What is the treatment for acute left-sided Bell's palsy?

Treatment for Acute Left-Sided Bell's Palsy

Oral corticosteroids are strongly recommended as first-line treatment for acute Bell's palsy, with prednisone 50-60 mg daily for 5 days followed by a 5-day taper showing significantly improved recovery rates. 1, 2

Diagnostic Approach

• Bell's palsy should be suspected in patients with acute onset of unilateral facial weakness/paralysis involving the forehead without other neurologic abnormalities 2
• Laboratory testing and imaging are not routinely required for diagnosis of Bell's palsy 1, 2
• A thorough history and physical examination focused on specific neurological findings should be the initial approach 1

Treatment Algorithm

First-Line Treatment:

• Oral corticosteroids: Prednisone 50-60 mg daily for 5 days followed by a 5-day taper 1, 2
  • High-quality evidence shows significantly improved recovery rates with early steroid administration
  • Treatment should be initiated within 72 hours of symptom onset for maximum effectiveness 3
  • In patients treated with prednisolone, complete recovery rates were 83% at 3 months and 94.4% at 9 months, compared to 63.6% and 81.6% in untreated patients 3

Optional Additional Treatment:

• Antiviral therapy: May be considered in combination with corticosteroids
  • Options include:
    • Valacyclovir 1 g three times daily for 7 days 2
    • Acyclovir 400 mg five times daily for 10 days 2
  • Evidence shows minimal additional benefit when combined with steroids 1
  • Antiviral treatment alone is ineffective and not recommended 2, 3

Eye Protection (Critical):

• For patients with impaired eye closure:
  • Artificial tears during the day
  • Lubricating ointment at night
  • Taping eyelids closed if necessary 1

Special Considerations

Elderly Patients:

• Elderly patients (>60 years) may particularly benefit from combined therapy with corticosteroids and antivirals
• One study showed 100% recovery in elderly patients treated with combination therapy versus only 42% in untreated patients 4

Rehabilitation:

• Physical therapy may be beneficial for patients with more severe paralysis 2
• Patients with persistent dysphagia should be referred to a facial nerve specialist if swallowing difficulties persist beyond 3 months 1

Prognosis

• Overall prognosis is good with appropriate treatment
• More than two-thirds of patients with typical Bell's palsy have complete spontaneous recovery 2
• Early treatment with corticosteroids significantly improves complete recovery rates at both 3 and 9 months 3

Common Pitfalls to Avoid

1. Delaying corticosteroid treatment beyond 72 hours of symptom onset
2. Using antivirals alone without corticosteroids
3. Neglecting eye protection measures in patients with impaired eye closure
4. Ordering unnecessary imaging or laboratory tests in typical presentations
5. Failing to consider alternative diagnoses in atypical presentations or when symptoms persist