Clinical Approach to Bell's Palsy
Updated: Nov 30, 2021
Today we're going back into the clinical application of light and laser therapy and talking specifically about how to approach Bell's palsy in clinic. If you've been in practice for any amount of time, you've seen Bell's palsy in practice and you've maybe even been the point of contact for a patient with an onset of Bell's palsy and even sent them off to the hospital to make sure that they didn't have a stroke.
Bell's palsy is partial or nearly complete paralysis of one side of the face. So the facial nerve is affected, which means travels from just forward of the ear, straight to midline on the face, leaving a pretty sharply demarcated zone of weakness. You'll see drooping of the eyelid, inability to close the eye completely, drooling sometimes out of that same side of the mouth, and inability to smile normally on that affected side. It does look a lot like stroke, but there's no other unilateral problems with the rest of the muscles of the body. It typically does not include any pain, but can include some difficulty with chewing swallowing, and again, closing the eye for sure can be a problem.
Bell's Palsy and Diabetes Mellitus
Bell's palsy is self-limiting in many cases, meaning that it completely resolves on its own without any real treatment. Medications have been used and some of the recommendations currently state antiviral medications as well as corticosteroids can be prescribed to limit the amount of irritation on the nerve. But there's not much solid evidence behind those. And the use of corticosteroids can be contra-indicated, especially for diabetic patients. We're going to talk about that a little more specifically today, and I'm going to be referring back to a study from the Journal of Lasers in Medical Sciences. The title is "The Efficacy of Low-level Laser Therapy in the Treatment of Bell's Palsy in Diabetic Patients."
This was just published this year, June of 2020 and it's quite interesting because they took 30 Bell's palsy cases with poorly controlled type two diabetes. They applied a series of 12 laser therapy treatments and saw very, very good recovery. I thought this was really interesting because this makes the connection between diabetic mono neuropathies and the potential for Bell's palsy episodes to be linked to DM2 and this diabetic monitor neuropathy. As a matter of fact, the authors say that Bell's palsy may be the first manifestation of diabetes. So something to think about when you are addressing a case of Bell's palsy in clinic, is when was the last blood work taken? Do we have fasting blood glucose numbers, and do we have the A1C? Because, this could be your first heads up that the patient is having issues with controlling sugars. They may not have the diabetic retinopathy going on or not detected. At they may not have the classic stocking and glove numbness or paresthesia that goes along with type two diabetic neuropathy. But this right here, an episode of Bell's palsy could actually be an indicator for the patient having a early onset diabetes.
Laser Therapy for Bell's Palsy
They did a series of 12 laser therapy sessions. Three times a week for four weeks is what they did. They used a low power laser pulsed at 100 Hertz, and they did a dose of about 16 joules/cm2, which is a fairly high dose. But again, with a very low power laser, very, very small spot size. Following the therapy delivery at the three month follow up, they had complete recovery in 18 of the 30 patients and then partial recovery in six of the patients. They also say that there were no symptoms of recurrence in any of the patients. The authors say that one of the best things about laser therapy is that there's no side effects. Conventional treatments like corticosteroids definitely have various adverse side effects, especially in patients with diabetes.
What you can take from this is that laser therapy can be very effective for attacks of Bell's palsy, even in patients who are diabetic. And you should keep an eye on these co-morbidities or potential causes for an episode of Bell's palsy. When you're in clinical practice, just in general, if someone comes in and they have a history of Bell's palsy, even if it resolved, check to see when the patient's last blood work was done. Do they know what their sugars are? What about their hemoglobin A1C? Do we know what those levels are? Because we should be checking that to make sure that we don't have an undiagnosed diabetic condition. The earlier you can catch a diabetic, the more likely you're going to be able to help that patient control the process through diet and exercise and head off some of the longer term consequences of diabetes like diabetic retinopathy and polyneuropathy.
The authors say that one of the best things about laser therapy is that there's no side effects. Conventional treatments like corticosteroids definitely have various adverse side effects, especially in patients with diabetes.
Laser Therapy Training and Evidence
So just a quick recap, you need to use laser with your Bell's palsy patients and make sure that you are getting blood work on them to make sure you're ruling out diabetes and other health conditions. Realize that between all the different studies we have, there's plenty of evidence that laser is very helpful for Bell's palsy. As a matter of fact, there are more than 380 laser therapy studies that have already been published in 2020. So that is a lot of new studies with new information that for the majority of those studies are showing positive outcomes on multiple different conditions by utilizing laser therapy. So the next time you hear that laser therapy is not proven or it's just too new or there's no studies that show what the outcomes are, know that we have excellent evidence about many conditions. If you're curious about a particular condition or you want to see us do a blog on a certain study or a certain topic, please shoot me an email firstname.lastname@example.org. To find out how to utilize laser in your practice, including custom settings and protocols for dozens of conditions, check out our membership options!