What is the treatment for Bell's palsy?

From the Guidelines

The treatment for Bell's palsy should involve prescribing oral steroids within 72 hours of symptom onset for patients 16 years and older, as this has been shown to significantly improve facial nerve function and reduce the risk of long-term facial weakness 1. This approach is based on high-quality randomized controlled trials that demonstrate a preponderance of benefit over harm. The use of 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 conclusive than for steroids 1. Key aspects of treatment include:

• Starting oral steroids within 72 hours of symptom onset
• Using antiviral medications in certain cases
• Implementing eye protection for patients with impaired eye closure to prevent corneal damage
• Considering physical therapy, including facial exercises and massage, to maintain muscle tone and stimulate nerve function, although the evidence for its benefit is limited 1
• Reassessing patients if symptoms worsen or do not improve after 3 weeks, as this may indicate another underlying condition requiring different treatment 1. It's crucial to follow a strong recommendation based on the latest and highest quality evidence to prioritize morbidity, mortality, and quality of life outcomes for patients with Bell's palsy.

From the Research

Treatment Options for Bell's Palsy

• The primary treatment for Bell's palsy involves the use of corticosteroids, such as prednisolone, to reduce inflammation and improve recovery rates 2, 3.
• Antiviral agents, like acyclovir, valacyclovir, and aciclovir, have been studied in combination with corticosteroids to determine their effectiveness in treating Bell's palsy 2, 3, 4, 5.
• Studies have shown that early treatment with prednisolone significantly improves the chances of complete recovery at 3 and 9 months 2.
• The addition of antivirals to corticosteroids may provide some benefit, although the evidence is not conclusive 2, 3, 4, 5, 6.
• A systematic review of 15 randomized controlled trials found that adding antivirals to corticosteroids probably reduces the risk of incomplete recovery in patients with Bell's palsy 6.

Comparison of Treatment Outcomes

• A study comparing treatment with valacyclovir and prednisone to no medical treatment found a significantly better outcome in the treatment group, with 87.5% of patients recovering completely compared to 68% in the control group 3.
• Another study found that treatment with aciclovir and prednisone resulted in a significantly better outcome than treatment with prednisone alone, with 52.1% of patients recovering completely in the combination group compared to 21.7% in the prednisone-only group 5.
• However, not all studies have found a significant benefit to adding antivirals to corticosteroids, highlighting the need for further research 2, 4.

Treatment Recommendations

• Early treatment with corticosteroids, such as prednisolone, is recommended for patients with Bell's palsy 2, 3.
• The addition of antivirals, such as acyclovir or valacyclovir, may be considered, although the evidence for their effectiveness is not conclusive 2, 3, 4, 5, 6.
• Treatment should be initiated as soon as possible after the onset of symptoms to maximize the chances of complete recovery 2, 3, 4.