Bell's Palsy (Acute Idiopathic Facial Paralysis)

Краткая информация для пациента

Есть ли FDA-допуск для этого показания?

Not FDA-cleared for Bell's palsy. FDA cleared medicinal leeches only for venous congestion in microsurgical reconstruction (K040187, 2004). Use for Bell's palsy is investigational.

Какие доказательства существуют?

Tier C (investigational). Small case reports describe facial recovery timelines with adjunctive leech therapy. There are no randomized controlled trials in Bell's palsy. Spontaneous recovery is high (about 70-85%) which complicates interpretation of uncontrolled reports. Evidence-based first-line therapy is high-dose oral corticosteroids started within 72 hours of symptom onset (NNT ~10), with consideration of antivirals in severe cases; physical therapy / facial-rehabilitation exercises also help.

Основные риски

• Bleeding from bite sites for 6 to 24 hours after detachment (placement on the face)
• Bruising and tenderness on visible facial skin for 5 to 10 days
• Itching and irritation at bite sites
• Local skin infection or, rarely, Aeromonas infection
• Allergic reaction to leech saliva (uncommon)
• Small permanent facial scars at bite sites — cosmetically significant
• Delayed presentation to neurology if used in place of evidence-based steroid therapy, missing the 72-hour window

Кому не следует это рассматривать

• Patients on blood thinners (warfarin INR >2.0, DOACs, heparin)
• Patients with hemophilia or other bleeding disorders
• Patients with severe anemia (Hb <10 g/dL)
• Patients considering this INSTEAD OF oral corticosteroids within the 72-hour window
• Patients with atypical features (bilateral, slowly progressive, other neurologic signs) — needs urgent neurology workup
• Patients with active herpes zoster (Ramsay Hunt syndrome) or Lyme disease (treat the cause)
• Patients with a weakened immune system

О чём спросить врача

• Have I been seen by a neurologist or ENT promptly to confirm Bell's palsy and rule out other causes (stroke, Ramsay Hunt, Lyme)?
• Have I started oral corticosteroids within the 72-hour window?
• Has eye-protection been arranged (lubrication, taping, eye patch) to prevent corneal injury?
• What evidence supports leech therapy for Bell's palsy specifically?
• Will leeches be kept away from the eye and lid?
• What is the practitioner's experience and Aeromonas-prevention plan?
• What is the cost?

Когда срочно обратиться за медицинской помощью

• Sudden facial weakness with other neurologic symptoms — arm/leg weakness, speech difficulty, vision change (possible stroke — call 911)
• Bilateral facial weakness, progressive weakness over days, or rash with painful blisters in or around the ear (Ramsay Hunt)
• Severe eye pain, redness, or vision change (corneal injury from inability to close the eye)
• Spreading redness, warmth, pus, or red streaks on the face (cellulitis)
• Bleeding from a bite site lasting more than 24 to 48 hours
• Fever above 38.0 C / 100.4 F or chills
• Hives, throat tightness, or breathing difficulty