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.