What is the treatment for bell palsy?

Treatment for Bell's Palsy

Oral corticosteroids should be prescribed within 72 hours of symptom onset as the primary treatment for Bell's palsy in patients 16 years and older. 1

First-Line Treatment

Corticosteroid Therapy

• Recommended regimen: 10-day course of oral steroids with at least 5 days at high dose 1
  • Option 1: Prednisolone 50 mg daily for 10 days
  • Option 2: Prednisone 60 mg daily for 5 days followed by a 5-day taper
• Timing: Must be initiated within 72 hours of symptom onset for maximum effectiveness 1, 2
• Evidence strength: Strong recommendation based on high-quality randomized controlled trials showing significant improvement in facial nerve function 1
  • 83% recovery at 3 months with prednisolone vs. 63.6% with placebo
  • 94.4% recovery at 9 months with prednisolone vs. 81.6% with placebo

Second-Line/Adjunctive Treatment

Antiviral Therapy

• Not recommended as monotherapy - strong recommendation against using antivirals alone 1
• Optional adjunctive therapy: May offer oral antiviral therapy in addition to oral steroids 1, 3
  • Recommended antivirals:
    • Valacyclovir 1 g three times daily for 7 days 2, 4
    • Acyclovir 400 mg five times daily for 10 days 2
  • Some evidence suggests combination therapy may reduce rates of synkinesis and improve recovery rates, especially in elderly patients 4, 3

Special Populations

Children

• Higher spontaneous recovery rates than adults 1
• Limited evidence for steroid use in children 1
• Consider oral steroids with significant caregiver involvement in decision-making 1

Pregnant Women

• Treatment should be individualized based on risk-benefit assessment
• Recovery rates up to 90% without treatment 2

Eye Protection

• Critical component of management: Implement eye protection for patients with impaired eye closure 1
• Prevents corneal damage and potential vision loss
• Options include:
  • Artificial tears during the day
  • Lubricating ointment at night
  • Eye patch or tape for complete closure if needed

Follow-Up and Referral

• Reassess or refer to a facial nerve specialist if: 1
  1. New or worsening neurologic findings develop at any point
  2. Ocular symptoms develop at any point
  3. Incomplete facial recovery after 3 months

Common Pitfalls to Avoid

1. Delayed treatment: Corticosteroids must be started within 72 hours for maximum benefit
2. Using antivirals alone: Not effective as monotherapy
3. Neglecting eye protection: Can lead to corneal damage and vision loss
4. Missing other causes of facial paralysis: Bell's palsy is a diagnosis of exclusion
5. Inadequate follow-up: Patients with incomplete recovery at 3 months need specialist referral

Treatment Algorithm

1. Confirm diagnosis: Acute unilateral facial weakness/paralysis with onset <72 hours without identifiable cause
2. Initiate corticosteroids: Within 72 hours of symptom onset
3. Consider adding antivirals: Especially in severe cases or elderly patients
4. Implement eye protection: For all patients with impaired eye closure
5. Follow up: At 3 months to assess recovery
6. Refer to specialist: If incomplete recovery at 3 months or new/worsening symptoms

Bell's palsy has a generally favorable prognosis with appropriate treatment, with up to 94% of patients experiencing complete recovery when treated with corticosteroids 1.