What is Bulbar Palsy?
Bulbar Palsy also known as Progressive Bulbar Palsy is a pathological condition in which the nerve cells which are responsible for movement get affected. Out of the 12 cranial nerves that are present 5 cranial nerves which control movement get affected in Bulbar Palsy. The cranial nerves affected in Bulbar Palsy are cranial nerve V, VII, IX, X, and XI. In this cranial nerve V which is also called as the trigeminal nerve is responsible for chewing movements. Cranial nerve VII or the facial nerve is responsible for blinking. Cranial nerves IX and X are responsible for swallowing and esophageal motility.
What Causes Bulbar Palsy?
The cause of Bulbar Palsy is variable. It can be caused due to toxic a chemical known as botulism, which can cause paralysis as the toxin reaches the digestive tract. Another potential cause for Bulbar Palsy may be some sort of a malignant condition in which there is metastasis to the brain causing glioma and eventually causing Bulbar Palsy. Inflammatory conditions like Guillain-Barre syndrome is also one of the causes of Bulbar Palsy. Some studies also point to a genetic link in development of Bulbar Palsy.
What are the Signs and Symptoms of Bulbar Palsy?
Just like with a condition like amyotrophic lateral disease, Bulbar Palsy also progresses with time albeit the progress is quite slow. The individual affected with Bulbar Palsy will experience symptoms like:
- Slurred speech
- Difficulty with chewing food
- Small appearance of the tongue
- Absence of a gag reflex
How Is Bulbar Palsy Diagnosed?
To begin with, a detailed neurologic examination will be done to check whether all the neurologic functions are normal. The physician will also take a detailed family history and past medical history of the patient. Blood tests will also be conducted to rule out other causes for the symptoms and confirmatively diagnose Bulbar Palsy. Imaging studies may also be ordered to include MRI and CT scans of the brain to look at the internal structures and see if any abnormality is identified structurally in the brain. Apart from this, an EMG study may also be performed to look at the muscle activity of the body and see if any abnormalities are present. All these tests will rule out any other condition causing the symptoms thus confirming the diagnosis of Bulbar Palsy
How is Bulbar Palsy Treated?
As of now, there is no clear cut treatment for Bulbar Palsy. Treatment is mainly aimed at control of symptoms and making life easier for the patient. As there is always muscle weakness associated with Bulbar Palsy an aide will always be required for comfort purposes aiding in patient's mobility, for feeding purposes. In severe cases of dysphagia in Bulbar Palsy patients, an NG tube may be inserted for feeding. Lastly, physical therapy is also an essential part of treatment so that the muscles do not become stiff and there is no disuse of the muscles. A speech therapist can also help a long way in aiding the patient to speak better as speech is also severely affected due to Bulbar Palsy. Since Bulbar Palsy is quite disabling the patient may get severely depressed and anxious about the condition and a referral to a psychiatrist or psychologist for counseling will be of significant help. Apart from this, certain medications are also given to help with the muscle spasms like baclofen.
Bulbar Palsy Life Expectancy
The overall prognosis of Bulbar Palsy is extremely poor as there is no cure for Bulbar Palsy and treatment is basically supportive. The degeneration of the neurons is something which cannot be reversed. An affected individual can survive for a maximum of three years after being diagnosed with Bulbar Palsy.