What is the treatment for Bell's palsy in pregnancy?

Treatment of Bell's Palsy in Pregnancy

Pregnant women with Bell's palsy should be treated with oral corticosteroids within 72 hours of symptom onset, with careful individualized assessment of benefits and risks. 1, 2

Diagnosis and Assessment

• Bell's palsy is an acute unilateral facial nerve paresis or paralysis with onset in less than 72 hours without an identifiable cause 2
• Pregnancy is a risk factor for Bell's palsy, with most cases occurring in the third trimester or postpartum period 3
• Pregnancy-related Bell's palsy has worse outcomes compared to non-pregnant women, with higher rates of complete facial paralysis 3

Treatment Recommendations

First-Line Treatment

• Oral corticosteroids should be prescribed within 72 hours of symptom onset 2, 4
• Recommended regimen: prednisolone 50 mg daily for 10 days or prednisone 60 mg daily for 5 days followed by a 5-day taper 2, 4
• The American Academy of Otolaryngology-Head and Neck Surgery guidelines note that pregnant women should be treated on an individualized basis 1
• Early treatment with steroids (within 3 days) is associated with better outcomes 3

Antiviral Therapy

• Antiviral therapy alone should not be prescribed for Bell's palsy 2, 5
• Combination therapy with oral antivirals and corticosteroids may be considered on an individualized basis 1, 4
• The benefit of antiviral therapy in addition to steroids remains controversial but may offer small potential improvement in facial nerve function 1

Eye Protection

• Eye protection is essential for patients with impaired eye closure to prevent corneal damage 1, 2
• Implement protective measures such as:
  • Frequent administration of lubricating ophthalmic drops 1
  • Use of ophthalmic ointments 1
  • Eye patching or taping 1
  • Use of sunglasses for outdoor protection 1

Special Considerations in Pregnancy

• Only about one-third of pregnant women with Bell's palsy receive corticosteroid treatment, despite recommendations 6
• Pregnancy itself is associated with persistent nerve palsy and potentially worse outcomes 3, 6
• The incidence of Bell's palsy in pregnancy and postpartum is approximately 60.5 per 100,000 women per year 6
• Recovery rates in children and pregnant women can reach up to 90%, though recent evidence suggests outcomes may be worse in pregnancy 5, 6

Follow-up and Monitoring

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

Common Pitfalls to Avoid

• Delaying treatment beyond 72 hours reduces effectiveness of therapy 4, 3
• Using antiviral therapy alone is ineffective and not recommended 4, 5
• Failing to provide adequate eye protection for patients with impaired eye closure 1, 2
• Withholding corticosteroid treatment due to pregnancy concerns despite evidence supporting its use 6, 7

Alternative Therapies

• While acupuncture has been reported in case studies to benefit pregnant patients with Bell's palsy 8, the American Academy of Otolaryngology-Head and Neck Surgery makes no recommendation regarding acupuncture due to poor-quality trials 2
• Physical therapy may be beneficial in patients with more severe paralysis, though evidence is limited 5

Remember that early intervention with corticosteroids is crucial for optimal outcomes, and pregnant women should not be denied this treatment solely based on pregnancy status 3, 7.