What accelerates the recovery from Bell's palsy?

From the Guidelines

To accelerate recovery from Bell's palsy, oral steroids should be prescribed within 72 hours of symptom onset, as they have been shown to significantly improve facial nerve function and reduce recovery time 1. The use of oral steroids, such as prednisolone, has been consistently supported by high-quality randomized controlled trials, demonstrating a preponderance of benefit over harm.

• Key points to consider:
  • Oral steroids should be started within 72 hours of symptom onset for patients 16 years and older.
  • The evidence base for antiviral therapy is less clear, but it may be considered in addition to oral steroids within 72 hours of symptom onset.
  • Protecting the affected eye with artificial tears, lubricating ointment, and an eye patch is also crucial to prevent corneal damage.
  • Gentle facial exercises, moist heat, and good nutrition may also support overall healing and recovery. The studies by Sullivan et al and Engstrom et al, as referenced in 1, provide strong evidence for the effectiveness of oral steroids in improving facial nerve function and reducing recovery time.
• The benefits of oral steroids include:
  • Significant improvement in facial nerve function
  • Reduced recovery time
  • Improved outcomes when started within 72 hours of symptom onset It is essential to consult with a healthcare provider before starting any treatment regimen, as they can provide personalized guidance and recommendations based on individual patient needs and circumstances.

From the Research

Accelerating Recovery from Bell's Palsy

The following factors have been identified as accelerating the recovery from Bell's palsy:

• Early treatment with oral corticosteroids, such as prednisolone, has been shown to improve the chances of recovery at 3 and 9 months 2, 3, 4, 5
• Combination therapy with an oral corticosteroid and antiviral, such as valacyclovir or acyclovir, may reduce rates of synkinesis and improve outcomes 3, 4, 6
• Administration of corticosteroids within 3 days of onset of palsy has been associated with better outcomes 5
• Treatment with antivirals alone is ineffective and not recommended 2, 3

Treatment Options

The following treatment options have been studied:

• Oral prednisolone (50-60 mg per day for 5-10 days) 2, 3, 4, 5
• Intravenous methylprednisolone (single dose of 500 mg) 5
• Valacyclovir (1 g three times per day for 7 days) 3, 6
• Acyclovir (400 mg five times per day for 10 days) 3, 4

Patient Outcomes

The following patient outcomes have been reported:

• Complete recovery rates: 70-90% with treatment, 30-50% without treatment 2, 3, 4, 6
• Residual deficit rates: 10-30% with treatment, 50-70% without treatment 2, 6
• Time to full recovery: reduced with early treatment and combination therapy 2, 3, 6