From the Guidelines
Facial palsy treatment should always begin with oral steroids within 72 hours of symptom onset for patients 16 years and older, as this has been shown to significantly improve recovery rates. This recommendation is based on high-quality randomized controlled trials, such as the study by Sullivan et al 1, which demonstrated that 83% of patients treated with prednisolone within 72 hours of onset had recovered facial nerve function 3 months after treatment, compared to 63.6% of those randomized to placebo.
Key Considerations
- The use of oral steroids, such as prednisolone, has been consistently shown to improve outcomes in Bell's palsy patients, with benefits including reduced inflammation and improved nerve function 1.
- Early treatment is crucial, with the best outcomes seen when oral steroids are initiated within 72 hours of symptom onset.
- Additional treatments, such as antiviral medications, eye protection, physical therapy, and electrical stimulation therapy, may be beneficial in certain cases, but oral steroids remain the foundation of treatment.
Treatment Details
- Oral steroids, such as prednisone, should be prescribed at a dose of 60-80mg daily for 7 days, then tapered to minimize side effects.
- Antiviral medications, such as valacyclovir, may be added if herpes virus infection is suspected, but their use is not universally recommended.
- Eye protection, including artificial tears and lubricating ointment, is essential for patients who cannot close their affected eye completely, to prevent corneal damage.
- Physical therapy, including facial exercises and massage, can help maintain muscle tone and stimulate nerve regeneration, and may be beneficial in some cases.
From the Research
Treatment Options for Facial Palsy
- Corticosteroids, such as prednisolone, are widely used to treat facial palsy, particularly Bell's palsy, as they reduce inflammation and facilitate recovery 2, 3, 4.
- Early administration of corticosteroids, preferably within 72 hours of symptom onset, considerably improves outcomes 2, 3.
- Antiviral agents, such as acyclovir, may be used in combination with corticosteroids in severe cases or when viral involvement is strongly suspected, but their effectiveness is uncertain 2, 3, 4.
- Current guidelines recommend oral steroids as the primary treatment for Bell's palsy, with antiviral agents used selectively in severe cases 3.
Efficacy of Treatment Options
- Studies have shown that prednisolone significantly improves the chances of complete recovery at 3 and 9 months 2, 4.
- The use of acyclovir alone or in combination with prednisolone has not been shown to provide a significant benefit 2, 4.
- Valacyclovir provides minimal added benefit to prednisolone alone 4.
Additional Treatment Considerations
- Physiotherapy, such as electrical stimulation of the facial muscles, is not recommended 5.
- Acupuncture, physical therapy, and chiropractic care may be used as alternative or complementary treatments, but their effectiveness is not well established 6.
- Treatment outcomes may vary depending on the severity of nerve damage and timeliness of intervention 3, 6.