What you need to know about Bell's palsy

One morning, aged 11, my eldest son complained that the left side of his face was drooping and that he was having trouble closing his left eye. His GP quickly diagnosed him with Bell’s palsy and placed him on a course of steroids. In a matter of weeks he had recovered and his face returned to normal.

Until then, I had viewed the condition as little more than a curious anachronism from a bygone era, yet it remains by some distance the most common cause of facial palsy, affecting as many as 24,800 people a year in the UK.

"Bell’s palsy is viewed as a niche issue, yet it accounts for around 60% of all forms of facial palsy seen in a clinic," says Charles Nduka, consultant surgeon and acting CEO of charity Facial Palsy UK (FPUK).

What is Bell’s palsy?

Named after the 19th-century Scottish anatomist Sir Charles Bell, who discovered that severing the seventh cranial (or facial) nerve causes facial paralysis, Bell’s palsy causes inflammation around said nerve, resulting in paralysis or 'drooping' on the affected side.

"Bell’s palsy manifests as a sudden onset of facial weakness," explains Nduka. "What differentiates it from a stroke is that the forehead is affected. With the onset of a stroke the forehead is spared, as are the eyebrows, but with Bell’s palsy the eyebrow is also paralysed.

"People who are concerned they are displaying symptoms usually visit their GP or their local A&E department, where staff can usually diagnose relatively easily whether it is a stroke or Bell’s palsy.

"There are also other causes of facial weakness, such as Ramsay Hunt syndrome, that need to be excluded."

As with my son, the onset of Bell’s palsy is swift and many patients report waking up with symptoms.

"Roughly half of the patients I see report some stress or illness or that their immune system was low for some reason in the days leading up to their symptoms," says Nduka. "Patients may report having had a headache the day before, particularly behind the ear, or a tingling sensation on the side affected by the palsy."

What causes Bell's palsy?

The condition is idiopathic, meaning no definitive cause has been found. However, it has been linked with viruses such as herpes, influenza and respiratory tract infections, as well as a depleted immune system and stress.

"Bell’s palsy is thought to be infective in origin but no one particular agent has been identified," says Nduka. "We do know it is more common in certain conditions such as diabetes, and that it may also be associated with high blood pressure.

"In the early phase, the facial nerve appears to become inflamed and stops functioning - a bit like when you hang your arm over the back of a chair and it goes numb. Steroids help to reduce the inflammation and swelling, so that the nerve can restore itself.

"A small number of patients - around 7% - will have Bell’s palsy more than once and it doesn’t really differentiate in terms of age - I’ve treated children as young as a year old and people as old as 90.

"There is a slight gender imbalance in the number of patients who attend the clinic, slightly more women than men, but overall it is fairly evenly matched."

Get treated within 72 hours

Steroids remain the most common treatment regime, often coupled with antiviral tablets. Nduka stresses it is imperative that patients receive treatment within 72 hours from first diagnosis.

"Research shows that if they receive medication after 72 hours, it is of no benefit," he says. "Around 70% of people make a full recovery in a matter of weeks and 15-20% are left with a mild degree of impairment.

"If patients don’t make a full or near recovery by month four, then there is a good chance they will be left with long-term problems."

Psychological impact

Surprisingly, because Bell’s palsy affects the face, it is still perceived by some to be a cosmetic rather than a medical issue. As a result, access to practical and emotional support within the NHS and wider society can be hard to find.

"One of the reasons we formed FPUK was to ask questions such as: What is the impact of Bell’s palsy on people in terms of psychology, socially and in the workplace?" Nduka explains. "What is really difficult is that Bell’s palsy affects the face and so it is very hard to hide away.

"One female patient with breast cancer said at least she could get dressed, put her clothes on, go out and try to forget about it, whereas she can’t hide her facial paralysis - it attracts questions and comments. She just wants to get on with her life and she can’t.

"Bell’s palsy is also neglected in terms of funding and research. Psychological therapies are often very limited in the UK and so there is a need to provide patients with an avenue for support."

General advice

What advice would Nduka give to someone worried that they may have Bell's palsy?

"The Facial Palsy UK website has a lot of information and advice vetted by medical and healthcare professionals, and is supported by a large network advisory board," he says.

"Patients need their health professional or GP to prescribe steroids in the early phase and if there is no evidence of recovery within the first few weeks, then I would strongly advise them to go back to their doctor."