A Case of Idiopathic Facial Nerve Palsy Managed with Classical Homeopathy

 Abstract:

Bell’s palsy is a condition that affects the facial nerve, resulting in sudden weakness or paralysis of the muscles on one side of the face. Bell’s palsy involves inflammation of the facial nerve, which can lead to compression and damage and can lead to difficulties with facial expression on the affected side.

Management of Bell’s palsy can be challenging, as there is no definitive cure and treatment options are limited. Prednisone is commonly used to reduce inflammation, while antiviral medication may be prescribed if an infection is suspected.

Other management strategies may include physiotherapy and eye care. Despite these measures, some patients may experience persistent facial weakness or other complications, highlighting the need for continued research and improved management approaches.

In such cases, classical homeopathy may be considered as an alternative therapy. In this case report, a 14-year-old male patient with Bell’s palsy was treated with classical homeopathy. In two months of treatment, the patient showed significant improvement in facial symmetry, motor function, and sensory perception along with overall betterment in quality of life.

Keywords:  Bell’s palsy, idiopathic facial palsy, homeopathy, case report

Background:

Facial nerve palsy is a very common neurological condition characterized by partial or complete paralysis of the cranial nerve VII (facial nerve).The most common cause is idiopathic peripheral facial nerve palsy, also known as Bell’s palsy.

Bell’s palsy is relatively uncommon and the incidence of  Bell’s palsy is estimated to be around 20-30 cases per 100,000 people per year.¹While the exact pathogenesis of Bell’s palsy remains an area of debate, it is believed to be related to a complex interplay of genetic, environmental, and immunological factors.¹

Facial nerve is a cranial nerve that emerges from the brainstem and exits via the stylomastoid foramen. The inflammation and swelling of the facial nerve can cause compression within the facial canal.¹ This can disrupt the transmission of signals from the brain to the facial muscles, resulting in paralysis of the muscles on one side of the face.

In addition to the physical compression of the nerve, there may also be damage to the myelin sheath that surrounds the nerve fibres, further impairing the nerve function.^2,3 Facial paralysis can be classified as central and peripheral depending on the site of affection.

Central facial palsy, also known as upper motor neuron facial palsy, occurs when there is damage to the upper motor neurons that control the facial nerve.³ In central facial palsy, the muscles on both sides of the face may be affected, but the forehead muscles are typically spared, therefore the ability to frown and close the lid is intact.¹

Peripheral facial palsy, also known as lower motor neuron facial palsy, occurs when there is damage to the facial nerve itself, typically as a result of inflammation, infection, or trauma. In peripheral facial palsy, only one side of the face is typically affected, and the forehead muscles may be involved. The lower facial muscles are only innervated by fibres from contra lateral hemispheres hence they are affected in both the palsies causing the mouth to droop.²

Diagnosis of Bell’s palsy is based on the patient’s symptoms and a physical examination by a doctor, although imaging tests such as MRI may be used to rule out other possible causes.¹ Management of Bell’s palsy typically involves a combination of corticosteroids and antiviral medications to reduce inflammation and manage any viral infection, as well as eye care and physiotherapy to improve facial muscle strength and prevent complications. ⁴

Most patients with Bell’s palsy experience full recovery within a few months with appropriate treatment, but ongoing support and management may be required for those who experience persistent symptoms or complications.³Alternative therapies such as classical homeopathy may also be recommended, although its effectiveness is not well established.

Few studies exist which provide favourable outcomes for use of homeopathy in facial paralysis.^5,6 This case report suggests an alternative for treatment of Bell’s palsy with classical homeopathy.

Case report:

A 14-year-old boy developed left sided facial paralysis since August 2020.Patient went to NIMHANS, Bangalore and underwent an MRI-Brain in September 2020 which appeared normal and conventional medicine was prescribed for a few weeks with no improvement. He took Ayurvedic treatment for 2 months and did not find any improvement. At this juncture, patient sought homeopathic help. First consultation took place on 04/11/2020. The symptoms available for prescriptions were:

• Face paralysis – one-sided (2+)
• Face paralysis – left-side (3+)
• Eye lachrymation -left, waking on(2+)
• Startles easily(2+)
• Thirst with dryness of mouth (2+)
• Anxiety about health (3+)
• Fear of blood (2+)
• Fear of injections (2+)
• Desires company (2+)
• Ailments from fright(2+)
• Skin –eruptions-suppressed (3+)

Past medical history:

• Patient developed pneumonia with a fever of 102^oF at 2 years of age and took antibiotics for the same.
• Patient started developing recurrent fevers from three years until 7 years of age, every 3months. He has taken antibiotics for the same.
• From 8-13 years of age, patient used to develop mild grade fevers once or twice a year. He took allopathic treatment.
• The last high fever of 101^oF developed in 2019.
• One week before developing Bell’s palsy, he got vesicular eruptions behind left ear. He applied ointments and the eruptions subsided.

Family history:

Father and mother are apparently healthy, and the younger sibling has no major illness.

Diagnosis: Bell’s palsy (ICD 10 – G51.0)⁷

Case analysis and prescription:

After a thorough investigation, it was obvious that the facial paralysis started after suppressing the skin eruptions with corticosteroids. The patient was frightened after witnessing a death due to COVID-19 infection and he developed tremendous anxiety concerning his own health. The most striking symptom was the anxiety about the health and it gave rise to a specific totality of symptoms as shown in the repertorisation in Figure 1.

Figure 1: Reportorial result on 04/11/2020 (Vithoulkas compass)

Phosphorus 200CH one dose was prescribed on 04/11/2020.

The follow up of the case is listed in Table 1.

Table 1 – Follow up of the case.

DATE	SYMPTOMS	ANALYSIS:	PRESCRIPTION
29/11/2020	Eye movement is better and lachrymation of the left eye aggravated. Mouth salivation during sleep is better. Old symptom –coryza and sneezing from head bathing has come back in lesser intensity. Change in generalities – a) Thirst has reduced b) Sweet desire increased c) Perspiration on nose and offensive foot perspiration. Anxiety about health is better by 50%. Patient can stay and sleep alone now	The remedy was simillimum, and the potency chosen was correct. Remedy is acting and patient developed old symptom in better intensity. There are mild changes in generalities. Case may need a new remedy in future. No clear remedy picture at the moment.	Nil
11/12/2020	Bell’s phenomenon is much better. Patient is able to close his eyes up to 60%. No lachrymation of left eye.(figure2 ) Deviation of angle of mouth is getting better. (figure 3) Mouth salivation during sleep is better. Old symptom –coryza and sneezing from head bathing aggravation still persists in the same intensity. Anxiety about health is better by 90%Patient is able to stay and sleep alone now. Patient even expresses his anger now	Emotionally patient is much better. Pathological symptoms are much better. Selected remedy is correct and is till acting.	Nil
27/01/2021	No lachrymation of left eye and bell’s phenomena is better.(figure 2) Salivating sleep during better Headache on washing hair persisted. Sneezing in the morning with coryza increased. Anger increased, cannot tolerate injustice. Forsaken feeling, weeps while expressing this. He says parent doesn’t love him much and shows love only to his younger brother. When enquired with mother, she denied such situations. He has no fears now and does not startle easily. Anxiety about health is completely better.	Bell’s phenomenon is better. Paralysis has gradually started getting better.   The old symptom still persisted and increased in intensity.   Emotional picture is changing. The generalities remain same like earlier.   Patient needs new remedy, especially in Group C cases, remedy picture may change quickly and if we do not identify the new picture and prescribe, the pathology might relapse. (Figure 4)	Magnesia carbonica 200CH one dose
14/03/2021	Bell’s phenomenon is negative. Patient is able to hold air in his mouth and is able to even whistle without much deviation of angle of mouth.(Figure 2 and figure 3) No lachrymation of eyes noted. Salivation during sleep is better. Headache on washing hair is better- frequency is better. Sneezing in the morning with coryza is better. Anger is better. He controls his anger and thinks why he gets angry. Forsaken feeling is better comparatively. Mother explains that he doesn’t complain as much as before. Face pain on left side since 3 days.(Proving symptom) Patient started to develop pityriasis Alba on face.	Patient is doing much better after the remedy.   Patient has developed a proving symptom. (Left face pain)	Nil
26/03/2021	Face paralysis is much better. Bell’s phenomenon is negative. Patient is able to hold air, whistle without much deviation of mouth. Patient developed fever of 101oF since yesterday – Started with coryza extending to chest (+) and cough. Cough with green expectoration (+) Vomiting from consuming milk (++) Patient is not liking to eat vegetables again (++) Forsaken feeling is better but is not still gone (+++) Pityriasis on face is getting better.	Patient has developed an acute after correct treatment with homeopathy.   Even during acute, this patient is still indicating a clear symptomatology of the chronic remedy therefore, the chronic remedy must be repeated to avoid any further relapse of symptoms.  (Figure 5)	Magnesia carbonica 200 CH one dose
25/04/2021	Acute subsided within 2 days after remedy. Bell’s phenomenon is completely better. He is able to hold air completely in mouth and whistle without any deviation in angle of mouth. There was no coryza on waking up in the morning. Forsaken feeling is completely better. He hasn’t complained about it at all. Head washing aggravation persists- Patient still gets headaches but frequency and intensity has reduced.	Patient is doing better. We must wait.	Nil
22/05/2022	Bell’s palsy is better (Figure 2 and figure 3) Patient had developed 2 acutes – one in September 2021 and the other in December 2021 – mild fever with coryza and it resolved on its own without any treatment. Forsaken feeling is completely better. Head pain from head washing is completely better Coryza and sneezing has completely reduced.	Follow up of case after 1 year. Patient did not have any complaints since one year. He is doing better	Nil

Figure 2: Bell’s phenomenon – Before, during and after homeopathic treatment.

Figure 3: Bell’s palsy – Before and after treatment.

Figure 4: Reportorial result on 27/01/2021 (Vithoulkas compass)

Figure 5: Reportorial result on 26/03/2021 (Vithoulkas compass)

Discussion:

Bell’s palsy is typically a temporary condition and most people experience a full recovery within few weeks to few months, although in some cases, symptoms can persist or recur.⁸ In addition, the visible symptoms of Bell’s palsy can lead to stigma and misconceptions about the condition, further exacerbating the social and emotional challenges experienced by affected individuals.¹

Such cases may benefit from classical homeopathy by minimizing the impact of residual symptoms on quality of life. It is important to note that Bell’s palsy is a condition that affects each individual differently. Therefore, treating it with a cookie-cutter approach may not be effective. It is essential to adopt an individualized treatment plan that takes into consideration the patient’s unique symptoms, medical history, and overall health.

According to the concept of “levels of health” propounded by Professor Vithoulkas, there are four groups (A-D) and 12 levels (1-12).¹⁰Each person has a unique level of health that reflects their overall vitality and resilience. This level of health is influenced by a range of factors, including genetics, lifestyle, environment, and emotional stress.^10,11The goal of classical homeopathy is to identify and address the underlying imbalances or disruptions in a person’s level of health, rather than merely treating their symptoms.

In the above case, patient was born in Group B – Level 5. Patient had recurrent fevers since childhood which were suppressed with conventional treatment. Patient developed a high fever before the development of Bell’s palsy. The fever was treated conventionally following which the health declined, and patient developed Bell’s palsy.

The patient developed mild grade fevers even after developing chronic pathology confirming that the case belongs to Group C – Level 7.¹¹ The remedy pattern was clear indicating a good immune system and a favourable prognosis with homeopathic treatment.

This case also exemplifies the correlation between the suppression of acute disease and the onset of chronic disease.^12,13 When acute diseases are suppressed through wrong treatment, the force is driven inward and deeper into the body which can result in more serious chronic diseases according to one’s predisposition.¹³

The correct homeopathic treatment usually produces the ability to develop acute infection with high fever again, which must be studied and treated properly in order to strengthen the defence mechanism’s effort to overcome the chronic disease.

The Modified Naranjo Criteria for Homeopathy (MONARCH) causality assessment provided a score of 9/13, suggesting a significant causal relationship between the treatment and the observed outcome (Table 2).¹⁴

Previous case reports have indicated that homeopathy may be beneficial in treating neurological conditions.^6,5,15,16 This case report suggests that classical homeopathy can be a safe and effective treatment option for individuals with Bell’s palsy.

Table 2: Modified Naranjo Criteria for Homeopathy (MONARCH) – for causality assessment

Criteria	Y	N	Not sure/NA	Score in case
1. Was there an improvement in the main symptom or condition for which the homeopathic medicine was prescribed?	2	-1	0	2
2. Did the clinical improvement occur within a plausible time frame relative to the drug intake?	1	-2	0	1
3. Was there an initial aggravation of symptoms?	1	0	0	1
4. Did the effect encompass more than the main symptom or condition, i.e., were other symptoms ultimately improved or changed?	1	0	0	1
5. Did overall well-being improve?	1	0	0	1
6 (A) Direction of cure: did some symptoms improve in the opposite order of the development of symptoms of the disease?	1	0	0	1
6 (B) Direction of cure: did at least two of the following aspects apply to the order of improvement of symptoms:- from organs of more importance to those of less importance, from deeper to more superficial aspects of the individual, from the top downwards	1	0	0	1
7. Did “old symptoms” (defined as non-seasonal and non-cyclical symptoms that were previously thought to have resolved) reappear temporarily during the course of improvement?	1	0	0	1
8. Are there alternate causes (other than the medicine) that with a high probability could have caused the improvement? (consider known course of disease, other forms of treatment, and other clinically relevant interventions)	-3	1	0	-3
9. Was the health improvement confirmed by any objective evidence? (photos before and after treatment)	2	0	0	2
10. Did repeat dosing, if conducted, create similar clinical improvement?	1	0	0	1
Total				9

 

Conclusion:

In this case, classical homeopathy has demonstrated encouraging outcomes in addressing Bell’s palsy. In addition to managing the symptoms of the condition, it also improved the overall quality of life of the patient. However, further research is needed to fully understand the mechanisms of the treatment and to determine its effectiveness in larger populations. It is important to continue exploring alternative therapies like classical homeopathy as they may provide valuable options for those suffering from Bell’s palsy and other neurological conditions.

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