ACUPUNCTURE TREATMENT

OF BELL’S PALSY USING TWO

DISTAL PONINTS:

SHENMAI (V62) AND HOUXI

(ID3)

DR. OSCAR RODRIGO MENDIZABAL POLANCO

MÉDICO CIRUJANO UNAM

ESPECIALISTA EN ACUPUNTURA IPN

Definition

Acute unilateral paralysis or paresis of facial expression muscles consistent with a peripheral nerve damage, without a detectable cause.

Coker NJ, Vrabec JT: Acute Paralisys of the Facial Nerve. En Bailey BJ, Calhoun KH, Healy GB,Pillsburry HC, Johnson JT et al. Head and Neck Surgery-Otolaryngology. 2006, 4th Ed. LippincottWilliams & Wilkins. Ch 144 pp 1843-1858.

Etiology

Associated to viral infections:

HSV 1

EBV

Positive serology in 6-10% of patients

Linder T, Bossart W, Bodmer D. Bell’s palsy and herpes simplex virus: fact or mystery? Otol Neurotol

2005;26:109-13.

Pathophysiology

???

Facial n. edema

Nerve compression

Neuropraxia

Axonomnesis

NeuromnesisFacial palsy

Danner CJ. Facial Nerve Paralysis Otolaryngol Clin North Am 2008; 41(3): 619-32,

Cuadro clínico

Diagnsis

Sudden onset

Unilateral paresis or paralysis of all muscle

groups on one side of the face

Absence of central neurological signs

Absence of otic and cerebropontine

angle pathology

Mattox DE: Clinical Disorders of the Facial nerve. En Cummings CW, Haughey BH, Thomas

JR, Harker LA, Flint PW. Cummings Otolaryngology: Head and Neck Surgery. 2005, 4th Ed.

Mosby. Ch 147 pp 3333-3354.

Stadification

House-Brackmann scale

Benecke JE: Facial Paralysis. Otlolaryngol Clin N Am. 2002; 35:357-365.

I Normal Normal function

II Mild Thorough inspection

III Moderate Obvious with maximum effort

IV Moderately severe Disfigures w/movement

V Severe Disfigures at rest

VI Complete No movement

Treatment

Prednisone 1 mg/kg/day for 7 days.

Antivirals have not shown better

outcomes.

85% full recovery at 2 months.

4% sequels after 6 months.

Danner CJ. Facial Nerve Paralysis Otolaryngol Clin North Am 2008; 41(3): 619-32.

Rehabilitation

Surgical reanimation.

Auricular major N.

Sural N.

Hypoglossal n.

Botox.

Facial excercises.

Danner CJ. Facial Nerve Paralysis Otolaryngol Clin North Am 2008; 41(3): 619-32.

CHINESE

MEDICINE

APPROACH

Definition

Qi and Xue stagnation in channels and colaterals of the face, mainly theyangming system due to invasión of wind and cold.

Zhaofa Z, Ding Z (Editors), Tai W (Translator): Fundament and Clinical Practice of Electroacupuncture. 1994. Beijing Science and Technology Press. Ch 6, pp 185-187.

Mayor DF: Electroacupuncture: An Introduction and its use for Periphereal Facial Paralysis. J Chin Med. 2007. 84: 1-19.

Staging

o Four stages:

- Acute stage: from onset to day 7, symptoms usually progressive.

- Stable stage: day eight to fourteen.

Mayor DF: Electroacupuncture: An Introduction and its use for Periphereal Facial Paralysis. J Chin Med. 2007. 84: 1-19.

Staging

- Convalesence stage: fromday 15 until begining of second month.

- Chronic stage: from month2.

Mayor DF: Electroacupuncture: An Introduction and its use for Periphereal Facial Paralysis. J Chin Med. 2007. 84: 1-19.

ETIOLOGY AND

PATHOPHISIOLOGY

Facial paralysis

Zheng Qi

deficiency

Qi/Xue stagnation on

Jingluo

Poor Qi/Xue circulation on face

Jingluo

Pre existing

phlegm

Liver Qi stagnation

Wind/cold

Couli not compacted

Syndromes

a) Invasion of wind/cold.

b) Jingluo obstuction by wind andphlegm.

c) Internal wind due tu Xuedeficiency.

Zuo Y (Compiler in chief), Zhongbao Z, Yezhong H, Jinwen T, Zhaoguo L (Translators). A Newly Compiled Practical English-Chinese Library of Traditional Chinese Medicine: Chinese Acupuncture and Moxibustion. 2002. Publishing House of Shanghai University of Traditional Chinese Medicine. Ch 5, pp 299-300.Zhaofa Z, Ding Z (Editors), Tai W (Translator): Fundament and Clinical Practice of Electroacupuncture.1994. Beijing Science and Technology Press. Ch 6, pp 185-187.

Ross J: Acupuncture Point Combinations: The Key to Clinical Success. 2005. Churchill Livingstone. Ch 32, pp 426.

Treatment

Acute stage distal points;

local points with shallow

insertion and no

manipulation.

Stable stage local points

with strong stimulation.

Zuo Y (Compiler in chief), Zhongbao Z, Yezhong H, Jinwen T, Zhaoguo L (Translators). A Newly Compiled Practical English-Chinese Library of Traditional Chinese Medicine: Chinese Acupuncture and Moxibustion. 2002. Publishing House of Shanghai University of Traditional Chinese Medicine. Ch 5, pp 299-300.

Prevention

Avoid spicy foods.

Protection from wind

and cold.

Relaxed emotional life.

Zhaofa Z, Ding Z (Editors), Tai W (Translator): Fundament and Clinical Practice of Electroacupuncture.

1994. Beijing Science and Technology Press. Ch 6, pp 185-187.

Ross J: Acupuncture Point Combinations: The Key to Clinical Success. 2005. Churchill Livingstone. Ch 32,

pp 426.

Rehabilitation

Focused on stage 4

local points with strong

stimulation.

Synkinesis (internal wind

and K-H deficiency )

very hard to treat.Zhaofa Z, Ding Z (Editors), Tai W (Translator): Fundament and Clinical Practice of Electroacupuncture. 1994.

Beijing Science and Technology Press. Ch 6, pp 185-187.

Complemetary treatment

methods

Low frequency electro acupuncture

Better results compared with manual acupuncture (not to be used during the first 15 days from onset).

Cupping

Moxibustion

Tuina

Zhaofa Z, Ding Z (Editors), Tai W (Translator): Fundament and Clinical Practice of Electroacupuncture.

1994. Beijing Science and Technology Press. Ch 6, pp 185-187.

Mayor DF: Electroacupuncture: An Introduction and its use for Periphereal Facial Paralysis. J Chin Med.

2007. 84: 1-19.

Zuo Y (Compiler in chief), Zhongbao Z, Yezhong H, Jinwen T, Zhaoguo L (Translators). A Newly Compiled

Practical English-Chinese Library of Traditional Chinese Medicine: Chinese Acupuncture and Moxibustion.

2002. Publishing House of Shanghai University of Traditional Chinese Medicine. Ch 5, pp 299-300.

Points to use

Houxi

- Location:

At the ulnar side of the hand, at the

depression proximal to the head of the

5th metacarpal, between the two skins.

Deadman P, Al-Khafaji M, Baker K: A Manual of Acupuncture. 1998. Journal of Chinese

Medicine Publications. Ch 11, pp 233-234.

Points to use

Houxi

- Actions:

Benefits the nape, neck and back,activates the cannel and relievespain, disperses wind and hot, calmsthe spirit and treats epilepsy, clearsheat and benefits sense organs,regulates Du Mai.

Deadman P, Al-Khafaji M, Baker K: A Manual of Acupuncture. 1998. Journal of Chinese

Medicine Publications. Ch 11, pp 233-234.

Points to use

Shenmai

- Location:

On the lateral aspect of the foot, 0.5 cun

inferior to the inferior border of the

external maleolus, at a depression

posterior to the fibular tendons.

Deadman P, Al-Khafaji M, Baker K: A Manual of Acupuncture. 1998. Journal of Chinese Medicine

Publications. Ch 11, pp 320-322.

Points to use

Shenmai

- Actions:

Pacifies internal wind and expells external

wind, calms the mind and treats epilepsy,

benefits the head and eyes, opens and

regulates Yang Qiaomai, activates the

cannel and aleviates pain.

Deadman P, Al-Khafaji M, Baker K: A Manual of Acupuncture. 1998. Journal of Chinese Medicine

Publications. Ch 11, pp 233-234.

Material and methods

Inclusion criteria:

Patients between 18 and 70 years old

attending to the acupuncture clinic of

the ENMyH, with periphereal facial

paralysis.

Material and methods

Exclusion criteria:

Central facial paralysis.

Periphereal facial paralysis of known

cause.

Repetition paralysis.

Evolution greater than two months.

Material and methods

Elimination criteria:

Patients who wished to abandon the

study.

Patients who did not completed at least

80% of sessions.

Material and methods

Variables:

Independent: acupuncture at

Houxi (ID3) and Shenmai (V62).

Dependent: staging according to

House- Brackmann scale.

Material and methods

Technique:

Patient lying on his back.

Needle insertion at the proposed points with monomanual bidigitaltechnique, starting with Shenmai(V62), then Houxi (ID3) on the affected side.

Material and methods

Wind dispersing manipulation

technique at Shenmai (V62).

Cold dispersing technique at

Houxi (ID3).

Needle retention for 30 min,

manipulation at 0, 15 and 30

min.

Material and methods

A total of 3 weekly sessions

during 3 consecutive weeks

with weekly staging

according to House-

Brackmann scale.

RESULTS

A total of 18 patients, 10

female and 8 male, 15 of them

met inclusion criteria. Thirteen

completed the three week

treatment course.

RESULTS

46%

54%

Sex distribution

female

male

Male: 8; female: 7

RESULTS

46%

54%

Laterality

right left

Left: 8; right: 7

RESULTS

10

2

3

0

2

4

6

8

10

12

< 2 weeks < 1 month < 2 months

Time of onset

RESULTS

1

4 4

2

3

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

21-30 31-40 41-50 51-60 61-70

Age distribution

RESULTS

7

6

1 1

0

1

2

3

4

5

6

7

8

VI V IV III

Initial stage

Name Age Sex Time Side W0 W1 W2 W3

MIR 48 F 5 d L IV III I I

AMG 38 M 4 d R V III II I

ETJ 69 M 2 m R V IV IV IV

VGG 59 M 2 m R V IV III III

MEF 42 M 9 d R VI III II I

JGS 50 F 7 d L VI IV III III

CCP 66 F 9 d R VI V V IV

JLA 36 M 3 d R III I I I

IIS 34 M 8 d L VI V IV III

MZR 45 M 1 m R VI V V V

SST 60 M 2 m L V IV III III

RTM 30 F 3 s L VI V III -

PGF 68 F 7 d L VI V IV -

GHA 50 F 8 d L V IV III III

AGA 29 F 9 d R V IV II I

RESULTS

All of the patients diminished one stage

according House-Brackmann scale at the

end of week one.

Recovery percentage at week 1 of

25.42% (p<0.05).

RESULTS

At the end of week 3, 5 patients

(33.3%) were fully recovered, all of

them had less tan 10 days of

evolution.

Total improvement percentage

was 52% (p < 0.05)

CONCLUSIONS

Acupuncture at Shenmai (V62) and

Houxi (ID3) has a beneficial effect

on patients with acute or sub acute

Bells palsy and should be

considered as an adjuvant to

conventional therapy.