From the Guidelines
Workup and Treatment for Bell's Palsy
For patients presenting with Bell's palsy, it is recommended to initiate treatment promptly, ideally within 72 hours of symptom onset 1. The primary treatment involves corticosteroids, with prednisone being the preferred choice, at a dose of 50 mg daily for 10 days, followed by a 5-day taper 1.
Key Components of Treatment
- Corticosteroids: Should be prescribed within 72 hours of symptom onset for Bell’s palsy patients 16 years and older 1.
- Antiviral Medications: May be considered in addition to oral steroids within 72 hours of symptom onset for patients with Bell’s palsy, especially if the patient presents early in the course of the disease 1.
- Eye Care: Artificial tears and eye ointments should be used to prevent corneal drying and potential complications in patients with impaired eye closure 1.
Diagnostic Approach
- Patient History and Physical Examination: Clinicians should assess the patient using history and physical examination to exclude identifiable causes of facial paresis or paralysis in patients presenting with acute-onset unilateral facial paresis or paralysis 1.
- Laboratory Testing and Diagnostic Imaging: Should not be obtained routinely in patients with new-onset Bell’s palsy 1.
- Electrodiagnostic Testing: May be considered for Bell’s palsy patients with complete facial paralysis, but not for those with incomplete facial paralysis 1.
Follow-Up and Referral
- Patient Follow-Up: Clinicians should reassess or refer to a facial nerve specialist those Bell’s palsy patients with new or worsening neurologic findings, ocular symptoms, or incomplete facial recovery 3 months after initial symptom onset 1.
- Referral to Specialist: May be necessary for patients with severe cases or those with incomplete recovery 1.
From the Research
Diagnosis of Bell's Palsy
- The diagnosis of Bell's palsy is based on exclusion and should include a thorough history and physical examination 2
- Laboratory testing and imaging are not required for diagnosis, but may be used to identify other causes of facial weakness 3, 4
- A common presentation of Bell's palsy is acute onset of unilateral facial weakness or paralysis involving the forehead in the absence of other neurologic abnormalities 3
Treatment of Bell's Palsy
- Corticosteroids are the mainstay of treatment and should be initiated within 72 hours of symptom onset 2, 3, 4, 5
- Antiviral therapy in combination with corticosteroid therapy may confer a small benefit and may be offered on the basis of shared decision making 2
- Antiviral therapy should be associated with steroids in patients with severe and early-onset disease and in Ramsay-Hunt syndrome 5
- Isolated antiviral therapy is not recommended 3, 5
- Physical therapy may be beneficial in patients with more severe paralysis 3
Treatment Outcomes
- The overall prognosis is good, with more than two-thirds of patients with typical Bell's palsy having a complete spontaneous recovery 3
- For children and pregnant women, the rate of complete recovery is up to 90% 3
- Recovery rates were highest in patients who received steroid monotherapy initiated within 72 h 6
- Patients with severe Bell's palsy tended to benefit more from combined therapy when treatment was initiated within 72 h 6