Facial paralysis/paresis

Paula experienced problems with her muscles during her attack of bipolar depression. She felt that her muscles were rigid, unable to relax. This was evident in her facial expression, which seemed fixed and mask like . This made her look upset and anxious, which she was, but the source of the problem was the function of the muscle, not her psychological state. She was not aware that she was not able to smile.

On a physical level, a smile is clear enough. There are 17 pairs of muscles controlling expression in the human face, plus a singular muscle, the orbicularis oris, that runs in a ring around the mouth.

Neurological Disorders
Impairment of muscle relaxation (i.e., myotonia) is involved in a wide spectrum of movement disorders such as myotonic dystrophy, dystonia, stroke, and Parkinson’s disease.

Our understanding of relaxation, especially its neural mechanisms, is still fragmentary. We need to clarify details about how muscle relaxation operates during actual performances in sports, music and daily life.

You can’t smile, frown, or move your eyes from side to side.
“You essentially have a mask on your face,” says Roland Bienvenu, 67, a Texan with Moebius syndrome.

Without being able to smile, others “can get the incorrect impression of you”, he says. “You can almost read their thoughts. They wonder, ‘Is something wrong with him? Has he had an accident?’ They question your intellectual ability, think maybe he’s got some intellectual disability since he’s got this blank look on his face.”
The challenges stemming from lack of a smile are frequently compounded. When people have a medical condition severe enough to keep them from smiling, other difficulties tend to be involved.
“It’s a huge problem,” says Tami Konieczny, supervisor of occupational therapy at the Children’s Hospital of Philadelphia (CHoP). “When you look at somebody, the first thing you see is their face, their ability to smile or not smile, or an asymmetrical smile. It’s your social world.
“If someone can’t read your facial expressions, then it’s difficult to be socially accepted. It’s hugely devastating. https://www.facialpalsy.org.uk/inform/what-is-facial-palsy/

Facial Palsy is a big unknown problem in bipolar depressive episodes. It is episodic rather than permanent. It is confused with depression; no one understands it is a sign of muscle weakness.

And it is related to psychomotor retardation seen in bipolar attacks.

it is complicated and it is most likely related to abnormal calcium metabolism of bipolar depressive attacks.

More research is needed to understand what is happening and how we can help these patients.

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