Familial Facial Palsy: A Case Series of Six Families from the Northern State, Sudan

Familial facial palsy is uncommon, accounting only for 4-14% of Bell's palsy cases. We report six families with single or recurrent episodes of familial facial palsy from Northern State, Sudan. The first family had two brothers with single episodes of Bell's palsy. The index case of the second family was a 19-year-old female who and nine other members of her family had a single or recurrent episodes of Bell's palsy. The third, fourth, fifth, and sixth families had eight, five, four, and five members, respectively, who developed either single or recurrent episodes of Bell's palsy. None of the index cases or other members of the six families who were examined showed evidence of facial swelling or fissured tongue suggestive of Melkersson-Rosenthal syndrome. Literature review revealed two studies on Bell's palsy from Sudan but no studies on familial facial palsy. The mode of inheritance was either autosomal dominant with variable penetrance or autosomal recessive. In the second family, there could be a possibility of autosomal recessive inheritance due to increased number of cases after consanguineous marriage. Steroids remain the mainstay of treatment together with protective eye regimens. The role of physiotherapy, although widely used, is controversial. Genetic analysis is recommended and family history should be considered in patients with Bell's palsy.