What is the recommended treatment for Bell's Palsy?

Treatment of Bell's Palsy

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

Pharmacological Management

Corticosteroid Therapy

• Prednisolone should be initiated within 72 hours of symptom onset 1, 2
• Dosing regimen:
  • Standard dose: 50-60 mg daily for 5 days, followed by a 5-day taper 1, 3
  • High-dose corticosteroids (≥80 mg) may be more effective than standard doses in improving recovery rates at 6 months, though this evidence is less robust 4
• Treatment with prednisolone significantly improves complete recovery rates:
  • At 3 months: 83.0% vs 63.6% without prednisolone 2
  • At 9 months: 94.4% vs 81.6% without prednisolone 2
• Number needed to treat (NNT) for one additional complete recovery: 6 patients 5

Antiviral Therapy

• Antiviral therapy alone is ineffective and not recommended 1, 3
• There is minimal additional benefit when antivirals are combined with steroids 1
• Studies show no significant difference in recovery rates between acyclovir and no acyclovir groups (71.2% vs 75.7% at 3 months) 2
• If antivirals are considered as adjunctive therapy, options include:
  • Valacyclovir 1 g three times daily for 7 days 3, 6
  • Acyclovir 400 mg five times daily for 10 days 3

Eye Protection Measures

• Critical for patients with impaired eye closure to prevent corneal damage 1
• Recommended measures include:
  • Artificial tears during daytime
  • Lubricating ointment at night
  • Taping eyelids closed if necessary for complete protection

Rehabilitation Considerations

• Physical therapy may benefit patients with more severe paralysis 3
• For persistent symptoms beyond 3 months:
  • Patients with dysphagia should be referred to a facial nerve specialist 1
  • Consider audiologic rehabilitation if hearing is affected 1

Prognosis

• Without treatment, over two-thirds of patients experience complete spontaneous recovery 3
• With early prednisolone treatment, recovery rates increase to 83% at 3 months and 94.4% at 9 months 2
• Children and pregnant women have higher spontaneous recovery rates (up to 90%) 3

Clinical Pearls and Pitfalls

• Key Pitfall: Delaying corticosteroid treatment beyond 72 hours may reduce effectiveness
• Important Consideration: Laboratory testing and imaging are not required for typical Bell's palsy diagnosis 3
• Caution: Ensure that facial weakness is truly Bell's palsy (idiopathic) and not due to other causes that would require different management
• Special Populations: Elderly patients may particularly benefit from combined treatment with corticosteroids and antivirals, with one study showing 100% recovery in treated patients over 60 years compared to only 42% in untreated controls 6