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The viruses that can paralyse your face overnight
00:21 GMT, 27 November 2012
Fiona Hawthorne understands only too well the role of the face as a window to the soul. As well as being a successful artist (her portrait of Barack Obama hangs in the U.S. Library of Congress), she is married to actor Colin Salmon, best known for his role in three Bond films and, most recently, on Strictly Come Dancing.
She has rubbed shoulders with the ‘beautiful people’ of film and TV throughout their 24-year marriage.
Then two years ago Fiona developed Bell’s palsy — a weakening or paralysis of the facial muscles, caused by a virus.
Nerve damage: Fiona Hawthorne with husband Colin Salmon. She is a trustee of a new charity, Facial Palsy UK
‘I felt like one side of my face was out of control — my left eye was stuck open, my mouth dropped and I couldn’t speak or drink properly,’ recalls the mother of four.
Fiona developed the palsy ten days after a minor operation on a perforated ear drum. She had just had a check-up to remove the dressing and the next night couldn’t sleep because of the excruciating pain.
‘It felt as if my teeth were being pulled out,’ she says. ‘But in the morning the pain had lessened and I couldn’t see anything wrong with my jaw, so I tried to press on with work.
‘However, by mid-afternoon I noticed one side of my face had begun to drop. I couldn’t lift the left side of my mouth so couldn’t smile, and my left eye was stuck open.’
Fearing that she was having a stroke, Fiona went to see an out-of-hours GP at her local hospital, some 48 hours after her symptoms began. The GP said it was most likely due to swelling and trauma from her operation and that she would be fine in a couple of days.
But the next day the symptoms were worse. ‘The left side of my face had dropped and I couldn’t move it at all,’ she says. ‘And I later realised I’d slept with one eye open.’
This time she went to Charing Cross Hospital, London, where she’d had her operation and her specialist immediately diagnosed Bell’s palsy.
It is the most common cause of facial palsy (paralysis of the facial muscles), which affects around 100,000 people in the UK, and is thought to account for around 60 per cent of cases.
While facial palsy can be caused by injury, neurological conditions, cancer, strokes and infections, Bell’s palsy is linked to a viral infection, usually the herpes virus (carried by around half of adults) or the varicella zoster virus (the chicken pox virus), particles of which can stay in the nerves and ‘reactivate’ when the immune system is weakened.
These viruses trigger inflammation in the facial nerve, causing it to become compressed; this in turn leads to the muscles becoming paralysed, and the face droops.
Symptoms include severe pain, an altered sense of taste due to a loss of sensation of the tongue, and difficulty eating and speaking. Particularly vulnerable are pregnant women in their last trimester, people with diabetes, and those recovering from flu or respiratory tract infections.
Fiona was at higher risk because of her recent ear operation; a Tube strike on the day of her check-up meant she’d also walked a long distance in icy winds (there is a higher incidence of Bell’s palsy in winter).
Symptoms develop quickly, peaking at 72 hours — during this time the condition will respond best to treatment, which is usually steroids and anti-viral drugs to reduce inflammation.
Fiona's friend Pierce Brosnan fell victim to Bell's palsy in 1984
Fiona’s consultant immediately prescribed these drugs, explaining that while 75 per cent of patients make a complete recovery within two to three months, getting diagnosed and treated quickly reduces the chances of long-term nerve damage. But despite this urgency, Colin had to wait seven hours to obtain his wife’s drugs from the hospital pharmacy.
Fiona adds: ‘Colin tried to speed up the prescription, but his pleas were met with raised eyebrows. “Everyone is important, sir,” he was told. ’
In fact, it was 70 hours after the onset of symptoms before Fiona finally started taking the steroid tablets. Because she was at the outer limits of the ‘treatment window’, she knew there was no guarantee of recovery.
‘I looked at myself in the mirror and thought: “Is this my face for the rest of my life” It wasn’t just about feeling I wasn’t attractive, it was about how other people respond to you. Some treat you as if you are drunk, or a second-class citizen.
‘It was our daughter’s 18th birthday around then, and she was desperate to know if my Bell’s palsy would heal in time for her party. I felt her sadness that her mum had a very different face. We changed plans from a big dinner party to a family celebration.’
Fiona also decided not to attend any red-carpet events with her husband. ‘Day to day you have to rethink so much — showering is difficult as you can’t close your eye and you need to carry a supply of straws for drinking with, and eye drops to use hourly. If you go to a restaurant, you try to find a tucked-away seat — eating with a semi-paralysed mouth is not easy to do or pleasant to watch.’
Colin adds: ‘Fiona is my wife and I will always love her no matter what, but every woman wants to feel confident in her looks.’
Fiona sought the advice of old friend Pierce Brosnan, her husband’s Bond co-star. He’d developed Bell’s palsy in 1984, just before going on The Tonight Show — people later commented on how he continually winked at the show’s host, Johnny Carson. Fortunately, he recovered within a couple of months. ‘Pierce thought it might have been caused by filming immersed in a pond for a movie. He told me not to worry and that it would go back to normal.’
Indeed, Fiona recovered steadily over the next two months and was able to avoid surgery — in severe cases, gold weights are placed in the upper eyelid to allow the eye to close, or muscle transplants are used to restore a smile.
She was also referred to a specialist facial palsy unit at the Queen Victoria Hospital in East Grinstead, Sussex, where she was given facial exercises to retrain the muscles, and counselling, which she says was ‘priceless’.
But two months after her symptoms started to ease, Fiona noticed strange new sensations in her face. ‘When I ate, my eye closed and the muscles pulled my chin off in one direction, which looked odd.’
She was diagnosed with synkinesis, a complication of facial palsy. ‘The longer the duration of paralysis, the greater the likelihood of “mis-wiring” of the nerves, so impulses destined for one muscle are directed to another,’ explains Charles Nduka, a plastic surgeon at the Queen Victoria Hospital.
‘Once synkinesis is established, it is difficult to treat.’
Quite why some people do not fully recover from Bell’s palsy is not clear, adds Mr Nduka. ‘It could be that the inflammation is more severe. There is also some evidence that the channel through which the facial nerve travels may be narrower in some people, which makes them more susceptible. Between 5 and 9 per cent of patients will have more than one attack.’
Synkinesis is treated with physiotherapy and Botox to prevent the muscles overacting.
‘More than a third of patients are told nothing can be done for them, when this is clearly not the case,’ says Mr Nduka. ‘Sadly, there is little awareness, even in the medical community itself, of the latest advances as well as the vital importance of early treatment.’
Two weeks ago he helped launch a new charity, Facial Palsy UK, with the hope of improving this.
Fiona, a trustee of the charity, was one of the lucky ones. She has injections three times a year to tackle her synkinesis, combining the treatment with facial exercises at home.
As a result, there’s now no obvious distortion to Fiona’s face, although there is a tendency for her eye to close when smiling.
‘I cannot stress enough how important this treatment is to me,’ says Fiona. ‘I feel normal again.’
She even joined her husband on the red carpet at the recent premiere for the movie Skyfall. ‘I have to stand on Colin’s other side now, though,’ she smiles, ‘so I can put my best side forward.’