From the Guidelines
Recurrent Bell's palsy is associated with Giant Cell Arteritis (GCA) and Polymyalgia Rheumatica (PMR), which are interlinked conditions that frequently overlap [ 1 ].
Key Rheumatologic Causes
- Giant Cell Arteritis (GCA): a medical emergency that requires immediate treatment due to the risk of sight loss and other ischemic events [ 1 ]
- Polymyalgia Rheumatica (PMR): often occurs as a symptom of relapse in GCA, and people with PMR who have recurrent relapses may have underlying GCA [ 1 ]
Management
In patients with GCA-associated Bell's palsy, immediate treatment with corticosteroids is crucial to reduce the risk of sight loss and other complications [ 1 ]. A multidisciplinary collaboration involving specialists such as ophthalmologists, neurologists, and vascular surgeons may be necessary to manage the condition [ 1 ].
Treatment Approach
A treat-to-target (T2T) strategy should be employed in the management of GCA and PMR, with regular evaluation of patients by an expert to ensure early recognition of a possible GCA/PMR overlap [ 1 ].
From the Research
Rheumatologic Causes of Recurrent Bell's Palsy
The rheumatologic causes of recurrent Bell's palsy can be attributed to various factors, including:
- Autoimmune disorders, such as rheumatoid arthritis, which may increase the risk of developing Bell's palsy 2
- Systemic comorbidities, including diabetes, hypertension, and hypothyroidism, which have been identified as significant risk factors for recurrence 3
- Melkersson-Rosenthal syndrome, a rare neuromucocutaneous syndrome characterized by recurrent facial paralysis, fissured tongue, and orofacial edema 4
Associated Factors and Outcomes
Studies have shown that:
- Recurrence of Bell's palsy is more likely to occur in patients with a family history of the condition, and in those who experience complete recovery from the initial episode 3, 4
- The severity of initial paralysis can influence recurrence rates, with more severe cases being more likely to recur 3
- Ipsilateral and alternative palsies have different characteristics, with ipsilateral palsy being more common in younger patients and alternative palsy being more common in older patients 5
Treatment and Management
While the treatment of Bell's palsy typically involves oral corticosteroids, the use of high-dose versus standard-dose corticosteroids has been debated, with some studies suggesting a favorable effect of high-dose corticosteroids in reducing nonrecovery rates 6 However, the relationship between rheumatoid arthritis and Bell's palsy was not found to be significant in one study 2.