From the Guidelines
Bell's Palsy treatment should begin with oral corticosteroids like prednisone, which should be 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 over the next 3-5 days) should be started within 72 hours of symptom onset.
- Antiviral medications such as valacyclovir (1000mg three times daily for 7 days) may be added, especially if herpes virus infection is suspected, but should not be used alone as monotherapy 1.
Eye Protection and Physical Therapy
- Eye protection is crucial for patients who cannot close their affected eye completely—use artificial tears during the day (every 1-2 hours), lubricating eye ointment at night, and consider an eye patch or tape to keep the eye closed while sleeping to prevent corneal damage.
- Physical therapy with facial exercises and massage may help maintain muscle tone and stimulate nerve function.
Follow-up and Further Evaluation
Most patients recover completely within 3-6 months without treatment, but early corticosteroid therapy increases the likelihood of full recovery and reduces the risk of long-term facial weakness.
- If symptoms don't improve after 3 months or worsen at any point, further medical evaluation is necessary to rule out other conditions.
- The benefits and risks of steroid use in children with Bell’s palsy need to be better elucidated, and further study is needed to more comprehensively compare the concurrent use of combined steroids and antiviral therapy on Bell’s palsy outcomes 1.
From the Research
Bell's Palsy Treatment Overview
- Bell's palsy is characterized by an acute onset of unilateral facial weakness or paralysis involving the forehead in the absence of other neurologic abnormalities 2.
- The overall prognosis is good, with more than two-thirds of patients with typical Bell's palsy having a complete spontaneous recovery 2.
Treatment Options
- An oral corticosteroid regimen (prednisone, 50 to 60 mg per day for five days followed by a five-day taper) is the first-line treatment for Bell's palsy 2.
- Combination therapy with an oral corticosteroid and antiviral may reduce rates of synkinesis (misdirected regrowth of facial nerve fibers manifesting as involuntary co-contraction of certain facial muscles) 2, 3.
- Recommended antivirals include valacyclovir (1 g three times per day for seven days) or acyclovir (400 mg five times per day for 10 days) 2.
- Treatment with antivirals alone is ineffective and not recommended 2, 4.
Timing of Treatment
- Corticosteroids should be initiated within 72 hours of symptom onset 3, 5.
- Initiating treatment beyond 72 hours was associated with a higher recovery rate than starting treatment within 72 hours in one study 5.
Patient-Specific Factors
- Patients aged 20 to 39 years had a higher recovery rate than other age groups 5.
- Fairly predictive EMG results were associated with significantly higher recovery rates 5.
- Patients with severe Bell's palsy tended to benefit more from combined therapy when treatment was initiated within 72 hours 5.