a) Developmental

Which usually occurs with other abnormalities, for example, minor problems such as webbing of fingers or toes through to more major problems of uneven bone growth.

b) Perinatal

The perinatal onset suggests, lack of oxygen or trauma at birth or undue interuterine pressure on the facial nerve. Cases range from increased amniotic fluid, to multiple pregnancies. For example often seen in one of identical twins. Both types need treatment as early as possible whilst the cerebral cortex is still under development. Treatment may be prolonged and be needed until growth stops i.e. 14 – 18 year old. It is clear that without intervention the paralysis becomes more severe as the child grows.

One example of a congenital palsy is called Moebius Syndrome, a very rare developmental problem affecting the 3rd, 6th, 7th and 9th cranial nerves and on occasion others. It may occur because of a disruption in the blood flow during pregnancy although the evidence is sketchy. A person with Moebius syndrome looks like they are wearing a mask. They can’t move their eyes from side to side, have little movement in their cheeks and can’t achieve voluntary lip seal. When originally diagnosed it was thought that the nerve to the muscle was completely absent. It now appears that this is not the case and electromyographic testing shows that in most cases signals are received and can be increased at will by the patient.

At the British Moebius conference attended by delegates from Europe (25/26th August 2000) Diana Farragher presented on her work with this patient group using Trophic electrical stimulation.

At the Lindens the approach has been to electrically map the presence of the facial nerve and the areas in which it is the most developed. Candidates without facial nerve are best to consider surgery at this stage. Others embark upon a course of home treatment using the Trophic simulator. Adult Moebius patients have reported increased feeling in the face and facilitation of muscle twitching under the eye and around the mouth. Slight movements can be enhanced with biofeedback procedures. One child had increased her movement to the extent that she can achieve lip seal and the speech therapist has been able to use this to rapidly advance the child’s clarity of speech particularly with vowel sounds. Others have commented they can now tell when the patient’s football team has lost without asking – there is enough expression in their face to tell them.

Stimulation for these patients is in its early days and may not be a complete answer to the problem, but then it has been long agreed that the treatment of Moebius will be a multidisciplinary task. Slight gains in movement, however, are vastly important if they give the outside world a chance to see what is behind the mask.

The following article is a one I wrote for the British Moebius Society Newsletter and it appeared in the July 2003 edition. I have added it to our website to provide more information on our approach to treating congenital palsies and specifically Moebius Syndrome to those people who don’t have access to the publication. click here to view article