Neurosensory

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Multiple sclerosis

Multiple sclerosis is anautoimmune diseasethat affects the brain and spinal cord (central nervous system).

Causes

Multiple sclerosis (MS) affects women more than men. The disorder is most commonly diagnosed between ages 20 and 40, but can be seen at any age.

MS is caused by damage to the myelin sheath, the protective covering that surrounds nerve cells. When this nerve covering is damaged, nerve signalsslow down or stop.

The nerve damage is caused by inflammation. Inflammation occurs when the body's own immune cells attack the nervous system. This can occur alongany area of the brain, optic nerve, and spinal cord.

It is unknown what exactly causes this to happen. The most common thought is that a virus or gene defect, or both, are to blame. Environmental factorsmay play a role.

You are slightly more likely to get this condition if you have a family history of MS or live in an part of the world where MS is more common.

Symptoms

Symptoms vary, because the location and severity of each attack can be different. Episodes can last for days, weeks, or months. These episodesalternate with periods of reduced or no symptoms (remissions).

Fever, hot baths, sun exposure, and stress can trigger or worsen attacks.

It is common for the disease to return (relapse). However, the disease may continue to get worse without periods of remission.

Because nerves in any part of the brain or spinal cord may be damaged, patients with multiple sclerosis can have symptoms in many parts of the body.

Muscle symptoms:

Loss of balance

Muscle spasms

Numbnessor abnormal sensation in any area

Problems moving arms or legs

Problems walking

Problems withcoordinationand making small movements

Tremorin one or more arms or legs

Weaknessin one or more arms or legs

Bowel and bladder symptoms:

Constipationand stool leakage

Difficulty beginning to urinate

Frequent need to urinate

Strong urge to urinate

Urine leakage (incontinence)

Eye symptoms:

Double vision

Eye discomfort

Uncontrollable rapid eye movements

Vision loss(usually affects one eye at a time)

Numbness, tingling, or pain

Facial pain

Painfulmuscle spasms

Tingling, crawling, or burning feeling in the arms and legs

Other brain and nerve symptoms:

Decreased attention span, poor judgment, and memory loss
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Difficulty reasoning and solving problems

Depressionor feelings of sadness

Dizzinessand balance problems

Hearing loss

Sexual symptoms:

Problems with erections

Problems with vaginal lubrication

Speech and swallowing symptoms:

Slurred or difficult-to-understand speech

Trouble chewing and swallowing

Fatigueis a common and bothersome symptoms as MS progresses. It is often worse in the late afternoon.

Exams and Tests

Symptoms of MS may mimic those of many other nervous system disorders. The disease is diagnosed by ruling out other conditions.

People who have a form of MS called relapsing-remitting may have a history of at least two attacks, separated by a period of reduced or no symptoms.

The health care provider may suspect MS if there are decreases in the function of two different parts of the central nervous system (such as abnormalreflexes) at two different times.

A neurological exam may show reduced nerve function in one area of the body, or spread over many parts of the body. This may include:

Abnormal nerve reflexes

Decreased ability to move a part of the body

Decreased or abnormal sensation

Other loss of nervous system functions

An eye examination may show:

Abnormal pupil responses

Changes in thevisual fieldsor eye movements

Decreased visual acuity

Problems with the inside parts of the eye

Rapid eye movements triggered when the eye moves

Tests to diagnose multiple sclerosis include:

Lumbar puncture(spinal tap) for cerebrospinal fluid tests, includingCSF oligoclonal banding

MRI scan of the brainand MRI scan of the spine are important to help diagnose and follow MS

Nerve function study (evoked potential test)

Treatment

There is no known cure for multiple sclerosis at this time. However, there are therapies that may slow the disease. The goal of treatment is to control

symptoms and help you maintain a normal quality of life.

Medications used to slow the progression of multiple sclerosis are taken on a long-term basis, they include:

Interferons (Avonex, Betaseron, or Rebif), glatiramer acetate (Copaxone), mitoxantrone (Novantrone), and natalizumab (Tysabri)

Fingolimod (Gilenya )

Methotrexate, azathioprine (Imuran), intravenous immunoglobulin (IVIg) and cyclophosphamide (Cytoxan) may also be used if the abovedrugs are not working well

Steroids may be used to decrease the severity of attacks.

Medications to control symptoms may include:
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Medicines to reduce muscle spasms such as Lioresal (Baclofen), tizanidine (Zanaflex), or a benzodiazepine

Cholinergic medications to reduce urinary problems

Antidepressants for mood or behavior symptoms

Amantadine for fatigue

For more information see:

Neurogenic bladder

Bowel retraining

The following may also be helpful for people with MS:

Physical therapy, speech therapy, occupational therapy, and support groups

Assistive devices, such as wheelchairs, bed lifts, shower chairs, walkers, and wall bars

A planned exercise program early in the course of the disorder

A healthy lifestyle, with good nutrition and enough rest and relaxation

Avoiding fatigue, stress, temperature extremes, and illness

Changes inwhat you eat or drink if there are swallowing problems

Making changes around the home toprevent falls

Social workers or other counseling services to help you cope with the disorder and get assistance (such as Meals-on-Wheels)

For more information about living with MS, see:Multiple sclerosis - at home

Household changes to ensure safety and ease in moving around the home are often needed.

Support Groups

For additional information, seemultiple sclerosis resources.

Outlook (Prognosis)

The outcome varies, and is hard to predict. Although the disorder ischronicand incurable, life expectancy can be normal or almost normal. Most peoplewith MS continue to walk and function at work with minimal disability for 20 or more years.

The following typically have the best outlook:

Females

People who were young (less than 30 years) when the disease started People with infrequent attacks

People with a relapsing-remitting pattern

People who have limited disease on imaging studies

The amount of disability and discomfort depends on:

How often you have attacks

How severe they are

The part of the central nervous system that is affected by each attack

Most people return to normal or near-normal function between attacks. Slowly, there is greater loss of function with less improvement between attacks.Over time, many require a wheelchair to get around and have a more difficult time transferring out of the wheelchair.

Those with a support system are often able to remain in their home.

Possible Complications

Depression

Difficulty swallowing

Difficulty thinking

Less and less ability to care for self

Need forindwelling catheter

Osteoporosisor thinning of the bones

Pressure sores

Side effects of medications used to treat the disorder
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Urinary tract infections

When to Contact a Medical Professional

Call your health care provider if:

You develop any symptoms of MS

Symptoms get worse, even with treatment

The condition deteriorates to the point where home care is no longer possible

Alternative Names

MS; Demyelinating disease

Myasthenia gravis

Myasthenia gravis is a neuromuscular disorder. Neuromuscular disorders involve the muscles and the nerves that control them.

Causes

Myasthenia gravis is a type ofautoimmune disorders. An autoimmune disorder occurs when the immune system mistakenly attacks healthy tissue. In

people with myasthemia gravis, the body producesantibodiesthat block the muscle cells from receiving messages (neurotransmitters) from the nerve

cell.

The exact cause of myasthenia gravis is unknown. In some cases, it may be associated with tumors of the thymus (an organ of the immune system).

Myasthenia gravis can affect people at any age. It is most common in young women and older men.

Symptoms

Myasthenia gravis causes weakness of the voluntary (skeletal) muscles. Voluntary muscles are those that are under your control. In other words, you

think about moving your arm, and it moves. The muscle weakness of myasthenia gravis worsens with activity and improves with rest.

The muscle weakness can lead to a variety of symptoms, including:

Breathing difficultybecause of weakness of the chest wall muscles

Chewingor swallowing difficulty, causing frequent gagging, choking, ordrooling Difficulty climbing stairs, lifting objects, or rising from a seated position

Difficulty talking

Drooping head

Facial paralysisor weakness of the facial muscles

Fatigue

Hoarseness or changing voice

Double vision

Difficulty maintaining steady gaze

Eyelid drooping

Exams and Tests

The health care provider performs a physical exam, including a detailed nervous system (neurological) examination. This may show:

Muscle weakness - eye muscles are usually affected first

Reflexes and feeling (sensation) are normal.

Tests that may be done may include:

Acetylcholine receptor antibodiesassociated with this disease

CTorMRIscan of the chest to look for a tumor

Nerve conduction studies

EMG
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Treatment

There is no known cure for myasthenia gravis. However, treatment may allow you to have prolonged periods without any symptoms (remission).

Lifestyle changes often help you continue your daily activities. The following may be recommended:

Scheduling rest periods

An eye patch if double vision is bothersome

Avoiding stress and heat exposure, which can make symptoms worse

Medications that may be prescribed include:

Neostigmine or pyridostigmine to improve the communication between the nerves and the muscles

Prednisone and other medications (such as azathioprine, cyclosporine, or mycophenolate mofetil) if to suppress the immune system response

if you have severe symptoms and other medicines have not worked well

Several medications may make symptoms worse and should be avoided. Therefore, it is always important to check with your doctor about the safety of a

medication before taking it.

Crisis situations, where muscle weakness involves the breathing muscles, may occur without warning with under- or overuse of medications. These

attacks seldom last longer than a few weeks. Hospitalization and assistance with breathing may be required during these attacks. Often procedure called

plasmapheresis is used to help end the crisis. In this technique, the clear part of the blood (plasma) containing the antibodies is removed from the body

and replaced with donated, antibody-free plasma or with other fluids.

Plasmapheresis may also help reduce symptoms for 4 - 6 weeks and is often used before surgery. Intravenous immunoglobulin infusions may work as

well as plasmapheresis. In this technique, a large amount of helpful antibodies are given directly into the bloodstream.

Surgery to remove the thymus (thymectomy) may result in permanent remission or less need for medicines, especially when there is a tumor present.

Patients with eye problems may try lens prisms to improve vision. Surgery may also be performed on the eye muscles.

Support Groups

The stress of illness can often be helped by joining support groups where members share common experiences and problems. See:Myasthenia gravis -

support group

Outlook (Prognosis)

There is no cure, but long-term remission is possible. You may have to restrict some daily activities. People who have only eye symptoms (ocular

myasthenia gravis), may develop generalized myasthenia over time.

Pregnancy is possible for a woman with myasthenia gravis but should be closely supervised. The baby may be temporarily weak and require

medications for a few weeks after birth but usually does not develop the disorder.


The condition may cause life-threatening breathing problems. This is called a myasthetnic crisis.

Patients with myasthenia gravis have a higher risk of having other autoimmune disorders, such asthyrotoxicosis,rheumatoid arthritis, andsystemic lupus

erythematosus(lupus).


Call your health care provider if you develop symptoms of myasthenia gravis.

Go to the emergency room or call the local emergency number (such as 911) if you have breathing difficulty or swallowing problems.

Alternative Names

Neuromusclar disorder - myasthenia gravis
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Guillain-Barre syndrome

Guillain-Barre syndrome is a serious disorder that occurs when the body's defense (immune) system mistakenly attacks part of the nervous system. This

leads to nerve inflammation that causesmuscle weaknessand other symptoms.

Causes

Guillain-Barre syndrome is anautoimmune disorder(the body's immune system attacks itself). Exactly what triggers Guillain-Barre syndrome is

unknown. The syndrome may occur at any age, but is most common in people of both sexes between ages 30 and 50.

It often follows a minor infection, such as a lung infection or gastrointestinal infection. Most of the time, signs of the original infection have disappearedbefore the symptoms of Guillain-Barre begin. It may also appear a few days or weeks after a surgery.

The swine flu vaccination in 1976 may have caused rare cases of Guillain-Barre syndrome. However, the swine flu and the regular flu vaccines used

today have not resulted in more cases of the illness.

Guillain-Barre syndrome damages parts of nerves. This nerve damage causes tingling,muscle weakness, andparalysis. Guillain-Barre syndrome most

often affects the nerve's covering (myelinsheath). Such damage is calleddemyelination, and it causes nerve signals to move more slowly. Damage to

other parts of the nerve can cause the nerve to stop working altogether.

Guillain-Barre syndrome may occur along with viral infections such as:

AIDS

Herpes simplex Mononucleosis

It may also occur with other medical conditions such assystemic lupus erythematosusorHodgkin's disease.

Some people may get Guillain-Barre syndrome after a bacterial infection. A similar syndrome may occur after surgery, or when someone is critically ill

(neuropathy of critical illness).

This syndrome can occur at any age, but is rare in children under age 2.

Symptoms

Symptoms of Guillain-Barre can get worse very quickly. It may take only a few hours to reach the most severe symptoms, but weakness that increases

over several days is also common.

Muscle weakness or the loss of muscle function (paralysis) affects both sides of the body. In most cases, the muscle weakness starts in the legs and

then spreads to the arms. This is called ascending paralysis.

Patients may notice tingling, foot or hand pain, and clumsiness. If the inflammation affects the nerves to the diaphragm and chest and there is weakness

in those muscles, the person may need breathing assistance.

Typical symptoms include:

Loss of reflexes in the arms and legs

Low blood pressureor poor blood pressure control

Muscle weakness or loss of muscle function (paralysis)

o In mild cases, there may be weakness instead of paralysiso May begin in the arms and legs at the same time

o May get worse over 24 to 72 hours

o May occur in the nerves of the head only

o May start in the arms and move downward

o May start in the feet and legs and move up to the arms and head

Numbness

Sensation changes, including pain and tingling

Tenderness or muscle pain (may be a cramp-like pain)

Uncoordinated movement(cannot walk without help)
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Other symptoms may include:

Blurred visionand double vision

Clumsiness and falling

Difficulty moving face muscles

Muscle contractions

Palpitations (sensation of feeling the heart beat)

Emergency symptoms (seek immediate medical help):

Breathing temporarily stops

Can't take a deep breath

Difficulty breathing


Drooling

Fainting

Feeling light-headed when standing

Exams and Tests

A history of increasing muscle weakness and paralysis may be a sign of Guillain-Barre syndrome, especially if there was a recent illness.

A medical exam may show muscle weakness and problems with involuntary (autonomic) body functions, such as blood pressure and heart rate. Theexamination will also show that reflexes, such as the "ankle or knee jerk," are decreased or missing.

There may be signs of decreased breathing caused by paralysis of the breathing muscles.

The following tests may be ordered:

Cerebrospinal fluidsample ("spinal tap")

ECG

Electromyography(EMG) tests the electrical activity in muscles

Nerve conduction velocitytest

Pulmonary function tests

Treatment

There is no cure for Guillain-Barre syndrome. However, many treatments are available to help reduce symptoms, treat complications, and speed up

recovery.

When symptoms are severe, the patient will need to go to the hospital for treatment, which may include artificial breathing support.

In the early stages of the illness, treatments that remove or block the proteins that attack the nerve cells, calledantibodies, may reduce the severity and

duration of Guillain-Barre symptoms.

One method is called plasmapheresis, and it is used to remove the antibodies from the blood. The process involves taking blood from the body, usually

from the arm, pumping it into a machine that removes the antibodies, and then sending it back into the body.

A second method is to block the antibodies using high-dose immunoglobulin therapy (IVIG). In this case, the immunoglobulins are added to the blood inlarge quantities, blocking the antibodies that cause inflammation.

Other treatments are directed at preventing complications.

Blood thinners may be used to prevent blood clots.

If the diaphragm is weak, breathing support or even a breathing tube and ventilator may be needed.

Pain is treated with anti-inflammatory medicines and narcotics, if needed.

Proper body positioning or a feeding tube may be used to prevent choking during feeding if the muscles used for swallowing are weak.

Support Groups

Guillain-Barre Syndrome Foundation International - www.gbs-cidp.org
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Outlook (Prognosis)

Recovery can take weeks, months, or years. Most people survive and recover completely. According to the National Institute of Neurological Disorders

and Stroke, about 30% of patients still have some weakness after 3 years. Mild weakness may persist for some people.

A patient's outcome is most likely to be very good when the symptoms go away within 3 weeks after they first started.


Breathing difficulty (respiratory failure)

Contracturesof joints or other deformity Deep vein thrombosis(blood clots that form when someone is inactive or confined to bed)

Increased risk of infections

Low or unstable blood pressure

Paralysis that is permanent

Pneumonia

Skin damage (ulcers)

Sucking food or fluids into the lungs (aspiration)


Seek immediate medical help if you have any of the following symptoms:

Can't take a deep breath Decreased feeling (sensation)

o Difficulty breathing

o Difficulty swallowing

o Fainting

o Loss of movement

Alternative Names

Landry-Guillain-Barre syndrome; Acute idiopathic polyneuritis; Infectious polyneuritis; Acute inflammatory polyneuropathy; Acute inflammatory

demyelinating polyneuropathy

Amyotrophic lateral sclerosis

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Amyotrophic lateral sclerosis, or ALS, is a disease of the nerve cells in the brain and spinal cord that control voluntary muscle movement.

ALS is also known as Lou Gehrig's disease.

Causes

1 out of 10 cases of ALS are due to a genetic defect. The other times, the cause is unknown.

In ALS, nerve cells (neurons) waste away or die, and can no longer send messages to muscles. This eventually leads to muscle weakening, twitching,

and an inability to move the arms, legs, and body. The condition slowly gets worse. When the muscles in the chest area stop working, it becomes hard

or impossible to breathe.

ALS affects approximately 5 out of every 100,000 people worldwide.

There are no known risk factors, except for having a family member who has a hereditary form of the disease.

Symptoms

Symptoms usually do not develop until after age 50, but they can start in younger people. Persons with ALS have a loss of muscle strength and

coordination that eventually gets worse and makes it impossible to do routine tasks such as going up steps, getting out of a chair, or swallowing.

Breathing or swallowing muscles may be the first muscles affected. As the disease gets worse, more muscle groups develop problems.
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ALS does not affect the senses (sight, smell, taste, hearing, touch). It only rarely affects bladder or bowel function, eye movement, or a person's ability to

think or reason.

Symptoms include:

Difficulty breathing


o Choking easily

o Drooling

o Gagging Head drop due to weakness of the neck muscles

Muscle cramps

Muscle contractionscalled fasciculations

Muscle weaknessthat slowly gets worse

o Commonly involves one part of the body first, such as the arm or hand

o Eventually leads to difficulty lifting, climbing stairs, and walking

Paralysis

Speech problems, such as a slow or abnormal speech pattern (slurring of words)

Voice changes, hoarseness

Weight loss

Exams and Tests

The doctor or nurse will examine you and ask questions about your medical history and symptoms.

The physical exam may show:

Weakness, often beginning in one area

Muscle tremors, spasms, twitching, or loss of muscle tissue

Twitching of the tongue (common)

Abnormal reflexes

Stiff or clumsy walk

Increased reflexes at the joints

Difficulty controlling crying or laughing (sometimes called emotional incontinence)

Loss of gag reflex

Tests that may be done include:

Blood tests to rule out other conditions

Breathing test to see if lung muscles are affected

Cervical spine CTor MRI to be sure there is no disease or injury to the neck, which can mimic ALS

Electromyographyto see which nerves or muscles do not work properly

Genetic testing, if there is a family history of ALS

Head CTorMRIto rule out other conditions

Swallowing studies

Spinal tap (lumbar puncture)

Treatment

There is no known cure for ALS. A medicine called riluzole helps slow down the symptoms and lets you live longer.

Treatments to control other symptoms include:

Baclofen or diazepam forspasticitythat interferes with daily activities

Trihexyphenidyl or amitriptyline for people with problems swallowing their own saliva

Physical therapy, rehabilitation, use of braces or a wheelchair, or other measures may be needed to help with muscle function and general health.

Chokingis common. Patients may decide to have a tube placed into their stomach for feeding. This is called a gastrostomy.
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A nutritionist is very important. Patients with ALS tend to lose weight. The illness itself increases the need for food and calories. At the same time,

problems with swallowing make it hard to eat enough.

Breathing devices include machines that are used only at night, and constant mechanical ventilation.

Patients should discuss their wishes regarding artificial ventilation with their families and doctors.

Support Groups

Emotional support is vital in coping with the disorder, because mental functioning is not affected. Groups such as the ALS Association may be available

to help people who are coping with the disorder.

Support for people who are caring for someone with ALS is also available, and may be very helpful.

See:ALS - support group

Outlook (Prognosis)

Over time, people with ALS progressively lose the ability to function and care for themselves. Death often occurs within 3 - 5 years of diagnosis. About 1

in 4 patients survive for more than 5 years after diagnosis.


Breathing in food or fluid (aspiration)

Loss of ability to care for self

Lung failure (See:Adult respiratory distress syndrome)

Pneumonia

Pressure sores

Weight loss


Call your health care provider if:

You have symptoms of ALS, particularly if you have a family history of the disorder

You or someone else has been diagnosed with ALS and symptoms get worse or new symptoms develop

Increased difficulty swallowing, difficulty breathing, and episodes ofapneaare symptoms that require immediate attention.

Prevention

You may want to see a genetic counselor if you have a family history of ALS.

Alternative Names

Lou Gehrig's disease; ALS; Upper and lower motor neuron disease; Motor neuron disease
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Trigeminal neuralgia


Trigeminal neuralgia is a nerve disorder that causes a stabbing or electric-shock-like pain in parts of the face.

Causes

The pain of trigeminal neuralgia comes from the trigeminal nerve. This nerve carries the feelings of touch and pain from the face, eyes, sinuses, and

mouth to the brain.

The condition usually affects adults, but it may affect anyone at any age. Trigeminal neuralgia may be part of the normal aging process.

Trigeminal neuralgia may be caused by:

Multiple sclerosis

Pressure on the trigeminal nerve from a swollen blood vessel or tumor

Often, no cause is found.

Doctors are more likely to find a cause in a person who is younger than age 40.

Symptoms

Very painful, sharp electric-like spasms that usually last a few seconds or minutes, but can become constant

Pain is usually only on one side of the face, often around the eye, cheek, and lower part of the face

Pain may be triggered by touch or sounds

Painful attacks of trigeminal neuralgia can be triggered by common, everyday activities, such as:

o Brushing teeth

o Chewing

o Drinking

o Eating

o Lightly touching the face

o Shaving

Exams and Tests

A brain and nervous system (neurologic) examination is usually normal.

Tests that are done to look for the cause of the problem include:

Blood tests

MRI of the head

Trigeminal reflex testing

Treatment

Your primary care physician, a neurologist, or a pain specialist may be involved in your care.

Certain medicines sometimes help reduce pain and the rate of attacks. These medicines include:

Anti-seizure drugs (carbamazepine, gabapentin, lamotrigine, phenytoin, valproate, and pregabalin)

Muscle relaxants (baclofen, clonazepam)

Tricyclic antidepressants (amitriptyline, nortriptyline, or carbamazepine)

Some patients may need surgery to relieve pressure on the nerve. Techniques include:

Cutting or destroying part of the trigeminal nerve

Destroying the trigeminal nerve with a needle or probe placed through the skin using radiofrequency ablation or an injection of glycerol

Electrostimulation

Percutaneous balloon microcompression

Removal of the tumor (when a tumor is the cause)
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Stereotactic radiosurgery(Gamma knife)

Surgery to remove a blood vessel that is putting pressure on the trigeminal nerve (called microvascular decompression, or MVD)

Outlook (Prognosis)

How well you do depends on the cause of the problem. If there is no disease causing the problem, treatment can provide at least some relief.

However, the pain may become constant and severe in some patients.

Alternative Names

Tic douloureux

Bell's palsy


Bell's palsy is a disorder of the nerve that controls movement of the muscles in the face. This nerve is called the facial or 7th cranial nerve.

Damage to this nerve causes weakness or paralysis of these muscles.Paralysismeans that you cannot use the muscles at all.

Causes

Bell's palsy affects about 30,000 - 40,000 people a year in the United States.

Bell's palsy involves damage to the seventh cranial (facial) nerve. This nerve controls the movement of the muscles of the face.

Bell's palsy is thought to be due to swelling (inflammation) of this nerve in the area where it travels through the bones of the skull.

The cause is often not clear. A type of herpes infection calledherpes zostermight be involved. Other conditions that may cause Bell's palsy include:

HIV infection

Lyme disease

Middleear infection

Sarcoidosis

Symptoms

Sometimes you may have a cold shortly before the symptoms of Bell's palsy begin.

Symptoms most often start suddenly, but may take 2 - 3 days to show up. They do not become more severe after that.

Symptoms are almost always on one side of the face only. They may range from mild to severe.

The face will feel stiff or pulled to one side, and may look different. Other symptoms can include:

Difficulty closing one eye

Difficulty eating and drinking; food falls out of one side of the mouth

Droolingdue to lack of control over the muscles of the face

Drooping of the face, such as the eyelid or corner of the mouth Problems smiling, grimacing, or making facial expressions

Twitching or weakness of the muscles in the face

Other symptoms that may occur:

Dry eye, which may lead to eye sores or infections

Dry mouth

Headache

Loss of sense oftaste

Sound that is louder in one ear (hyperacusis)

Twitching in face
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Exams and Tests

Often, Bell's palsy can be diagnosed just by taking a health history and doing a complete physical exam.

If your health care provider is worried that a braintumoris causing your symptoms, you may need:

CT scan of the head

Magnetic resonance imaging (MRI) of the head

Sometimes, you will need a test to check the nerves that supply the muscles of your face:

Electromyography(EMG)

Nerve conductiontest

Treatment

Often, no treatment is needed. Symptoms often begin to improve right away. However, it may take weeks or even months for the muscles to get

stronger, and this may be frustrating.

Your health care provider may give you lubricating eye drops or eye ointments to keep the surface of the eye moist if you cannot close it completely. You

may need to wear an eye patch while you sleep.

Sometimes medicines may be used, but it is not clear how much they help. If medicines are used, they should be started right away.

Corticosteroids may reduce swelling around the facial nerve

Medications can fight the virus that may be causing Bell's palsy

Surgery to relieve pressure on the nerve (decompression surgery) has not been shown to benefit most people with Bell's palsy.

Outlook (Prognosis)

Most cases go away completely within a few weeks to months.

If you did not lose all of your nerve function and symptoms began to improve within 3 weeks, you're more likely to regain all or most of the strength in

your facial muscles.

Sometimes, the following symptoms still may be present:

Long-term changes in taste

Spasms of muscles or eyelids

Weakness that remains in facial muscles


Excess drying of the eye surface, leading to eye sores or infections.


Call your health care provider right away if your face droops or you have other symptoms of Bell's palsy. Your health care provider can rule out other,

more serious conditions, such as stroke.

Prevention

There is no known way to prevent Bell's palsy.

Alternative Names

Facial palsy; Idiopathic peripheral facial palsy; Cranial mononeuropathy
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