A 75-year-old man with Bell’s palsy has had recurrent episodes on the side presently affected and one episode on the opposite side. His mother has had several episodes, and each of his three siblings has been affected at one time or another. All were older than 50 at the time of occurrence, and all recovered completely. He was unaware of any of his wife’s relatives’ having Bell’s palsy, and it has not yet occurred in the next generation. Is there a genetic aspect involved in Bell’s palsy or in possible arthritis or facial-nerve encroachment that would account for these familial cases?
—Ray S. Greco, MD, Weirton, W.Va.
There are reports of familial recurrent Bell’s palsy in the literature. One analysis of 25 patients with Bell’s palsy found 4% had a family history with a mode of inheritance thought to be autosomal dominant with low penetrance (Ann Otol Rhinol Laryngol Suppl. 1988;137:8-10). The etiology is unknown, but vascular, metabolic, and immunologic mechanisms have been proposed (Neurology. 1987;37:1369-1371).
—Susan Kashaf, MD, MPH (105-9)