bilateral facial paralysis - 6 year old

[bjs]

My 6 year old son became paralyzed on the right side of his face on August 8th of this year.  At the time, he was diagnosed with Bells Palsy.  On August 23rd the left side became paralyzed (the right side was already healing, and almost back to normal).  Then again on September 3rd his right side became paralyzed again, this time lasting for a few hours before he started to have some movement again.  They immediately did a CT Scan (which actually showed a previous stroke - which they said may have happened before he was born - and has nothing to do with this), and an MRI(normal).  On August 23rd they performed a spinal tap (normal), and on September 6th an MRI with contrast(showed inflammation around the 7th cranial nerve - they expected to see this).  They have also done numerous blood tests (3 times for Lyme - 1st came back borderline, 1.02, next two were negative - he never had any sign of a tick or rash). His right side is now almost back to normal, but his left side is still completely paralyzed.  We have a wonderful pediatrician who is working closely with us, as well as a great pediatric neurologist, but he has never seen anything like this before (actually calling it bizarre).   Have you ever seen any cases like this before?  We are desperate to find an answer to help our son, and would greatly appreciate any help you can give us.  Thank You.

[CCF-Neuro-M.D.-JT]

Facial weakness in a child can be caused by a number of diseases such as Bell's palsy, myasthenia gravis, and muscular disorders which are all disorders that we routinely see in our neuromuscular clinic. However, what's different about your son's case is the fact that it;s been coming and going over the last 6 weeks.  It's important to note whether or not it really is getting better on one side or if it's a fixed deficit.  One disease called Melkersson syndrome consists of a clinical triad of recurrent facial weakness, a deeply furrowed tongue (look for a deep fold in his tongue), and facial swelling. There is a big genetic predisposition and the presence of a deep and furrowed tongue in a relative with similar symptoms can confirm the diagnosis. Other diseases that should be considered are the muscular diseases such as "facioscapulohumeral dystrophy," fancy term for a disorder affecting the face arms and shoulders. This can be picked up by special genetics testing from blood samples.
Toxins such as the ingestion of antifreeze can cause similar symptoms. Infectious, postinfectious, and autoimmune disorders are also possiblities. MS and brainstem tumor have been ruled out with MRI, thankfully. And finally myasthenia gravis is a thought.

Consider a second opinion at a major clinical or academic center nearby. An EMG of the facial muscles may also be helpful. GOod luck.