What is the recommended treatment for Bell's palsy?

From the Guidelines

The recommended treatment for Bell's palsy is oral corticosteroids, such as prednisone, started within 72 hours of symptom onset, as it has been shown to decrease recovery time and improve facial nerve functional recovery 1. The dose of prednisone is typically 60-80mg daily for 5-7 days, followed by a taper over the next 5-7 days. Some key points to consider in the treatment of Bell's palsy include:

• Antiviral medications like valacyclovir or acyclovir may be added, especially if there is suspicion of herpes virus involvement, though evidence for their benefit is less robust than for steroids 1.
• Eye protection is crucial for patients who cannot fully close the affected eye, including artificial tears during the day and lubricating ointment at night 1.
• Physical therapy with facial exercises and massage may help maintain muscle tone and prevent contractures, although the evidence for its benefit is limited 1.
• Most patients (about 70-85%) will recover completely within 3 months without treatment, but early corticosteroid therapy increases the likelihood of complete recovery and reduces the risk of long-term facial weakness 1. The use of oral steroids within 72 hours of symptom onset is a strong recommendation based on high-quality randomized controlled trials with a preponderance of benefit over harm 1.

From the Research

Treatment Options for Bell's Palsy

• The primary treatment for Bell's palsy is corticosteroids, which should be initiated within 72 hours of symptom onset 2, 3.
• Antiviral therapy in combination with corticosteroid therapy may confer a small benefit and may be offered on the basis of shared decision making 2.
• The use of high-dose corticosteroids (≥80 mg) may be more effective than standard-dose corticosteroids (40-60 mg) in the treatment of Bell's palsy 4.
• Steroid monotherapy remains effective, although combined treatment with antivirals may have potential advantages, especially in patients with more severe disease 5.

Timing of Treatment Initiation

• Initiating treatment within 72 hours of symptom onset is crucial for optimal recovery rates 2, 3, 5.
• However, one study suggests that there may be more flexibility in the application of the 72-hour treatment period, and treatment initiation beyond 72 hours may still be associated with a higher recovery rate than starting treatment within 72 hours 5.

Factors Affecting Recovery

• Age: patients aged 20 to 39 years had a higher recovery rate than other age groups 5.
• Electroneurography (ENoG) and electromyography (EMG) results: fairly predictive EMG results were associated with significantly higher recovery rates 5.
• Comorbid conditions: may affect recovery rates, but further research is needed to determine the specific impact of comorbidities on Bell's palsy recovery 5.

Adverse Events

• The use of antivirals and corticosteroids may be associated with adverse events, such as transient elevated liver enzymes and fecal occult blood 6, 4.
• However, the evidence is too uncertain to draw conclusions about the risk of adverse events associated with antiviral treatment 6.