Response of axonal regeneration in chronic Bell's palsy to low intensity shockwave therapy: Randomized control trial

Background : Bell’s paralysis is an acute paralysis onset due to idiopathic facial nerve inflammation It is the commonest cause of lower motor neuron facial paralysis with an annual rate of 15-30 per 100,000. Objectives: Our aim of the study to detect the difference of axonal regeneration response in chronic Bell’s palsy to low intensity radial shock wave therapy and kabbat exercises Patients and methods : 60 chronic bell’s palsy patients (six months post injury) with age 35-60 years old randomly allocated to one of two groups; group A [Shock Wave (SW)](n=30) treated with low intensity shock wave plus kabbat exercises and facial muscle exercise for six weeks. KE (kabbat exercise) group (n=30) treated with kabbat exercises plus sham treatment by a shock wave and facial muscle exercise for six weeks. patients were assessed by electrophysiological study (Amplitude and degeneration index of facial nerve). The assessment was done before and after treatment. Results : Degeneration index decrease significantly in the group A (p < 0.001), but not in the group B (p = 0.295). Amplitude of facial nerve was low at baseline, indicating sever axonal degeneration. After treatment, amplitude increased significantly in the two groups; however, the significance was higher in group A (SW) than group B (KE)(p < 0.001). Conclusion : low intensity shock wave therapy is safe and effective treatment of chronic bell’s palsy after 6 months from the onset.