There apparently was a reason Angelina Jolie, one of the most famous women in the world, stayed out of sight for a time last year.
The actress had developed a condition called Bell’s palsy, which results in facial paralysis.
Jolie made the surprise announcement last week that she had developed the condition while separating from her husband, actor Brad Pitt.
“Sometimes women in families put themselves last,” Jolie told Vanity Fair, “until it manifests itself in their own health.”
By sharing her story, Jolie spotlighted a condition that affects about 1 in 60 people during their lifetime.
Here’s key information on the condition and what doctors have to say about how to cure it.
What causes Bell’s palsy?
Bell’s palsy is a form of facial paralysis that results from trauma or damaged facial nerves.
“The most commonly affected muscles are closure of the eye and half the smile so the patient is unable to close their eye or smile on half their face,” said Dr. David Simpson, director of the neuromuscular division in the Department of Neurology at Mount Sinai Hospital in New York. “They end up looking like someone with a crooked face.”
A facial nerve, called the 7th cranial nerve, travels through a narrow, bony canal in the skull. The nerve controls sensation and helps move tiny muscles in the face.
If the nerve is damaged and stops functioning it can cause the face to droop. It can also affect tear ducts and taste sensations from the tongue.
It was named after the Scottish surgeon Sir Charles Bell, who figured out what the facial nerve did and how it was connected to facial paralysis.
Currently, doctors believe viral infections can kick-start inflammation and cause the nerve to swell and become damaged.
But, Bell’s palsy has also been associated with headaches, chronic middle ear infections, high blood pressure, diabetes, tumors, and Lyme disease, among other things, according to the National Institute of Neurological Disorders and Stroke (NINDS).
Jolie told Vanity Fair that she developed hypertension, (high blood pressure) last year, and also mentioned stress.
Simpson said stress is associated with the condition, but it’s not clear that it can actually cause the condition to develop or if it’s a coincidence.
Usually people with the condition start to recover within two weeks, with full normal function returning three to six months later, according to the NINDS.
For people who have long-term symptoms other issues like spasms can develop. In rare cases, people can develop a condition called synkinesis, where facial muscles may move in tandem. For example, a person may smile and blink at the same time involuntarily.
How is it treated?
The standard treatment for Bell’s palsy is steroids and antiviral medication, according to Simpson.
“Those two medicines are best instituted in the first couple of days of the Bell's palsy and given for fairly short periods for seven to 10 days,” said Simpson.
Physical therapy can also be done to try and minimize the duration of the facial paralysis.
Jolie told the magazine that she credited acupuncture with helping her recover.
Simpson said there isn’t a lot of solid evidence on how effective acupuncture is at diminishing symptoms.
“There have been some research studies, and there is some relatively weak evidence that acupuncture may help,” Simpson said.
One published analysis examined 14 studies that investigated acupuncture treatment for Bell’s palsy. The research authors found that people in those studies who received the acupuncture treatment did better and had fewer symptoms than those who did not receive the treatment.
However, the analysis authors warned that many of the studies they reviewed had poor methodology, and more research is needed.
Simpson said while there is not good evidence that acupuncture helps, there’s also little risk associated with having it done.
“Since the risk is quite low, if the patient is interested in acupuncture that is perfectly OK,” he said.
For patients who have symptoms months to years after initial onset, there are other more invasive options including Botox injections and surgery to help fix the appearance of drooping.
Who is at risk?
Bell’s palsy affects approximately 40,000 people in the United States every year, mainly between the ages of 15 to 60.
Men and women are affected about equally.
Many people may think they’re having a stroke when they develop the facial droopiness, but a stroke will also lead to weakness on the side where the face is drooping.