Neuromodulation
Jacob S. Levine, MD
Resident Physician
Icahn School of Medicine at Mount Sinai Physical Medicine and Rehabilitation Residency
New York, New York, United States
Marya Ghazzi, DO
Resident Physician
Icahn School of Medicine at Mount Sinai Physical Medicine and Rehabilitation Residency
New York, New York, United States
Bogdan I. Davidescu, MD
Attending
James J Peters VA Medical Center
Briarwood, New York, United States
Jacob S. Levine, MD
Icahn School of Medicine at Mount Sinai Physical Medicine and Rehabilitation Residency
New York, New York, United States
A 40-year-old male with a 34-year history of Bell’s Palsy presented for an acupuncture trial to facilitate voluntary left eye closure. The patient had tried lidweights and tarsal-strip procedures without success; concern heightened for advanced corneal deterioration. As the patient was considering extensive facial nerve transposition, acupuncture served as a last surgical-sparing effort. He was treated with acupuncture to the scalp and face with high-frequency electricity to bilateral lower 2/5 motor & sensory, & foot-motor-sensory, at 200Hz for 90 minutes, followed by left BL-2, SI-19, ST-3, LI-20 at 200Hz electricity for 7 minutes, and GV 24.5. After this first treatment, he could temporarily close the left eyelid and lift the left lip to ~160-degree near-horizontal smile. Treatments continued every 5-7 days for the following 3 months, while completing home exercises activating the eyes and lips. Throughout 10 visits, voluntary left eye closure duration increased, including in supine sleep position.
Discussions: Bell’s Palsy is the most common cause of facial nerve paralysis and presents as unilateral hemifacial paralysis. The lifetime risk of Bell’s is 1 in 60, and carries an annual incidence of about 0.04%. And 10% of cases lead to a recurrence. 70-80% of patients make a complete recovery without treatment, and 95% resolve with timely medication initiation. For those who do not recover seamlessly, long-term consequences can be significant and oftentimes extensive surgical interventions are employed. Electroacupuncture offers a non-invasive, low-risk, surgical-sparing technique for treating symptoms of facial paralysis, and restoring quality of life.
Conclusions: There is suggestive data to support the safety of acupuncture in neurologic conditions. However, there is limited data examining efficacy of electroacupuncture in facial nerve paralysis, particularly in a case with a decades-long presence of the condition. This case report supports the safety and efficacy of electroacupuncture for the treatment of facial nerve paralysis.
