From the Guidelines
Bell's palsy treatment should begin with oral corticosteroids, specifically prednisone, within 72 hours of symptom onset to reduce inflammation and improve recovery outcomes, as supported by high-quality randomized controlled trials 1. The treatment of Bell's palsy typically involves the use of oral corticosteroids to reduce inflammation and improve recovery outcomes.
- The use of oral steroids within 72 hours of symptom onset is strongly recommended for patients 16 years and older, based on high-quality randomized controlled trials with a preponderance of benefit over harm 1.
- Antiviral medications like valacyclovir may be added, especially if herpes simplex virus is suspected, though evidence for their benefit is less robust than for steroids 1.
- Eye protection is crucial for patients who cannot close their affected eye completely; artificial tears during the day and lubricating ointment with eye patching at night prevent corneal damage 1. Some key points to consider in the treatment of Bell's palsy include:
- The importance of early treatment with oral corticosteroids to improve recovery outcomes 1
- The potential benefits and limitations of antiviral therapy in addition to oral steroids 1
- The need for eye protection and other supportive measures to prevent complications and promote recovery 1 Overall, the goal of treatment is to reduce inflammation, promote recovery, and prevent complications, with a focus on improving morbidity, mortality, and quality of life outcomes for patients with Bell's palsy.
From the Research
Treatment Options for Bell's Palsy
- The first-line treatment for Bell's palsy is an oral corticosteroid regimen, such as prednisone, 50 to 60 mg per day for five days followed by a five-day taper 2.
- Combination therapy with an oral corticosteroid and antiviral, such as valacyclovir or acyclovir, may reduce rates of synkinesis 2, 3, 4.
- Treatment with antivirals alone is ineffective and not recommended 2, 5.
- Physical therapy may be beneficial in patients with more severe paralysis 2, 5.
Corticosteroid Dosage
- Standard-dose corticosteroids (40-60 mg daily) are typically used to treat Bell's palsy 6.
- High-dose corticosteroids (≥80 mg) may be more effective in reducing nonrecovery rates, but may also increase the risk of adverse events 6.
Antiviral Therapy
- Valacyclovir and prednisolone therapy has been shown to be more effective in treating Bell's palsy than conventional prednisolone therapy 3, 4.
- The use of antiviral therapy in combination with corticosteroids may confer a small benefit and may be offered on the basis of shared decision making 5.
Patient Outcomes
- More than two-thirds of patients with typical Bell's palsy have a complete spontaneous recovery 2.
- For children and pregnant women, the rate of complete recovery is up to 90% 2.
- Treatment with valacyclovir and prednisone has been shown to significantly improve outcomes in patients with Bell's palsy, especially among elderly patients 3.