Background: There are limited clinical and epidemiological data on patients diagnosed with Bell’s palsy. While investigating an apparent clustering of Bell’s palsy, we sought to characterize the spectrum of illness in patients with this diagnosis. Methods: A telephone survey of persons with idiopathic facial (Bell’s) palsy in the Greater Toronto Area (GTA, population = 4.99 million) and Nova Scotia (population = 0.93 million) from August 1 to November 15, 1997 collected information on subject demographics, neurological symptoms, constitutional symptoms, medical investigation and management. Information regarding potential risks for exposure to infectious agents, past medical history, and family history of Bell’s palsy was also collected. Subjects with other secondary causes of facial palsy were excluded. Results: In the GTA and Nova Scotia, 222 and 36 patients were diagnosed with idiopathic facial (Bell’s) palsy, respectively. The crude annualized incidence of Bell’s palsy was 15.2 and 13.1 per 100,000 population in the GTA and Nova Scotia, respectively. There was no temporal or geographical clustering, and symptomatology did not differ significantly between the two samples. The mean age was 45 years, with 55% of subjects being female. The most common symptoms accompanying Bell’s palsy were increased tearing (63%), pain in or around the ear (63%), and taste abnormalities (52%). A significant number of patients reported neurological symptoms not attributable to the facial nerve. Conclusion: No clustering of cases of Bell’s palsy was observed to support an infectious etiology for the condition. Misdiagnosis of the etiology of facial weakness is common. Patients diagnosed with Bell’s palsy have a variety of neurological symptoms, many of which cannot be attributed to a facial nerve disorder.

We present three patients with atypical chronic inflammatory demyelinating polyradiculoneuropathy and discuss the management of patients who appear treatment resistant or present with unusual manifestations. The clinical features of the patients included massive nerve root hypertrophy causing myelopathy and movement-provoked paresthesia, pupillary dysfunction, visual loss due to increased intracranial pressure, and focal brachial plexus involvement. Each patient ultimately required prolonged courses of immune modulating therapy before benefit was attained, illustrating the importance of intensive and prolonged treatment combined with objective assessment of response to therapy.

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