Bell’s palsy represents an episode of severe facial muscle weakness or paralysis, which results from swelling or damage to the facial nerve. Bell’s palsy can strike at any age, in both males and females. Bell’s palsy is the most common cause of facial paralysis during pregnancy. No one knows what causes Bell’s palsy during pregnancy, but it does share associations with other conditions, including diabetes, viral infections, high blood pressure, and Lyme disease.
Diagnosing Bell’s Palsy During Pregnancy
The signs and symptoms of Bell’s palsy in pregnancy occur suddenly and typically worsen over 48 hours. The most common presenting symptom of Bell’s palsy during pregnancy, as well as in those not pregnant, is a one-sided facial droop. Other common symptoms, which typically occur on the affected side, may include:
- Loss of feeling in the face
- Excessive tear production
- Ringing in the ear
- Impaired speech
- Loss of the sense of taste
- Hypersensitivity to sound
- Inability to close the eye or blink properly
- Difficulty smiling
- Change in speech
Bell’s palsy during pregnancy is often confused with the symptoms of a stroke, which is why immediate medical evaluation is required.
Pregnant women are three times more likely to experience Bell’s palsy than non-pregnant women, with a predominance in the third trimester. Several theories exist as to why there is an increased incidence of Bell’s palsy in pregnancy and include the following:
- Increased total body water leading to swelling and/or compression of the facial nerve
- Weakened immune system, especially in the third trimester, which can lead to the reactivation of the herpes simplex virus (HSV), the causative organism for “cold sores”
- Increased blood clotting factors
- Elevated levels of the female hormones estrogen and progesterone.
Furthermore, Bell’s palsy during pregnancy has been associated with preeclampsia, also known as pregnancy-induced high blood pressure, and hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome, which is a variant of pre-eclampsia. Perhaps these conditions combine with other factors to increase the risk of Bell’s palsy during pregnancy.
Managing and Treating Bell’s Palsy in Pregnancy
The treatment of Bell’s palsy in pregnancy is controversial. Some physicians choose not treat with steroids or antivirals, especially occurrences in the first trimester. Others choose to treat Bell’s palsy during pregnancy, especially occurrences in the third trimester. Steroids have been rated as “highly effective” treatment for Bell’s palsy during pregnancy, while antivirals have been rated as “possibly effective” only when combined with steroids (not when used alone). Physical therapy is another option for Bell’s palsy in pregnancy treatment, as it is safe and does not require medication, and can also be continued months after giving birth.
Recovering from Bell’s Palsy Post-Pregnancy
In general, those who experience Bell’s palsy will experience a full recovery within 6 months. Unfortunately for Bell’s palsy during pregnancy, the prognosis for complete recovery isn’t as great as the general population, 52% vs. 80%, respectively. It should be noted that the poorer outcomes reported are likely related to the past reluctance of physicians to prescribe steroids and antivirals in treatment. Today, management of Bell’s palsy in pregnancy should mirror that of nonpregnant individuals and include steroids combined with antivirals, with the exception of first trimester cases.
What if Bell’s Palsy Does Not Resolve Post-Pregnancy?
Only 52% of women who develop Bell’s palsy during pregnancy recover completely. If Bell’s palsy symptoms last longer than 8 months in pregnant (and non-pregnant) females, consideration should be given to long-term treatment options, as there is usually permanent one-sided (unilateral) facial paralysis. Novel treatments for persistent/permanent Bell’s palsy symptoms post-pregnancy include Botox, neuromuscular retraining (NMR), and selective neurolysis.
Botox injections can provide safe, reliable, and painless treatment of permanent Bell’s palsy post-pregnancy. When administered to the normal side of the face, the nonsurgical injections relax the overactive muscles, restoring facial symmetry and improving facial appearance. All this can be accomplished in a 10 to 15-minute outpatient office visit with no downtime. You can return to your normal daily activities immediately after Botox injections. Results may be noticeable in as little as 24 hours after the procedure and reach maximal levels in 1 to 2 weeks and may persist for as long as 4 months.
NMR is a form of physical therapy (PT) for permanent Bell’s palsy post-pregnancy. It is administered by an experienced occupational therapist or physical therapist with training in neuromuscular therapy. A personalized PT protocol will be formulated to fit your exact needs and provide optimal results. NMR is typically provided in conjunction with Botox injections for permanent Bell’s palsy.
Selective neurolysis is a state-of-the-art surgical treatment option for permanent Bell’s palsy post-pregnancy. The surgery provides reanimation of the smile that is lost with persistent Bell’s palsy. The procedure involves intricate mapping of the facial nerves to weaken those nerves counterproductive to the smile mechanism. The surgery is performed in an outpatient/same-day surgery facility with minimal risks and downtime. Results may be noticeable as soon as 1 day after surgery and are typically permanent.
Can you Prevent Bell’s Palsy?
Unfortunately, there is no known way to prevent Bell’s palsy during pregnancy.
Bell’s Palsy Post-Pregnancy
After delivery, women may still be susceptible to the disease. There are a significant number of women who develop Bell’s palsy post-pregnancy, usually 7 to 10 days after delivery, for the same possible reasons alluded to earlier.
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