What is the treatment for Bell's palsy?

Treatment of Bell's Palsy

Oral corticosteroids should be prescribed within 72 hours of symptom onset as the first-line treatment for Bell's palsy in patients 16 years and older. 1, 2, 3

First-Line Treatment

• Recommended corticosteroid regimens include prednisolone 50 mg daily for 10 days, or prednisone 60 mg daily for 5 days followed by a 5-day taper 1, 2, 3
• Strong evidence supports corticosteroid use, with studies showing 83% recovery at 3 months with prednisolone versus 63.6% with placebo, and 94.4% recovery at 9 months with prednisolone versus 81.6% with placebo 1, 2, 4
• Treatment should be initiated within 72 hours of symptom onset for maximum effectiveness 2, 3

Eye Protection

• Eye protection is essential for all Bell's palsy patients with impaired eye closure to prevent corneal damage 2, 5
• Protective measures include lubricating ophthalmic drops, ophthalmic ointments, eye patching or taping, and sunglasses for outdoor protection 2

Antiviral Therapy

• Antiviral therapy alone should NOT be prescribed for Bell's palsy as it is ineffective 2, 3, 6
• Combination therapy with oral antivirals and corticosteroids may be considered as an option within 72 hours of symptom onset 2, 3
• Some evidence suggests combination therapy may reduce rates of synkinesis (involuntary co-contraction of facial muscles) 6
• When used, recommended antivirals include valacyclovir (1 g three times daily for 7 days) or acyclovir (400 mg five times daily for 10 days) 6

Special Populations

Children

• Children with Bell's palsy have a better prognosis than adults, with higher rates of spontaneous recovery 2, 6
• Evidence for corticosteroid use in children is less conclusive 2, 3

Pregnant Women

• Pregnant women should receive oral corticosteroids within 72 hours of symptom onset, with careful individualized assessment of benefits and risks 2
• Spontaneous recovery rates in pregnant women can reach up to 90% 6

Follow-up and Monitoring

• Patients should be reassessed or referred to a facial nerve specialist if they have: 2, 3, 5
  • New or worsening neurologic findings at any point
  • Ocular symptoms developing at any point
  • Incomplete facial recovery 3 months after initial symptom onset

Diagnostic Testing

• Routine laboratory testing and diagnostic imaging are NOT recommended for typical Bell's palsy diagnosis 2
• MRI with and without contrast is the imaging test of choice when indicated, such as for atypical presentations or no sign of recovery after 3 months 1, 2

Recovery Timeline

• Most patients begin showing signs of recovery within 2-3 weeks of symptom onset 2
• Complete recovery typically occurs within 3-4 months for most patients 2
• Approximately 70% of patients with complete paralysis recover facial function completely within 6 months 2
• Patients with incomplete paralysis have higher recovery rates, up to 94% 2

Emerging Research

• Recent research suggests high-dose corticosteroids (≥80 mg) may be more effective than standard doses (40-60 mg), showing decreased non-recovery at 6 months follow-up 7
• Physical therapy may be beneficial for patients with more severe paralysis and developing synkinesis, though evidence for specific protocols is limited 5, 6

Common Pitfalls to Avoid

• Delaying treatment beyond 72 hours, which reduces effectiveness of therapy 2, 3
• Using antiviral therapy alone, which is ineffective 2, 3, 6
• Failing to provide adequate eye protection for patients with impaired eye closure 2, 5
• Neglecting to reassess patients with incomplete recovery after 3 months 2, 5