What are the treatments for palsy?

Treatment of Palsy: A Comprehensive Approach

The treatment of palsy depends on the specific type, with oral corticosteroids being the first-line treatment for Bell's palsy when administered within 72 hours of symptom onset, while cerebral palsy requires early intervention with task-specific, motor training-based therapies such as GAME (Goals-Activity-Motor Enrichment) or CIMT (Constraint-Induced Movement Therapy).

Types of Palsy and Their Treatments

Bell's Palsy Treatment

Bell's palsy is an acute peripheral facial nerve palsy that requires prompt intervention:

1. First-line treatment:

   • Oral corticosteroids within 72 hours of symptom onset 1
   • Recommended regimen: Prednisolone 50 mg daily for 10 days or prednisone 60 mg daily for 5 days with a 5-day taper 1

2. Antiviral therapy:

   • Should NOT be used as monotherapy 1
   • May be offered as an adjunct to steroids within 72 hours of symptom onset 1
   • Combination therapy may provide modest additional benefit in some cases 1

3. Eye protection:

   • Critical for patients with incomplete eye closure
   • Options include artificial tears, eye ointment, taping, and humidified eye chambers 1
   • Ophthalmology referral for severe cases with incomplete eye closure 1

4. Nonsurgical management for persistent cases:

   • Occlusion therapy (eye patch, Bangerter filter)
   • Prism therapy for stable deviations 1
   • Botulinum toxin injection to the medial rectus muscle to reduce contracture 1

5. Surgical management:

   • Consider if deviation persists after 6 months 1
   • Options include medial rectus recession with lateral rectus resection for mild cases 1
   • Transposition procedures for more severe cases with no abducting force 1

Cerebral Palsy Treatment

Cerebral palsy requires early, targeted intervention to maximize neuroplasticity:

1. Early intervention approaches:

   • Task-specific, motor training-based therapies are recommended as the new paradigm of care 1
   • GAME (Goals-Activity-Motor Enrichment) for all subtypes 1
   • CIMT (Constraint-Induced Movement Therapy) for hemiplegic cerebral palsy 1
   • Bimanual therapy for hemiplegic cerebral palsy 1

2. Spasticity management:

   • Intramuscular botulinum toxin A for focal spasticity 2
   • Systemic muscle relaxants like baclofen (use with caution due to sedation) 3
   • Intrathecal baclofen for severe generalized spasticity 2
   • Selective dorsal rhizotomy for lower limb spasticity 2

3. Orthopedic management:

   • Regular hip surveillance with anteroposterior pelvic radiographs every 6-12 months starting at age 12 months 1
   • Early intervention for hip displacement, contractures, and scoliosis 1

4. Communication interventions:

   • Speech language pathology interventions to foster parent-infant transactions 1
   • Alternative and augmentative communication for nonverbal children 1

Special Considerations

Bell's Palsy in Children

• Limited evidence for steroid use in children with Bell's palsy 1
• Higher rates of spontaneous recovery than adults 1
• Consider steroids with caregiver involvement in decision-making 1

Cerebral Palsy Comorbidities

Address associated conditions:

• Pain management (avoid untreated procedural pain) 1
• Epilepsy management with standard antiepileptic drugs 1
• Sleep disorders (sleep hygiene, melatonin 2.5-10 mg, gabapentin 5 mg/kg) 1
• Bladder control problems 1
• Vision and hearing impairments 1

Follow-up and Monitoring

Bell's Palsy

• Follow-up to determine if palsy spontaneously resolves 1
• If no improvement after 3 months, consider MRI with contrast 1
• Referral to specialists for incomplete recovery (facial plastic surgeon, ophthalmologist) 1

Cerebral Palsy

• Regular monitoring of motor function using standardized tools like Gross Motor Function Classification System 2
• Ongoing surveillance for hip displacement and other orthopedic complications 1
• Regular assessment of comorbidities and functional status 1

Pitfalls to Avoid

1. Diagnostic pitfalls:

   • Failing to recognize atypical features suggesting alternative causes of facial palsy 1
   • Not considering giant cell arteritis in elderly patients with scalp tenderness or jaw claudication 1

2. Treatment pitfalls:

   • Delaying corticosteroid treatment beyond 72 hours in Bell's palsy 1
   • Using antiviral therapy alone for Bell's palsy 1
   • Neglecting eye protection in patients with incomplete eye closure 1
   • Performing surgery too early before spontaneous recovery has a chance to occur 1
   • Overlooking the importance of early intervention in cerebral palsy 1

3. Medication considerations:

   • Baclofen may cause sedation and should be used with caution when spasticity helps maintain posture 3
   • Monitor patients with epilepsy closely when using baclofen 3

By following these evidence-based approaches, outcomes for patients with various forms of palsy can be significantly improved, reducing long-term disability and improving quality of life.