From the Guidelines
The treatment for Bell's palsy should include oral steroids, such as prednisone, prescribed within 72 hours of symptom onset, as this has been shown to significantly improve facial nerve recovery and reduce the risk of long-term complications, as demonstrated in high-quality randomized controlled trials 1.
Key Considerations
- The use of oral steroids, such as prednisone, is strongly recommended for patients with Bell's palsy who are 16 years and older, with the goal of starting treatment within 72 hours of symptom onset 1.
- Antiviral medications, like valacyclovir, may be considered in addition to oral steroids, especially if herpes simplex virus is suspected as a cause, although the evidence for their benefit is less strong than for steroids 1.
- Eye protection is crucial for patients who cannot close their affected eye completely, and can be achieved with artificial tears during the day and lubricating ointment with eye patching at night to prevent corneal damage 1.
- Physical therapy, including facial exercises and massage, may help maintain muscle tone and stimulate nerve function, but its effectiveness is uncertain due to the lack of standardized therapy modalities and protocols 1.
Treatment Approach
- Oral steroids: Prescribe prednisone at a dose of 60-80mg daily for 7 days, then taper over the next 3-5 days, as this regimen has been shown to be effective in reducing inflammation and improving facial nerve recovery 1.
- Antiviral medications: Consider adding valacyclovir (1000mg three times daily for 7 days) to the treatment regimen, especially if herpes simplex virus is suspected as a cause, although the evidence for its benefit is less strong than for steroids 1.
- Eye protection: Implement eye protection measures, such as artificial tears and lubricating ointment with eye patching, to prevent corneal damage in patients who cannot close their affected eye completely 1.
- Physical therapy: May be considered to help maintain muscle tone and stimulate nerve function, but its effectiveness is uncertain and more research is needed to determine its benefits 1.
From the Research
Treatment for Bell's Palsy
The treatment for Bell's palsy typically involves the use of corticosteroids, which have been shown to be effective in improving the chances of complete recovery 2, 3, 4, 5.
- Corticosteroids: These are the mainstay of treatment for Bell's palsy and should be initiated within 72 hours of symptom onset 2, 5.
- Antiviral therapy: The use of antiviral agents, such as acyclovir, in combination with corticosteroids may confer a small benefit, but the evidence is not conclusive 3, 6.
- Other treatments: There is currently no evidence to support the use of acupuncture, physical therapy, electrotherapy, or surgical decompression for the treatment of Bell's palsy 2.
Effectiveness of Treatment
Studies have shown that early treatment with corticosteroids significantly improves the chances of complete recovery from Bell's palsy 3, 4, 5.
- Corticosteroids vs. placebo: Corticosteroids have been shown to be more effective than placebo in reducing the risk of incomplete recovery 5.
- Antivirals vs. corticosteroids: Antivirals alone have not been shown to be more effective than corticosteroids alone in treating Bell's palsy 6.
- Combination therapy: The combination of antivirals and corticosteroids may be more effective than corticosteroids alone in reducing the risk of incomplete recovery, particularly in severe cases of Bell's palsy 6.
Safety of Treatment
The available evidence suggests that corticosteroids are safe and well-tolerated in the treatment of Bell's palsy 5.
- Adverse effects: The risk of adverse effects, such as sleep disturbances, is low and similar to that of placebo 5.