The Efficacy of Acupuncture in the Treatment of Bell's Palsy Sequelae
Öksüz et al. · Journal of Acupuncture and Meridian Studies · 2019
Evidence Level
MODERATEOBJECTIVE
To evaluate the efficacy of acupuncture in the treatment of Bell's palsy sequelae
WHO
40 patients with Bell's palsy of at least 3 months' duration
DURATION
12 sessions over 4 weeks
POINTS
25 needles per session including ST-2, ST-6, TE-17, Ex-HN5, and systemic points
🔬 Study Design
Acupuncture
n=20
Electroacupuncture and Nogier auriculotherapy
Control
n=20
Waiting list, no treatment
📊 Results in numbers
Improvement in CMAP amplitude in the acupuncture group
Significant improvement on HB and SB scales in both groups
Higher improvement rate in the acupuncture group
Patients with functional improvement — acupuncture
Patients with functional improvement — control
Percentage highlights
📊 Outcome Comparison
Functional improvement rate
This study shows that acupuncture can help people who still have symptoms of Bell's palsy after initial treatment. Patients who received acupuncture were more likely to improve than those who received no additional treatment.
Article summary
Plain-language narrative summary
This randomized controlled trial investigated the efficacy of acupuncture in the treatment of Bell's palsy sequelae, a condition that affects the facial nerve and causes weakness or paralysis of the muscles on one side of the face. Although most cases of Bell's palsy resolve spontaneously within three weeks, some patients develop permanent sequelae such as paresis, contracture, facial spasm, or synkinesis. The study was conducted at Karadeniz Technical University in Turkey and involved 40 patients who had Bell's palsy sequelae of at least three months' duration after initial diagnosis. The participants were randomized into two groups: 20 received acupuncture treatment, and 20 were maintained on a waiting list as the control group.
The acupuncture protocol included electroacupuncture and Nogier auriculotherapy, with 25 needles inserted per session at specific points such as ST-2, ST-6, TE-17, and Ex-HN5 on the affected side, in addition to systemic points. Treatment was performed three times a week over four weeks, totaling 12 sessions. Assessment was performed using electromyography measuring the compound motor action potential of the facial nerve and the House-Brackmann and Sunnybrook functional scales. The results showed significant improvement in the acupuncture group compared with the control.
The compound motor action potential improved significantly only in the acupuncture group (p = 0.036), indicating recovery of nerve function. Both groups showed improvement on the functional scales, but the acupuncture group showed a significantly higher rate of improvement (p = 0.011). Specifically, 75% of patients in the acupuncture group showed functional improvement compared with only 35% in the control group. The proportion of patients with severe paralysis (House-Brackmann grade III or worse) decreased from 45% to 5% in the acupuncture group, while in the control group it decreased from 35% to 20%.
No treatment-related adverse events were observed. Agreement analysis between the House-Brackmann and Sunnybrook scales showed acceptable concordance, validating the assessment instruments used. The limitations include the relatively small sample size, the impossibility of blinding due to the nature of the intervention, and the limited follow-up period. The study contributes to the evidence that acupuncture may be a safe and effective therapeutic option for Bell's palsy sequelae, especially when conventional treatments are insufficient.
The authors suggest that acupuncture may be considered as complementary therapy for patients with persistent sequelae, offering a non-pharmacological approach with the potential to improve facial function and quality of life in these patients.
Strengths
- 1Randomized controlled trial with appropriate methodology
- 2Objective evaluation through electromyography
- 3Use of validated scales for facial function
- 4Well-defined acupuncture protocol based on the literature
- 5No adverse events observed
Limitations
- 1Small sample size (n = 40)
- 2Impossibility of blinding participants
- 3Follow-up period limited to 4 weeks
- 4Waiting-list control group may have ethical limitations
- 5Need for replication in larger studies
Expert Commentary
Dr. Marcus Yu Bin Pai
MD, PhD · Pain Medicine · Physical Medicine and Rehabilitation · Medical Acupuncture
▸ Clinical Relevance
Sequelae of Bell's palsy represent a real challenge in the rehabilitation clinic: the patient who has gone through the acute phase, received adequate corticosteroid therapy, and still carries paresis, synkinesis, or contractures months later. It is precisely in this window — at least three months after initial diagnosis — that this work is situated, making it directly applicable to our usual caseload. The protocol evaluated combines electroacupuncture at facial points on the affected side with Nogier auriculotherapy across 12 sessions over four weeks, a structure that is logistically feasible in rehabilitation services. For the clinician who treats this population, the most relevant data point is the objective improvement in the compound motor action potential of the facial nerve, confirming that the effect is not limited to the patient's subjective perception. Acupuncture positions itself here as an adjuvant to the already available arsenal — facial physical therapy, biofeedback, and botulinum toxin for synkinesias — expanding the options for cases that have not achieved satisfactory functional recovery.
▸ Notable Findings
The finding that most stands out is not the improvement on clinical scales — expected to some degree from late spontaneous recovery — but the divergence between groups on electroneuromyography: only the acupuncture group showed significant improvement in the CMAP amplitude of the facial nerve (p = 0.036), suggesting accelerated axonal regeneration or remyelination rather than simply compensatory functional adaptation. Added to that, the proportion of patients with severe grade on the House-Brackmann scale dropped from 45% to only 5% in the treated group, against a reduction from 35% to 20% in the control group — a clinically expressive difference over four weeks. The fact that both groups improved on the functional scales reinforces the presence of ongoing spontaneous recovery, but the significantly higher rate of improvement in the acupuncture group (p = 0.011) and the 75% functional response rate versus 35% in the control indicate a real therapeutic effect, not merely temporal.
▸ From My Experience
In my practice with peripheral facial neuropathy sequelae, I typically see the first perceptible responses between the fourth and sixth session — the patient reports reduced asymmetry when smiling or less morning stiffness on the affected hemiface. The protocol in this study, with three weekly sessions over four weeks, is compatible with what I adopt in service, although I usually extend it to 16 to 20 sessions in cases with established synkinesis, where I combine botulinum toxin in hyperactive groups before initiating needling. I have observed that patients with three to twelve months of involvement respond better than those with very consolidated sequelae beyond two years, possibly due to greater axonal plasticity in this window. When there is an associated pain component — postherpetic neuralgia or periorbital myofascial pain — I combine distal points such as LI-4 and ST-36 with the facial protocol, which improves adherence. Cases with very severe paralysis and absence of electrical conduction on baseline CMAP are those that offer the lowest prognosis of response, and I prefer to communicate this to the patient from the outset.
Full original article
Read the full scientific study
Journal of Acupuncture and Meridian Studies · 2019
DOI: https://doi.org/10.1016/j.jams.2019.03.001
Access original articleScientific Review
Marcus Yu Bin Pai, MD, PhD
CRM-SP: 158074 | RQE: 65523 · 65524 · 655241
PhD in Health Sciences, University of São Paulo. Board-certified in Pain Medicine, Physical Medicine and Rehabilitation, and Medical Acupuncture. Scientific review and curation of every entry in this library.
Learn more about the author →Medical disclaimer: This content is for educational purposes only and does not replace consultation, diagnosis, or treatment by a qualified professional. Some information may be assisted by artificial intelligence and is subject to inaccuracies. Always consult a physician.
Content reviewed by the medical team at CEIMEC — Integrated Centre for Chinese Medicine Studies, a reference in Medical Acupuncture for over 30 years.
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