Recurrent facial palsy is relatively rare, and its clinical features are not well known. The authors set out to investigate this further by undertaking a retrospective study of patients with recurrent facial palsy over a 14-year period. Only Bell’s palsy or Varicella Zoster Virus (VZV)-related facial palsy patients were included. Recurrent facial palsy was observed in 104 out of 1243 patients (8.4%). Among the 104 patients, 89 (85.6%) had Bell’s palsy and 15 (14.4%) had VZV-related palsy, 35 patients (34%) had ipsilateral recurrent facial palsy and 69 (66%) had alternative facial palsy. Alternative facial palsy was defined as more than one occurrence of facial palsy on each side. The mean age of patients in the ipsilateral group was significantly younger than that of the alternative group (38.9 vs. 48.4 years). The number of recurrences ranged from one to three in the ipsilateral group, and one to four in the alternative group. Among the ipsilateral group, six patients experienced more than second recurrence. In two cases, the condition failed to resolve after the second recurrence. There were four cases of recurrent VZV-related paralysis in both initial and recurrent cases. All four cases were zoster sine herpete (ZSH) initially. The authors hypothesised that the reason for the higher age of the first onset of palsy in the alternative group might be due to reduction of HSV-1 immunity with age. Moreover, their results suggested that more than two ipsilateral recurrent episodes could be a risk factor for incomplete recovery. In terms of VZV-related palsy in both initial and recurrent cases, the authors felt that ZSH does not confer strong VZV-specific immunity and suggested VZV vaccinations for ZSH patients to prevent further recurrence of VZV-related facial palsy. The authors acknowledge that further research is required to investigate their hypotheses.
Recurrent facial palsy
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