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Ask an expert - neuro and psycho logical - bell's palsy

5 questions

Q:  Can you recommend a practitioner in or around York/Harrogate who could offer my husband acupuncture for post shingles pain. He has Bell's palsy type symptoms and acute pain in his face and eye area with some facial paralysis. The condition is known as Ramsey Hunt syndrome.
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A:We do not recommend individual practitioners. Our view is that all of our members are sufficiently well trained to treat all patients within the limits of their competence, and there are very few areas where we would seek to define standards of expert practice where we might want to recommend that people seek out a member with specific additional training. The only three areas where we are likely to head down this path are obstetrics, paediatrics and mental health problems. Otherwise using the practitioner search fucntion on our homepage www.acupuncture.org.uk should take you to a BAcC member very local to you, especially if you use the postcode search function.
 
The treatment of post herpetic pain is an area which has been heavily researched in China, as our factsheet
 
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/herpes.html
 
says, but the quality of trials is not that great. Bell's Palsy
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/bellas-palsy.html
 
has a slightly better success rate when acupuncture treatment is applied, but neither has evidence of such a high standard that we could make an unqualified recommendation. We have treated many cases of shingles, and we have to be honest and say that there has been a significant number of cases where it has been very difficult indeed to reduce the pain, which as we are sure you know to your cost can be excruciating.
 
However, there is no point in being unduly pessimistic. There have been cases both of pain and paralysis where the acupuncture treatment has made significant inroads into the symptoms from a mixture of constitutional treatment to bring balance back to the system as a whole and local treatment to free up some of the blockage and stagnation which paralysis represents. The earlier that treatment commences after an attack, the better, before the area becomes 'settled' in a fixed pattern which can be difficult to shift.
 
The best advice that we can give is that you visit a BAcC member local to you for a brief face to face assessment. The one caution we always voice in these cases is that if you decide to go ahead with treatment you set review dates for assessing progress and also try to set specific outcome measures, objective evidence that the condition is improving. This can be quite difficult with chronic conditions like this which can still have acute episodes, but it is really important to try to find a marker which can show that there has been progress.

Q:  Its my 6th day since I have been diagnosed with Bells palsy. I am 31 years old.  The last 2 days my affected side is worse than in the beginning. I am taking prednisolone and acyclovir tablets.  Howerver the doctor says  I don't need anything else like acupuncture or physiotherapy.  I strongly believe I do for to help me get better.  Please advise me when and where could I start my acupuncture treatment. Would I need to wait until the course of treatment is finished?

A:From a Chinese medicine perspective, if you plan to have acupuncture treatment, the sooner the better. There is a certain amount of research evidence to support the use of acupuncture, and although it falls a long way short of being conclusive, as our factsheet shows

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/bellas-palsy.html

there is no doubt that the most encouraging research shows that a combination of medication and acupuncture seems to be the most effective treatment. We always say that out work is complementary to, not alternative to, conventional medicine, and there are few problems associated with experiencing both forms of treatment at the same time. There are some occasions when the effects of the drugs themselves can be quite considerable, but an experienced practitioner will factor this into their assessment of the situation and adjust their treatment accordingly.

Bell's Palsy is a great deal more common in China where a huge proportion of the population still work in the fields, and the Chinese were very clear that it was exposure to the wind or to a sudden burst of wind bringing a different air temperature, especially hot to cold, which could cause this often distressing condition. In modern times, before air conditioning became more common it was not unusual to see two or three patients a year who managed to bring it on by motorway driving on hot days with a window open on the driver's side. However, the increasing amount of stress in modern life means that it is mow possible for mental and emotional factors to come into play.

We would usually see someone possibly twice a week to deal with the problem before it became too entrenched, but timetable and cost might make this problematic. We would also keep an eye on progress because Bell's either responds well and quickly, or it can take a great deal of time to achieve little more than the medication alone. You need to have some very clear and measurable outcomes to see if there is progress, and some clear review periods agreed to make sure that continuing treatment is worthwhile.

Q:  Can acupuncture assist in the recovery of a long term (over 4 years)bells palsy sufferer?

A:  The BAcC has a factsheet on Bell's Palsy
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/bellas-palsy.html
 
which makes encouraging noises about what acupuncture can achieve, and there is certainly a huge amount of research literature from China where this is a much higher incidence of the problem. Chinese medicine describes this as a problem to do with 'invasion of wind.' This is rather alien sounding to the western ear, but Chinese medicine is based on a fundamental theory about the flow of energy, called qi, in the body, and what helps and hinders its flow. In Chinese medicine theory external/climate factors are just as relevant and important as internal or material causes, and for an agrarian race exposed to the climate day to day, the idea that the wind as a pervasive force could disrupt the flow is a natural consequence of the thought pattern. In fact, one common cause, before aircon became standard, of Bell's Palsy was driving along motorways on sunny days with the window open for fresh air, and getting a 70mph blast of air on one side of the face. This expert has treated half a dozen people who did this very thing.

 

The one concern we have, however, is the length of time which you have had the problem. In China problems like this are treated immediately and vigorously, often daily, to expel the pathogen (wind is said to invade, and so needs to be removed) and to restore the flow in the area. Once the patter has settled, however, it becomes more difficult to shift. It is almost as though the body accepts this as a natural state and accommodates it. The Chinese talk about stagnation and stasis of conditions like this where the flow is disturbed for a long time, and it can take a great deal of effort to make things move again.

 

There is also the question of the backdrop against which it is set. Chinese medicine rarely looks at a symptom in separation from the whole system, and many cases of Bell's Palsy resolve relatively quickly of their own accord. A practitioner will automatically look at the whole system anyway, because that's what we do, but would in particular be interested to see if the healing responses of the body as a whole were compromised in some way, hindering attempts to get local improvement. There would be signs which the practitioner could see but perhaps other aspects of overall health which the patient might not recognise as evidence of a wider pattern, like sleeping badly or having mild digestive problems.

 

Our best advice is to visit a BAcC member local to you for a brief face to face assessment of the problem. If you do decide to go ahead with acupuncture treatment, however, we would recommend that you set a finite limit of treatments, perhaps four or five, and set very clear outcome measures and review periods to see whether the problem is improving. It is far too easy to build up a 'treatment habit' where through no-one's fault the clock can run to a dozen sessions or more with no discernible change. We are very keen to ensure that good dialogue is maintained to make the decision to take a longer time a conscious one.     

 

 

Q: Could Acupuncture help with Hemi Facial Spasms?

A: Intuitively acupuncture would seem to be an obvious treatment for a condition like this.  Chinese medicine has a way of describing disturbances in function (in this case the facial nerves) within the context of the flowing nature of qi (energy).  Utilizing the pathways of the flow of energy to promote the smooth passage of qi in the affected areas and so possibly seeing improvement in the way the nerves behave, can be seen a improving this condition.  In Chinese medicine theory, many tics and tremors are seen as a manifestation of Internal Wind, and there are well established treatment protocols for addressing this.
 
Our best advice for conditions like this, though, is always to visit a BAcC member local to you and ask for a brief face to face assesment of what they think might be able to influence. It’s always worth a go to find out how much improvement can be made.   

 

Q. Is acupuncture helpful to bells palsy

 

A. As you can see from our factsheet
 
http://www.acupuncture.org.uk/index.php?option=com_k2&;view=item&id=1128:bellas-palsy&Itemid=106
 
the evidence for the successful treatment of Bell's Palsy is not very conclusive. The trials which have been done are not of a very high standard, and their results not all that compelling.
 
However, it is fair to say that in China the condition is a great deal more common and acupuncture is often used alongside, or occasionally instead of conventional medications, as a form of treatment. The Chinese believe that exposure to cold wind can sometimes trigger an attack, and since a great many people work the land the incidence is much higher. Oddly enough, in the days before air conditioning in cars there were often cases which appeared to have been triggered by high speed driving with the driver's window open. Most often, though, the direct cause is not apparent.
 
The received wisdom of Chinese medicine is that any condition involving paralysis or rigidity of muscles becomes more difficult the longer after initial onset the treatment begins. Any well-trained practitioner will take this into account before offering a view of the potential success of treatment.