study. All those cases of facial palsy that had related recovered completely within a week of treatment.
history of stroke or upper motor neuron lesion and Closure of the eye was symptom next to recover.
cases of Bell’s palsy in first 2 weeks of illness were Watering of affected eye and drooping at the nasolabial
excluded. A referred case of traumatic facial palsy fold required specific points for treatment and they
with history of head injury was also not included in responded well. Frowning of the forehead showed
this study. moderately good recovery. Recovery of this symptom
The patients were subjected to electro- was taken as the limiting point to stop further treatment.
acupuncture at four points: Jiache (S6) Dicang (S4) Angle of mouth showed partial recovery. This required
(Corresponding to buccinator and angle of the long term management as residual symptoms persist
mouth), and Zanzhu (B2), Sizhukong (SJ23) giving mild to moderate cosmetic effects and grin on the
(corresponding to eyebrow). Yanbai (G14) Yifeng effected side is not completely restored. All cases
(SJ17), and Jingming (B1) were used for weakness of recovered from disability (Table-3).
occipitofrontalis, nasolabial fold and watering of the
Table-2: Duration of illness and response to
eye respectively (Figure-1).
electro-acupuncture treatment in Bell’s palsy
Daily stimulation was given for 20–25
Duration of illness Response
minutes. Frequency was kept at 60–80 cycles per First week No
minute. Treatment was given for 10 days. Patient is Second week Slow
then given rest for a week. Improvement is evaluated 3–4 weeks Good
at the end of this period. Second course of treatment 5 weeks and beyond Good

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Table-3: Response to treatment in specific facial facial palsy. This has been indicated in various
muscles in patients of Bell’s palsy with duration of studies.1–11,15–19
illness from third week onwards It seems that the facial nerve suffers
Risorius, neurapraxia and stands a good chance at recovery
Orbicularis Orbicularis Occipito- when treated by electro acupuncture in recovery
Muscles Buccinator oculi Oris frontalis
Response Good Good Very slow Slow
phase. This will specially prevent the left out cases
Recovered 5–10 10–15 Full 10–20 going into Wallerian degeneration as the time factor
in sittings sittings recovery not sittings towards recovery is the most important factor
achieved* preventing complication such as permanent facial
Symptom Collection of Closure of Angle of the Frowning of weakness with muscle contractures. We studied the
recovered food under the eye is mouth is the forehead
cheek on the achieved partially on the results in patients with Bell’s palsy with duration of
effected side and watering restored in effected side illness from 3 weeks onward. We limited our
is relieved of the eye is place is gradually observation of response to treatment in cases, from
relieved achieved third week onwards as this is the time period when
*Residual symptoms persist, causing mild to moderate cosmetic
effect at the angle of the mouth.
the nerve is in the recovery phase and the results are
uniform. Electro-acupuncture restored the normal
DISCUSSION function is all forty-nine cases. It is thus indicated
Bell’s palsy has a fair prognosis without treatment, that a new algorithm be established and following
with almost three quarters of patients recovering antiviral and steroid therapy in patients of facial palsy
normal mimetical function and just over a tenth electro-acupuncture therapy be introduced in the
having minor sequelae. In patients who recover recovery phase for optimum and early results. Thirty-
without treatment, major improvement occurs within one cases had fallen in the time period from 5th week
3 weeks mostly. Inflammation of the nerve initially onwards. Up to 3 weeks is the time period that is
results in a reversible neurapraxia, but ultimately considered in most studies as the period of
Wallerian degeneration ensues. If recovery does not spontaneous recovery. Beyond this, cases are
occur within this time, then it is unlikely to be seen considered as having gone into sequel. For these
until 4–6 months, when nerve re-growth and re- cases conventional form of treatment have no
innervation have occurred.9 Patients who have effective valid options. All these cases responded to
complete facial palsy, who have no recovery by three treatment and recovered. This confirms affectivity of
weeks or who have suffered from herpes zoster virus electro-acupuncture in treating facial palsy.
(Ramsay Hunt Syndrome) have poor prognosis in
Bell’s palsy. Untreated Bell’s palsy leaves some
CONCLUSION
patients with major facial dysfunction and a reduced Electro acupuncture is effective in restoring functions
quality of life. of muscles affected in facial palsy. In the new
A Study evaluated 2,570 persons with algorithm, following antiviral and steroid therapy
untreated facial nerve palsy, including 1,701 with patients failing to show recovery of facial palsy may
idiopathic (Bell’s) palsy and 869 with palsy from be subjected to electro-acupuncture treatment in the
other causes; 70% had complete paralysis. Function recovery phase, i.e., third week onwards, for optimum
returned within three weeks in 85% of patients, 29% and early recovery.
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