Question Title: Help required

Forum: Neurology Forum
Topic: Bell's Palsy

Mr. Friedmann had some kind of a stroke on January 1993,
and as a result suffers since from 'Periphere Facial Palsy'
(Facial Paralisis Bell's, or Anastomosis), or 'S/P Let Facialis
Paresis - Spastic Paresis/Left hemi facial spasm'.

One expert told him he is not fit for a local, physical or
electric treatment, which may only do him worse.

One expert recommended the use of 'Botelinium foxin' to reduce
the spasm, which is his main problem, and the use of 'Tab Doparid',
but Mr. Friedmann did not take those two medicines!

As he was told by another expert there is no cure for his
problem, he asked me to assist him in searching for other/new
possibilities to help him.

One expert said there is a surgery called 'Hyposlossal -
Facial Anastomosis', but it is not recommended in this case,
as it is a relatively mild one and won't help much.

The problems Mr. Friedmann suffers from right now are as follows:
1. The left side of his face remained paralized.
2. The hearing in his left ear has deteriorated.
3. He has quite a difficulty in shutting his left eye's lid.
4. Mr. Friedmann has a constant ache in the left side
of his face, accompanied by an ache coming from the top
of his head.

A mouth distortion he had at the early stage of his problem
disappeared by its own after a while.

Mr. Friedmann is living with all these problems, yet is
ready to go to any length to get rid of it.

I would very much appreciate a reply.

Yours sincerely,

Amnon Glas

=

Bell's palsy is the result of damage to the nerve (on one side) which works the muscles of facial expression (cranial nerve 7). A stroke could affect one side of the face, but by a different mechanism - it's brain injury rather than nerve injury (the nerve exists outside of the brain). I'm not sure exactly what you mean, you might ask the doctors to clarify whether it's a stroke or Bell's palsy. The terminology helps us understand what happened, so precision is important.

Judging from the symptoms you reported, including the difficulty with eye lid closure and the hearing loss, I'd suppose that this was due to nerve (rather than brain) injury and probably was a Bell's palsy rather than a stroke.

Bell's Palsy is commonly the result of a viral infection and rather aggressive immune response of the body to eliminate the virus. Usually, it resolves (completely or partially) with time and then just stays the same for the rest of your life. There are some other causes, and I am quite concerned about Mr Friedmann because of the hearing loss. Sometimes a tumor grows in the ear canal and can produce hearing loss and progressive facial weakness. If Mr Friedmann's facial weakness has been getting worse (instead of staying the same over many years), then you should have that looked into. Ask the doctor about acoustic neuroma.

Hemifacial spasm is seen sometimes with mild injury to the seventh nerve. The patient experiences twitching (sometimes sustained contractions) of the eye lid, mouth, or other parts of that half of the face. Usually, the mechanism of injury is thought to be compression from a nearby tiny artery. A related phenomenon, synkinesis, is seen as the injured nerve recovers from the damage. The eyelid and corner of the mouth twitch together because the nerve fibers grow back and sort of connect the two to the same control area in the brain.

Hemifacial spasm is treatable with BoTox (botulinum toxin). The problem is that if Mr Friedmann has trouble closing his eyelids, the main symptom appears to be weakness rather than muscle spasm, and BoTox isn't so helpful (could even make it worse for a couple of months). So it's hard to reconcile the data.

I don't know what "tab doparid" is.

Not sure what the left side ache is all about.

I'd be very wary of surgery until the main problem is well-defined and understood, and all other options have been considered. The anastomosis between the 12th (hypoglossal) and 7th (facial) nerves doesn't sound like a trivial procedure at all.

Even if there is no "cure" (permanent reversal of injury), there may be something that could be done to help. You are welcome to call 800 223-2273 and ask for neurology appointments at extension 4-5559 (outside the US, call 216 444-5559). If hemifacial spasm really is the problem, ask to see a movement disorders specialist.

As you know, this forum is for education only and can't substitute for medical advice from your doctor. I hope this helps. CCF MD mdf.

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