What is the initial treatment for Bell's palsy?

From the Guidelines

The initial treatment for Bell's palsy should involve oral corticosteroids, specifically prednisone, started within 72 hours of symptom onset, as this has been shown to improve outcomes by reducing inflammation of the facial nerve. 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.

Key points to consider in the treatment of Bell's palsy include:

• Oral corticosteroids, such as prednisone, should be prescribed at a dose of 60-80 mg daily for 7 days, started within 72 hours of symptom onset 1
• Eye protection measures, including artificial tears during the day, lubricating eye ointment at night, and taping the eye closed if unable to completely close the eyelid, should be implemented for patients with impaired eye closure 1
• Antiviral medications, such as valacyclovir, may be added, especially in cases with severe symptoms, though evidence for their benefit is less robust than for steroids 1
• Physical therapy with facial exercises and massage may be beneficial during recovery
• Patients should be reassured that approximately 70-85% of cases will recover completely within 3-6 months even without treatment, but early steroid therapy improves outcomes

It is essential to note that the evidence for antiviral therapy alone is no better than placebo with regard to facial nerve recovery in Bell's palsy 1. Additionally, the use of steroids in children is not well established, and the need for steroid treatment is unclear 1. However, given the presumed similar disease process of Bell's palsy in adults and children, oral steroids may be considered in pediatric patients with a large role for caregiver involvement in the decision-making process.

From the Research

Initial Treatment for Bell's Palsy

The initial treatment for Bell's palsy typically involves the use of corticosteroids, such as prednisolone, to improve the chances of complete recovery.

• The use of prednisolone within 72 hours of symptom onset is supported by several studies 2, 3, 4, 5, 6.
• The recommended dose of prednisolone is 1 mg/kg body weight for up to 70 or 80 mg/day 2.
• Antiviral therapy, such as acyclovir or valacyclovir, may be used in combination with prednisolone, but its effectiveness is still debated 2, 3, 4, 6.
• Other treatment options, such as physiotherapy, acupuncture, and surgical decompression, may be considered in certain cases, but their effectiveness is not well established 2, 3.

Timing of Treatment

The timing of treatment is crucial in Bell's palsy, with earlier treatment resulting in better outcomes.

• Treatment with prednisolone within 24 hours of symptom onset has been shown to result in significantly higher complete recovery rates 5.
• Treatment within 25-48 hours of symptom onset also results in higher complete recovery rates, but the benefit decreases with delayed treatment 5.

Age and Treatment Outcome

The effectiveness of treatment may vary depending on the patient's age.

• Patients aged 40 years or older may benefit more from treatment with prednisolone, while younger patients may not differ in terms of treatment outcome 5.
• However, synkinesis (involuntary muscle movements) may be less common in younger patients treated with prednisolone 5.