Acupuncture for the sequelae of Bell's palsy: a randomized controlled trial
Kwon et al. · Trials · 2015
Evidence Level
MODERATEOBJECTIVE
To investigate the efficacy of acupuncture in treating sequelae of Bell's palsy that persist beyond 6 months from symptom onset
WHO
39 patients with Bell's palsy sequelae for at least 6 months
DURATION
8 weeks of treatment with follow-up
POINTS
12 points including ST-4, ST-6, ST-1, EX-HN4, TE-23, LI-20, TE-17, ST-9, LI-10, LI-4, ST-36, GB-34
🔬 Study Design
Acupuncture
n=26
Acupuncture 3x/week for 8 weeks
Waiting list
n=13
No treatment for 8 weeks
📊 Results in numbers
Improvement in FDI social score
Improvement in FDI physical function
Improvement in Sunnybrook scale
Reduction in facial stiffness
📊 Outcome Comparison
Facial Disability Index - Social
Facial Disability Index - Physical
This study showed that acupuncture can help people who continue to have facial problems after Bell's palsy, even months after the condition begins. The treatment improved both physical and social aspects of patients' quality of life.
Article summary
Plain-language narrative summary
This randomized controlled trial investigated the efficacy of acupuncture in treating the sequelae of Bell's palsy, a condition that affects approximately 30% of patients who do not recover completely within the first 6 months after onset of facial paralysis. Bell's palsy is a condition that causes sudden, idiopathic facial paralysis, affecting 30 in every 100,000 individuals per year. Although most patients recover within 6 months, persistent sequelae include unrecovered paresis, contractures of the facial muscles, facial spasms, and synkinesis, causing significant social and physical impact on quality of life. The study was conducted at Kyung Hee University Hospital of Korean Medicine in Seoul, Korea, between August 2010 and July 2011.
Investigators recruited 39 participants with Bell's palsy sequelae of at least 6 months' duration, randomizing them into two groups: 26 to the acupuncture group and 13 to the waiting-list group. The acupuncture protocol involved 18 needles inserted into 12 specific points, including local facial points such as ST-4, ST-6, ST-1, EX-HN4, TE-23, and LI-20, as well as systemic points such as TE-17, ST-9, LI-10, LI-4, ST-36, and GB-34. Treatments were performed three times per week for 8 weeks, for a total of 24 sessions. Needles were retained for 10 minutes with manual manipulation to elicit the qi sensation.
The primary outcome was the change in social score of the Facial Disability Index (FDI) at 8 weeks. Secondary outcomes included the FDI physical score, House-Brackmann grade, Sunnybrook facial nerve grading system, lip mobility, and stiffness scales. Results demonstrated significant improvements in the acupuncture group compared with the control group. At week 8, the acupuncture group showed greater improvement in FDI social score (mean difference 23.54 points), better physical function (difference 21.54 points), higher score on the Sunnybrook system (difference 14.77 points), and significant reduction in facial stiffness (difference -1.58 points).
Six of the nine participants in the acupuncture group with moderately severe to severe dysfunction (House-Brackmann grade 4-5) improved to mild-to-moderate levels (grade 2-3) at 8 weeks, a statistically significant within-group change. The study demonstrates that acupuncture may have beneficial effects on both physical and social aspects of Bell's palsy sequelae. The focal effects of acupuncture on paralysis may be attributable to local effects of stimulation of nerve fibers in skin and muscle, while psychosomatic effects on autonomic nervous system regulation may contribute to improvements in other outcomes. Limitations include the relatively small sample size and the inability to blind participants due to the use of a waiting-list control group.
The absence of serious adverse events strengthens the safety profile of acupuncture. This study represents the first randomized controlled evidence of acupuncture efficacy specifically for Bell's palsy sequelae, suggesting that acupuncture may be a viable therapeutic option for patients with this challenging condition, where conventional medical options are limited.
Strengths
- 1First RCT focused specifically on Bell's palsy sequelae
- 2Well-defined acupuncture protocol based on TCM principles
- 3Multiple validated assessment instruments
- 4Good protocol adherence with a 15% dropout rate
- 5Excellent safety profile with no serious adverse events
Limitations
- 1Small sample size (n=39)
- 2Inability to blind participants
- 3Use of waiting list as control instead of sham acupuncture
- 4Lack of long-term follow-up
- 5Restrictive inclusion criteria may limit generalizability
Expert Commentary
Dr. Marcus Yu Bin Pai
MD, PhD · Pain Medicine · Physical Medicine and Rehabilitation · Medical Acupuncture
▸ Clinical Relevance
Bell's palsy sequelae represent a genuine clinical challenge: roughly 30% of patients do not recover full facial function within six months, and the conventional therapeutic armamentarium for this chronic phase is notoriously limited. Corticosteroids and antivirals have already played their role in the acute phase; what remains for the neurologist or physiatrist is myofunctional rehabilitation, botulinum toxin for synkinesis, and, until recently, little structured evidence for complementary interventions. This RCT fills a gap by demonstrating, in patients with sequelae established for at least six months, clinically meaningful improvements in both physical function and social impact as measured by the FDI. The magnitude of the differences — more than 20 points on the FDI social and physical scales — positions acupuncture as a reasonable adjunct in the facial rehabilitation plan, especially for patients with House-Brackmann grade 4-5 who have no other immediately available salvage options.
▸ Notable Findings
The finding that deserves heightened attention is the House-Brackmann grade migration: six of nine patients with moderately severe to severe dysfunction progressed to grades 2-3 at the end of eight weeks, which, in this chronic population, is a functionally relevant change, not merely a statistical one. The 14.77-point improvement on the Sunnybrook system — which separately weights synkinesis, voluntary movement, and resting symmetry — indicates that the benefit is not limited to subjective gain in well-being but involves objective neuromuscular components. The 1.58-point reduction in facial stiffness suggests action on the pathological muscle contraction that characterizes late sequelae. From a mechanistic standpoint, the protocol combined local facial points with systemic points such as LI-4 and ST-36, suggesting that the effect is not merely peripheral but involves modulation of the autonomic nervous system and descending motor control pathways — an argument consistent with contemporary neurophysiology of needling.
▸ From My Experience
In my practice in facial rehabilitation, I have observed that patients referred after six months of sequelae frequently arrive frustrated by the narrative that 'what hasn't recovered by now isn't going to recover anymore.' This view is mistaken, and the present study reinforces what I commonly see: there is a therapeutic window beyond six months, especially when acupuncture is combined with myofunctional rehabilitation directed by a physical therapist trained in facial work. My usual protocol contemplates sessions two to three times per week during the first four weeks, with perceptible response — reported by the patient as less morning stiffness and improved symmetry when smiling — around the third or fourth week. For patients with established synkinesis, I usually combine focal application of botulinum toxin, which potentiates the result of acupuncture without interfering with the needling protocol. The profile that responds best, in my experience, is the motivated patient with sequelae between six months and two years and without complete neuropraxia on electroneuromyography.
Full original article
Read the full scientific study
Trials · 2015
DOI: 10.1186/s13063-015-0777-z
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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