Surge of Bell's Palsy in the era of COVID‐19: Systematic review

Abstract

Background and purpose With the progression of coronavirus infectious disease 2019 (COVID‐19), various neurological manifestations have been noticed in infected patients, and Bell's Palsy (BP) is one of the peripheral neuropathies among those. BP has been associated with various other viral agents. Its evidence in patients with COVID‐19 signifies the possibility of association between BP and severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). This research was undertaken to evaluate the number of published cases of BP as the only major neurological manifestation in patients with COVID‐19 from March 2020 to December 2021 and to investigate the association of SARS‐CoV‐2 and BP. Methods A systematic review of the published English literature was performed using an electronic search in the PubMed/Medline, Scopus, Research Gate, Research Square, and Google Scholar databases, using keywords such as "COVID‐19" OR/AND "SARS‐CoV‐2" OR/AND "Bell's palsy" OR/AND "facial nerve palsy" OR/AND "neurological" OR/AND "manifestation". Results The search strategy revealed 32 relevant publications with a total of 46 patients. BP was the initial manifestation in 37% of cases, and in 63% of cases it developed after COVID‐19 symptoms; 71.7% of cases showed complete recovery, and 21.7% showed only partial relief from BP. Conclusions Although the number of documented cases in this research is low, evidence of BP as the only major neurological manifestation in patients with COVID‐19 signifies an important clinical finding and the possibility of another viral etiology of BP. More evidence is needed to establish the exact correlation between these two entities.

Facial Palsy in COVID-19 Patient: A Case Report

“…Administration of corticosteroid early within 3 days of the onset of symptoms have a positive outcome and speedy recovery. 3 , 5 In our patient prednisolone 30 mg was started and was gradually tapered after which the patient's symptoms started to improve.…”

“… 3 , 4 The aetiology of Bell's palsy is mostly unknown; however, viral infections such as Herpes Simplex Virus (HSV-1) and Herpes Zoster Virus (HZV) are seen to be associated with it. 4 , 5 Recent studies have shown emerging cases of bell palsy in patients with COVID-19 infection. According to a study done out of 348088 COVID-19 infected patients, 153 patients had new onset of Bell's palsy.…”

“…During COVID-19 infection, there is a surge in proinflammatory cytokines resulting in a cytokine storm which damages the blood-brain barrier (BBB) and activates glial cells resulting in neuroinflammation and functional disruption. 5 , 9 , 10 These mechanisms can impair and damage facial nerves resulting in bell's palsy.…”

Investigation of Neurological Complications after COVID-19 Vaccination: Report of the Clinical Scenarios and Review of the Literature

“…The actual mechanism of Bell’s palsy after vaccination is unclear. Cytokine storm and direct invasion were the possible mechanisms that made SARS-CoV-2 the possible etiology of Bell’s palsy [ 25 ]. A sponsor (Pfizer) of the FDA’s Vaccines and Related Biologic Products Advisory Committee raised the possibility of innate immune activation from a combined effect of mRNA and lipids [ 26 ].…”

SARS-CoV-2 Neuroinvasion, Inflammatory Neurodegeneration and Alzheimer's Disease

“…Early in the COVID-19 pandemic it was also noted that many patients, during or after COVID-19 infection over the "short term" complain of a general malaise and extra-respiratory neurological symptoms including confusion, delirium, headache, mental and psychiatric disorders, disorders in mood (depression and dysthymic disorder), disturbances in sleep (insomnia), cognitive and memory impairment, "brain fog", deficiency in smell (anosmia) or taste (ageusia), muscle weakness and myalgia, sensorimotor deficits, dysautonomia as well as convulsions and/or peripheral neuropathies that include Bell's palsy and peripheral neuropathies with pain (Gupta and Jawanda, 2022;Lingor et al, 2022;Stefanou et al, 2022). COVID-19 associated ocular manifestations have been also documented to include a wide range of ophthalmic symptoms associated with eye irritation (chemosis), conjunctivitis, conjunctival hyperemia, anterior uveitis, retinitis, and optic neuritis and in advanced COVID-19 infection with visual and perception disturbances including visual disorientation and hallucinations, especially in elderly COVID-19 patients (Hill et al, 2021;Hixon et al, 2021;Lin et al, 2021;Reinhold et al, 2021;Al-Namaeh, 2022;Lukiw, 2022a,b).…”