From the Guidelines
Bell's Palsy treatment should begin with oral corticosteroids like prednisone, started within 72 hours of symptom onset, to reduce inflammation and improve recovery chances, as supported by high-quality randomized controlled trials 1.
Treatment Overview
The treatment of Bell's Palsy typically involves the use of oral corticosteroids, with or without antiviral medications, to reduce inflammation and improve recovery chances.
- Oral corticosteroids like prednisone (60-80mg daily for 7 days, then tapered) should be started within 72 hours of symptom onset, as recommended by the clinical practice guideline 1.
- Antiviral medications such as valacyclovir (1000mg three times daily for 7 days) may be added, especially if herpes virus infection is suspected, although their use alone is not recommended 1.
Eye Protection and Physical Therapy
- Eye protection is crucial for patients who cannot close their affected eye completely, using artificial tears during the day, lubricating ointment at night, and an eye patch or tape to keep the eye closed while sleeping, to prevent corneal damage.
- Physical therapy, including facial exercises and massage, may help maintain muscle tone and stimulate nerve function, although more research is needed to determine its effectiveness 1.
Monitoring Progress
Most patients recover completely within 3-6 months without treatment, but medications significantly improve outcomes and reduce the risk of permanent facial weakness. While waiting for recovery, patients should protect their affected eye, maintain good nutrition, and follow up with their healthcare provider to monitor progress. The House-Brackmann facial nerve grading scale can be used to assess recovery, although it was not designed to assess initial facial nerve paresis or paralysis of Bell’s palsy 1.
From the Research
Bell's Palsy Treatment Overview
- Bell's palsy is characterized by an acute onset of unilateral facial weakness or paralysis, and its treatment is primarily focused on managing symptoms and promoting recovery 2, 3.
- The overall prognosis for Bell's palsy is good, with more than two-thirds of patients experiencing complete spontaneous recovery 2.
Treatment Options
- Oral corticosteroids, such as prednisone, are the first-line treatment for Bell's palsy, with a recommended dosage of 50-60 mg per day for five days, followed by a five-day taper 2, 4.
- Combination therapy with an oral corticosteroid and an antiviral, such as valacyclovir or acyclovir, may reduce the risk of synkinesis and improve recovery rates 2, 5.
- Antiviral therapy alone is not recommended, as it has been shown to be ineffective in promoting recovery 4.
- Physical therapy may be beneficial for patients with more severe paralysis, but its effectiveness is not well established 2, 3.
Timing of Treatment
- Initiating treatment within 72 hours of symptom onset is crucial for optimal recovery, with steroid monotherapy being the most effective treatment option during this time frame 6, 4.
- Delaying treatment beyond 72 hours may still result in good recovery rates, but the effectiveness of treatment may be reduced 6.
Patient Factors
- Age, electroneurography (ENoG) and electromyography (EMG) results, and comorbid conditions can affect recovery rates, with patients aged 20-39 years and those with fairly predictive EMG results tend to have higher recovery rates 6.
- Individualized treatment approaches, taking into account patient-specific factors, may be necessary to optimize recovery outcomes 6.