What is the treatment for Bell's palsy (Idiopathic Facial Paralysis)?

From the Guidelines

Bell's Palsy treatment should involve prescribing oral steroids within 72 hours of symptom onset for patients 16 years and older, as it has been shown to improve recovery outcomes 1. The treatment of Bell's Palsy typically involves a combination of corticosteroids and sometimes antiviral medications started as soon as possible after symptom onset.

• Prednisone is the most commonly prescribed corticosteroid, usually given at a dose of 60-80mg daily for 7 days, then tapered over the next 3-5 days.
• If started within 72 hours of symptom onset, it reduces inflammation of the facial nerve and improves recovery outcomes, with studies showing significant improvement in facial nerve function in patients treated with prednisolone within 72 hours of onset 1.
• For patients with severe symptoms or those at higher risk for poor outcomes, an antiviral medication like valacyclovir (1000mg three times daily for 7 days) may be added, though evidence for its benefit is less robust than for steroids alone 1.
• Eye protection is crucial if the eye cannot close properly; artificial tears during the day (every 1-2 hours) and lubricating eye ointment at night, along with taping the eye closed while sleeping, can prevent corneal damage.
• Physical therapy with facial exercises and massage may help maintain muscle tone during recovery.
• Most patients recover completely within 3-6 months, though some may have residual weakness, and if no improvement occurs within 3 months or symptoms worsen, further evaluation is recommended to rule out other conditions. It's worth noting that the evidence for antiviral therapy alone is limited, and it is not recommended as a replacement for steroid therapy 1.

From the Research

Treatment Options for Bell's Palsy

• Corticosteroids are the mainstay of treatment for Bell's palsy and should be initiated within 72 hours of symptom onset 2, 3, 4, 5, 6
• Antiviral therapy in combination with corticosteroid therapy may confer a small benefit and may be offered on the basis of shared decision making 2, 3, 5, 6
• High-dose corticosteroids (≥80 mg) may be more effective than standard-dose corticosteroids (40-60 mg) in the treatment of Bell's palsy 4
• Steroid monotherapy remains effective, although combined treatment may have potential advantages, especially in patients with more severe disease 5
• The best treatment results were achieved when steroid treatment was administered within 72 hours 5

Factors Affecting Recovery

• Age: patients aged 20 to 39 years had a higher recovery rate than other age groups 5
• Electroneurography (ENoG) and electromyography (EMG) results: fairly predictive EMG results were associated with significantly higher recovery rates 5
• Comorbid conditions: may affect recovery rates, but further research is needed to determine the impact of specific comorbidities 5

Comparison of Treatment Modalities

• Corticosteroids alone vs. corticosteroids plus antivirals: corticosteroids alone may be sufficient for most patients, but combined treatment may be beneficial for patients with severe disease 3, 5, 6
• High-dose vs. standard-dose corticosteroids: high-dose corticosteroids may be more effective, but further research is needed to confirm this finding 4