Bulbar palsy is characterized by conditions that arise from damage to the motor neurons of the lower cranial nerves (9 – 12). It is a motor neuron lesion that affects the nerves that control the movement of muscles responsible for swallowing, chewing (the articulation muscles) and head and neck movement, resulting in facial paralysis or weakened articulation muscles. Subsequently, a speech deficit occurs and several other conditions.
Lower motor neurons link the spinal cord and brain (the central nervous system) to the muscles they innervate. Therefore, various symptoms can result, depending on which cranial nerves are damaged.
Progressive and Non-Progressive Bulbar Palsy
Bulbar palsy can be classified as progressive or non-progressive. With progressive bulbar palsy, the symptoms escalate over time, whereas with non-progressive bulbar parsley, the condition does not worsen. Unfortunately, non-progressive bulbar palsy is very rare.
Most people affected will have progressive bulbar palsy. These symptoms will present as the articulation muscles are affected, accordingly:
- A trembling lip
- Drooling due to the inability to swallow (dysphagia), causing saliva to gather in the mouth
- Dysphonia, altered vocal ability or a rasping voice caused by vocal cord paralysis
- Dysarthria, or articulation difficulties and slurred speech
- Weak jaw due to weak facial muscles
- Pharyngeal (throat) muscle weakness
Other clinical features of bulbar palsy include a lack of a gag reflex, nasal regurgitation, aspiration of secretions, difficulty in handling secretions, an atrophic (wasting) tongue and a normal or absent jaw jerk.
Bulbar Palsy Causes and Diagnosis
A brainstem stroke or a tumor are the most common causes of bulbar palsy. These ailments can damage the brainstem, thus damaging the cranial nerves and disrupting motor control. In addition, certain degenerative disorders (like amyotrophic lateral sclerosis) and genetic and autoimmune diseases (like Kennedy disease and Guillain–Barré syndrome, respectively) can cause bulbar palsy.
The following conditions can also cause bulbar palsy:
- Head injury
- Cerebrovascular – medullary infarction
- Toxin – Botulism
- Inflammatory – Lyme disease
- Subacute meningitis (carcinoma and lymphoma)
A diagnosis can be made by reviewing a patient’s medical history (symptoms and clinical features). Then, blood tests and other screening methods, including a CT scan and MRI, will help determine the underlying cause and establish a treatment plan.
Bulbar Palsy Treatment
There is no cure for progressive and non-progressive bulbar palsy. Sadly, the progressive cases can be fatal, with a life expectancy ranging between 6 to 36 months from the onset of symptoms.
Treatment is focused on managing the symptoms and underlying conditions to minimize discomfort and extend the lifespan. A treatment plan may include:
- Medications such as steroids and intravenous immunoglobulin (antibody)
- Drugs to control drooling
- A feeding tube for those with severe difficulty swallowing
- Physical therapy to help improve posture, aid in joint mobility and slow muscle atrophy
- Strength and stretching exercises to reduce spasticity
- Speech and language therapy to assist with difficulties in speaking, chewing and swallowing
- Nutritional guidance to maintain body weight and strength through a proper, balanced diet
The patient could require additional condition-specific treatments if a genetic, degenerative or autoimmune disease was the cause of bulbar palsy.
At New York Facial Paralysis Center, we provide cutting-edge treatment for bulbar palsy and all other causes of facial paralysis. Contact our leading team of doctors today to schedule a consultation for you or a loved one so you can find answers and solutions.