Familial Facial Palsy: A Case Series of Six Families from the Northern State, Sudan

Abstract

Familial facial palsy is uncommon, accounting only for 4–14% of Bell's palsy cases. We report six families with single or recurrent episodes of familial facial palsy from Northern State, Sudan. The first family had two brothers with single episodes of Bell's palsy. The index case of the second family was a 19-year-old female who and nine other members of her family had a single or recurrent episodes of Bell's palsy. The third, fourth, fifth, and sixth families had eight, five, four, and five members, respectively, who developed either single or recurrent episodes of Bell’s palsy. None of the index cases or other members of the six families who were examined showed evidence of facial swelling or fissured tongue suggestive of Melkersson-Rosenthal syndrome. Literature review revealed two studies on Bell's palsy from Sudan but no studies on familial facial palsy. The mode of inheritance was either autosomal dominant with variable penetrance or autosomal recessive. In the second family, there could be a possibility of autosomal recessive inheritance due to increased number of cases after consanguineous marriage. Steroids remain the mainstay of treatment together with protective eye regimens. The role of physiotherapy, although widely used, is controversial. Genetic analysis is recommended and family history should be considered in patients with Bell's palsy.

Familial Facial Palsy: Another Case Series of Seven Families from the Northern State, Sudan. Is it common?Familial Facial Palsy: Another Case Series of Seven Families from the Northern State, Sudan. Is it common?

“…The total number of cases with facial palsy in this second case series was 23 with 14(60.9%) females and a female to male ratio of 1.55:1. The total number of affected cases was less and more females were affected, compared to that reported in the previous study from Northern State which showed that 34 cases from 6 families were affected with 38.2% females [10].…”

“…Only two female patients from two different families developed recurrent facial palsy, compared to 7 cases of recurrent facial palsy from 4 families in the previous study [10].…”

“…Interestingly, the index case of the first family had 10 episodes of facial palsy whereas that of the 6 th family had two attacks, the maximum number of recurrences in the previous study was 3 [10]. There is an 8% increased risk of recurrence after the first episode of facial palsy and the risk increases within familial cases [2].…”

“…About 4-14% of cases of facial palsy have a positive family history [7]. Most of the reported cases follow an autosomal dominant inheritance pattern but some cases suggest autosomal recessive inheritance and three genes have been implicated [8,9] Literature review revealed a case series of 34 patients belonging to six different families from the Northern State, Sudan, with single or recurrent episodes of familial facial palsy [10]. We report 7 other families from the Northern State, Sudan, with 23 family members who had single or recurrent episodes of facial palsy.…”