From the Guidelines
Bell's palsy should be treated with oral corticosteroids, primarily prednisone, which should be started within 72 hours of symptom onset for maximum effectiveness. The standard regimen is prednisone 60mg daily for 5 days, followed by a taper over the next 5 days (50mg, 40mg, 30mg, 20mg, 10mg) 1. This treatment approach is based on high-quality randomized controlled trials that demonstrate a significant improvement in facial nerve function and recovery rates compared to placebo 1.
Key Considerations
- Antiviral medications like valacyclovir (1000mg three times daily for 7 days) or acyclovir (400mg five times daily for 7 days) may be added, especially if herpes simplex virus is suspected as a cause, though evidence for their benefit is less robust than for steroids 1.
- Eye protection is crucial for patients who cannot close their affected eye completely; artificial tears during the day and lubricating ointment at night help prevent corneal damage.
- Physical therapy, including facial exercises and massage, may aid recovery.
- Corticosteroids work by reducing inflammation of the facial nerve within the narrow facial canal, while antivirals target potential viral causes of the inflammation.
Special Considerations
- The use of oral corticosteroids in children is less clear due to limited evidence, but they may be considered in pediatric patients with a large role for caregiver involvement in the decision-making process 1.
- Most patients recover completely within 3-6 months with appropriate treatment.
Treatment Approach
- The treatment approach should prioritize the use of oral corticosteroids, with antiviral medications and other therapies considered on a case-by-case basis.
- The goal of treatment is to reduce inflammation, promote recovery, and prevent complications such as corneal damage.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Medications for Bell's Palsy
The primary medications used to treat Bell's palsy include:
- Corticosteroids, such as prednisone, which are considered the first-line treatment 2, 3, 4, 5
- Antivirals, such as valacyclovir or acyclovir, which may be used in combination with corticosteroids to reduce the risk of synkinesis 2, 6
Treatment Regimens
The following treatment regimens have been studied:
- Prednisone 50-60 mg per day for 5 days, followed by a 5-day taper 2
- Valacyclovir 1 g three times per day for 7 days, in combination with prednisone 6
- High-dose corticosteroids (≥80 mg) versus standard-dose corticosteroids (40-60 mg) without antivirals 4
Efficacy of Treatments
Studies have shown that:
- Corticosteroids can significantly improve outcomes in patients with Bell's palsy 2, 3, 4, 5
- Antivirals may provide additional benefit when used in combination with corticosteroids 2, 6
- High-dose corticosteroids may be more effective than standard-dose corticosteroids in reducing the risk of non-recovery 4
- Valacyclovir did not affect facial recovery in one large randomized controlled trial 5