The History of Bell's Palsy, Facial Paralysis on One Side of the Face

Ryan Fan Charles Bell, photo from Granger on Public Domain

As a teacher, I have heard multiple students and parents talk about Bell’s palsy and the potential to get facial paralysis on one side of the face from the COVID-19 vaccine. Before we move forward, it’s important to note there’s no evidence the COVID-19 vaccine causes Bell’s palsy, and in FDA trials of both the Moderna and Pfizer vaccines, the FDA said:

“The observed frequency of reported Bell’s palsy in the vaccine group is consistent with the expected background rate in the general population.”

Part of the misinformation stems from a viral video of an alleged registered nurse in Tennessee named Khalilah Mitchell, who says she got Bell’s palsy from the vaccine. Mitchell urges people not to take the vaccination. However, the Tennessee Department of Health said no registered nurse by that name was in the health professional licensure system. The Associated Press also says there is no link between Bell’s palsy and the COVID-19 vaccine.

Fighting misinformation is important, especially during a global pandemic. Before the start of the week, I didn’t even know what Bell’s Palsy was. So why not dive deep into the history behind the condition?

According to Johns Hopkins Medicine, Bell’s palsy is an episode of facial muscle weakness or paralysis and begins and worsens over 48 hours. It results from damage to a facial nerve called the 7th cranial nerve and usually affects only one side of the face. The people most likely to get Bell’s palsy are pregnant women with diabetes, influenza, or any other upper respiratory ailment, and it usually disappears.

However, there is no cure for Bell’s palsy and recovery begins two weeks after the onset of symptoms, with most people recovering full facial expression. The cause is not known, but in rare cases, Bell’s palsy does not disappear.

First discoveries

According to Sajadi et al. in a 2011 paper in Neurology, Bell’s palsy is named after Sir Charles Bell, a Scottish doctor and surgeon in the 19th century. In 1821, Bell described the anatomy of the facial nerve and its “association with the unilateral facial palsy that bears his name.”

However, Bell was not the first to discover the facial paralysis. Other Greek, Roman, and Persian physicians distinguished a facial muscle spasm from having a paralyzed face. In particular, a 9th-century Persian physician named Razi described the facial distortion in the most detail.

The descriptions of the facial distortion were first told by early Greek and Roman physicians. Hippocrates once said in Prorrhetics II, a 5th century B.C.E. book:

“Distortions of the face, if they coincide with no other disorder of the body, quickly cease, either spontaneously or as the result of treatment. Otherwise there is paralysis.”

Other Greek and Roman physicians came close to describing classic facial palsy.

Razi, also known as Abu Bakr Muhammad ibn Zakariya Razi, lived from 865–925 CE. He lived in Samanid-era Persia and was born close to the city of Rey, which is close to Tehran, Iraq. He practiced between Rey and Baghdad and placed a lot of regard for his ethical behavior in medicine and his other activities.

“He made a point of providing detailed references and being even-handed and was well-known for being meticulous in citing work that was not his own,” Sajadi et al. wrote.

In the book al-Hawi, he made observations on facial muscle disorders, starting with facial spasm and paralysis. Razi made sure to differentiate facial paralysis from spasm, and even described a clinical method for differentiating spasms and paralysis: is there pain? There is pain during a spasm, but no pain during a paralysis. Razi also described a loss of wrinkling on the forehead and affected side, which according to Sajadi’s group, is the first description “of the loss of wrinkling that is currently used to distinguish peripheral from central seventh nerve palsy.”

Razi noted that paralysis didn’t affect the distorted side of the face. Rather, it affected the opposite side. He also made sure to differentiate the more serious lesions in the brain. If a patient had a central lesion that led to difficulty moving the body or limbs, he recommended immediate treatment. Facial distortions do not result from central brain lesions, and Razi said that a patient was at risk of death if symptoms included a loss of vision or hearing.

He said most cases of facial palsy and spasms recovered naturally, but treatment included warming oils, warm compresses, massages until the “skin turns red,” laxatives, and an application of a bandage to the distorted area. He also recommended less exposure to light, with a patient resting in a warm dark room.

“I have seen more than one case of facial distortion in which the patient in no way rested at home, did not stay in the dark, continued doing their daily routine, and got better,” Razi said.

After Razi

The next known comprehensive description of Bell’s palsy is that of Cornelis Stalpart van der Wiel, who hailed from The Hague, The Netherlands, who described the facial paralysis in 1683. According to van de Graaf and Nicolai in a 2005 paper in Otology & Neurotology, Stalpart van der Wiel credited Persian physician, Ibn Sina, for a previous discovery of Bell’s palsy. Stalpart van der Wiel called the distortion “a twisting of the mouth or one-sided spasm of the mouth.”

Van der Graaf and Nicolai argue that Stalpart should have “priority of being the first to describe Bell’s palsy,” but speculate that earlier accounts than Stalpart’s would be discovered. Throughout the paper, Stalpart van der Wiel describes the symptoms of peripheral facial analysis and its spontaneous recovery within weeks. Stalpart van der Wiel also developed a treatment of antirheumatic ointments and medicines for the treatment, which were later used by other physicians, Nicolaus Anton Friedreich and James Douglas.

Of course, Charles Bell, the namesake for the distortion, coined the name for the affliction in an 1821 paper to the Royal of London titled On the Nerves: Giving an Account of some Experiments on Their Structure and Functions, Which Lead to a New Arrangement of the System. Throughout his life, Bell had a career in both teaching and clinical practice and was a Professor of Anatomy and Surgery at the Royal College of Surgeons. Afterward, he was elected a Professor of Physiology at the University of London.

In the 1821 paper, Bell found the long thoracic nerve, a motor nerve that innervates the serratus anterior muscle. Another name for the long thoracic nerve today is the external respiratory nerve of Bell, and in the same paper, Bell showed the importance of the seventh cranial nerve in controlling muscles of facial expression. Lesions to this nerve result in facial paralysis (Bell’s palsy).

Present-day Chretien — photo from Michael Ignatieff on Flickr

Bell’s palsy has made it back into the media due to misinformation about its link to the COVID-19 vaccine, but the general incidence of Bell’s palsy is in 1 to 4 per 10,000 people per year. About 1.5% of people are affected by it in their lifetime.

A particularly high profile case of Bell’s palsy was during the 1993 Canadian federal election. The Progressive Conservative Party (Tories) produced a variety of attack ads on Jean Chrétien, the leader of the Liberal party. According to Gordon Donaldson, author of The Prime Ministers of Canada, the attack ad showed a picture of Chrétien’s face when he suffered from Bell’s palsy and asked: “Is this a Prime Minister?” Although the ad never directly insults his face, the chosen pictures are intended to embarrass Chretien based on his facial deformity.

One line of the ad says: “I would be very embarrassed if he became Prime Minister of Canada.”

From llehman84 on YouTube

Chretien and his party would later call the ads a new low for the Progressive Conservative Party. Chretien had a permanent form of Bell’s palsy, ever since suffering from it as a child.

As a politician, however, Chretien unleashed dramatic speeches to gain voters’ affection, and make a counterattack towards the Tories:

“They tried to make fun of the way I look. God gave me a physical defect. And I have accepted that since I was a kid. It’s true that I speak on one side of my mouth. I’m not a Tory, I don’t speak from both sides of my mouth.”

In Canadian radio shows across the country, many voters, especially many who suffered from Bell’s palsy, called into shows about their own experiences with Bell’s palsy and proclaim they were definitely not going to vote for the Tories. Many Progressive Conservative members of the party issued public statements of apology, going against their own party. One politician on the Tory side even called it a caricature and said it was putting a distance between himself and his political party. The sitting Prime Minister, Kim Campbell, also rebuked the ads and decided to pull the second attack ad, less than 24 hours after it premiered.

While the effects of the ads and the reactions to them aren’t quantified, the Liberal party and Chretien won a majority, winning 177 out of 295 seats in the Canadian Parliament. More than half of the Canadian electorate changed parties from the 1988 election, and Chretien would be the Prime Minister until he retired from politics.

The Progressive Conservatives would never recover. They would lose almost 3.5 million votes and lose 167 out of 295 seats in the Canadian Parliament. The party won only two seats and lost its official party status. They would dissolve as a party in 2003, merging with the Canadian Alliance to form the Conservative Party of Canada.

Bell’s palsy is a facial distortion and condition that has been around for a long time, but in this day and age, combating misinformation is incredibly important. Although the FDA has recommended tracking vaccine patients for facial paralysis, there is no evidence there is a causal relationship between either vaccine and Bell’s palsy. In fact, the incidence rate in the vaccine clinical trial groups was lower than that of the general population, and an indication that much of the fear about Bell’s palsy is misguided and misinformed.

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