What is the treatment for Bell's palsy?

Bell's Palsy Treatment

The first-line treatment for Bell's palsy is oral corticosteroids, specifically prednisone 60-80 mg daily for 7 days with taper, administered within 72 hours of symptom onset. 1

Core Treatment Components

Corticosteroid Therapy

• Oral corticosteroids are strongly recommended based on high-quality evidence showing significantly improved recovery rates 1
• Standard regimen: Prednisone 50-60 mg daily for 5 days followed by a 5-day taper 2
• Treatment should be initiated within 72 hours of symptom onset for maximum effectiveness 1
• Delaying treatment beyond 72 hours significantly diminishes benefits 1

Antiviral Therapy

• Optional addition to corticosteroids, not recommended as monotherapy 1
• Options include:
  • Valacyclovir 1 g three times daily for 7 days 2
  • Acyclovir 400 mg five times daily for 10 days 2
• Combination therapy may reduce rates of synkinesis (involuntary co-contraction of facial muscles) 2
• Evidence shows minimal additional benefit when combined with steroids (RR 0.75,95% CI 0.56-1.00) 1

Eye Protection (Critical)

• Strongly recommended for patients with impaired eye closure to prevent corneal damage 1
• Measures include:
  • Artificial tears and lubricating ophthalmic drops/ointments
  • Eye patching or taping
  • Moisture chambers 1

Treatment Algorithm

1. Confirm diagnosis: Acute onset unilateral facial weakness/paralysis involving the forehead without other neurologic abnormalities 2
2. Initiate corticosteroids: Start within 72 hours of symptom onset
3. Consider adding antivirals: Especially in severe cases or patients with comorbidities
4. Implement eye protection: For all patients with incomplete eye closure
5. Monitor and follow up: Reassess if symptoms worsen or fail to improve

Special Considerations

• Elderly patients: May benefit particularly from combination therapy with corticosteroids and antivirals 3
• Severe cases: Physical therapy may be beneficial for patients with more severe paralysis 2
• Persistent symptoms: Refer to facial nerve specialist if incomplete recovery after 3 months 1
• Bilateral Bell's palsy: Rare and should prompt investigation for other conditions like Guillain-Barré syndrome or Lyme disease 1

Expected Outcomes

• Without treatment: More than two-thirds of patients experience complete spontaneous recovery 2
• With appropriate treatment: Recovery rates improve to 87.5% with combination therapy versus 68% with no treatment 3
• Children and pregnant women: Up to 90% recovery rate even without treatment 2

Common Pitfalls to Avoid

• Delaying treatment: Benefits diminish significantly after 72 hours from symptom onset 1
• Using antivirals alone: Not effective as monotherapy 2
• Neglecting eye protection: Can lead to corneal damage and permanent vision problems 1
• Missing alternative diagnoses: Bilateral symptoms or other neurological findings warrant further investigation 1

Remember that early intervention with corticosteroids is the cornerstone of effective Bell's palsy management, with eye protection being essential for preventing complications in patients with incomplete eye closure.