Multiple sclerosis is an autoimmune disorder characterized by patches of demyelination throughout the nervous system. Presentation is highly variable but typically involves a neurologic deficit such as paresthesia, visual disturbance, motor weakness, or autonomic dysfunction. The disease has a highly variable clinical spectrum, with some patients entering into remission and others deteriorating with recurrent and unremitting exacerbations of neurologic dysfunction. Diagnosis is confirmed by characteristic sclerotic patches on fluid attenuated inversion recovery (FLAIR) sequence using magnetic resonance imaging as well as lumbar puncture demonstrating oligoclonal bands. Facial palsy is considered a common feature of multiple sclerosis and has a reported prevalence of 20% (91).
Facial nerve involvement is from demyelination of the facial nerve along its course and within its nucleus at the pons. Although it typically occurs years after initial diagnosis, a literature review revealed a range of 1% to 5% of patients with facial paralysis as the initial presenting symptom (91).
Preventative medications used for multiple sclerosis are Copaxone and p-interferon injections. Treatment is with high-dose corticosteroids for exacerbations. In a recent study, 22 patients with multiple sclerosis and facial palsy were treated with corticosteroids at the onset of facial palsy, with 12 of the 22 demonstrating complete recovery. The remaining 10 patients had variable facial nerve function ranging from mild abnormality of mobility to asymmetry at rest in the most severe cases. Of four untreated multiple sclerosis patients with facial palsy, one had full recovery with persisting facial nerve dysfunction in the other three (91).
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