What is the recommended treatment for Bell's palsy?

From the Guidelines

The recommended treatment for Bell's palsy is oral steroids, such as prednisone, started within 72 hours of symptom onset, as it has been shown to significantly improve outcomes by reducing inflammation of the facial nerve. This recommendation is based on high-quality randomized controlled trials, including 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 in the treatment of Bell's palsy include:

• Oral steroids should be prescribed within 72 hours of symptom onset for patients 16 years and older, as recommended by the clinical practice guideline 1.
• Antiviral medications like valacyclovir or acyclovir may be added, especially if there's 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, and includes artificial tears, lubricating eye ointment, and possibly taping the eye closed or using an eye patch 1.
• Physical therapy with facial exercises and massage may help maintain muscle tone and prevent contractures, although the evidence for its effectiveness is limited 1.
• Patients should be reassessed if no improvement occurs within 3 weeks or if symptoms worsen, as this may indicate an alternative diagnosis 1.

From the Research

Treatment for Bell's Palsy

The recommended treatment for Bell's palsy includes:

• Early intake of prednisone (1 mg/kg body weight for up to 70 or 80 mg/day) or the combined use of prednisone and acyclovir (or valacyclovir) within 72 h following the onset of paralysis 2
• Corticosteroids, such as prednisolone, which have been shown to significantly improve the chances of complete recovery at 3 and 9 months 3
• Valacyclovir and prednisone, which have been found to be more effective than no medical treatment at all in patients with Bell's palsy, especially among elderly patients 4
• High-dose corticosteroids (≥80 mg), which have been found to be more effective than standard-dose corticosteroids (40-60 mg) in the treatment of Bell's palsy 5

Physical Therapy

Physical therapy strategies and devices are also commonly used to treat Bell's palsy, including:

• Electrical stimulation, which has been found to produce no benefit over placebo for incomplete recovery after six months 6
• Facial exercises, which have been found to be beneficial for people with chronic facial palsy and may help to improve facial function and reduce sequelae in acute cases 6
• Acupuncture, which has been found to be of low quality evidence and does not provide useful data due to high risk of bias 6

Key Findings

Key findings from the studies include:

• Early treatment with prednisolone significantly improves the chances of complete recovery at 3 and 9 months 3
• Valacyclovir and prednisone are more effective than no medical treatment at all in patients with Bell's palsy, especially among elderly patients 4
• High-dose corticosteroids are more effective than standard-dose corticosteroids in the treatment of Bell's palsy 5
• There is no high-quality evidence to support significant benefit or harm from any physical therapy for idiopathic facial paralysis 6