What is the recommended treatment for a 74kg patient with facial palsy?

From the Guidelines

For a 74kg patient with facial palsy, the recommended treatment is oral prednisolone at a dose of 60-80mg daily (approximately 1mg/kg/day) for 10 days, started within 72 hours of symptom onset. This recommendation is based on high-quality randomized controlled trials, such as the study by Sullivan et al 1, which reported significant improvement of facial nerve function in patients treated with prednisolone within 72 hours of onset. The study found that 83% of participants randomized to prednisolone had recovered facial nerve function 3 months after treatment, compared to 63.6% of those randomized to placebo. Some key points to consider when treating a patient with facial palsy include:

• Starting treatment within 72 hours of symptom onset to maximize the effectiveness of prednisolone 1
• Using a dose of 60-80mg daily for 10 days, as this has been shown to be effective in improving facial nerve function 1
• Accompanying prednisolone treatment with eye protection measures, such as artificial tears and lubricating eye ointment, to prevent corneal damage
• Considering antiviral therapy with valacyclovir if the palsy is suspected to be due to herpes zoster (Ramsay Hunt syndrome) or if treatment is started within 72 hours of symptom onset
• Reassessing the patient after 3-4 weeks, as most cases of Bell's palsy resolve within this timeframe, and referring to a specialist if there is no improvement after 3 months 1.

From the Research

Treatment of Facial Palsy

The treatment of facial palsy, including the use of prednisolone, is a complex topic with various approaches.

• The recommended dose of prednisolone for a 74kg patient is 1 mg/kg body weight, which would be approximately 74mg per day, up to a maximum of 70 or 80 mg/day 2.
• The timing of ingestion is not specified in the provided studies, but it is recommended to start treatment within 72 hours of the onset of paralysis 2.
• The use of prednisolone in combination with other treatments, such as acyclovir or valacyclovir, may also be beneficial 2, 3.
• Physical therapy, including exercises, electrical stimulation, and biofeedback training, may also be useful in the treatment of facial palsy 2, 4, 5.

Dose Regimen

The dose regimen for prednisolone in the treatment of facial palsy is as follows:

• 1 mg/kg body weight per day, up to a maximum of 70 or 80 mg/day 2.
• The treatment should be started within 72 hours of the onset of paralysis 2.
• The duration of treatment is not specified in the provided studies, but it is likely to be several days or weeks.

Combination Therapy

The use of combination therapy, including prednisolone and other treatments, may be beneficial in the treatment of facial palsy.

• The combination of prednisolone and acyclovir or valacyclovir may improve outcomes 2, 3.
• Physical therapy, including exercises, electrical stimulation, and biofeedback training, may also be useful in combination with prednisolone 2, 4, 5.