What is the recommended steroid dose for Bell's Palsy?

Recommended Steroid Dose for Bell's Palsy

For patients with Bell's palsy, a 10-day course of oral steroids with at least 5 days at a high dose should be prescribed, using either prednisolone 50 mg daily for 10 days or prednisone 60 mg daily for 5 days followed by a 5-day taper, initiated within 72 hours of symptom onset. 1, 2, 3

Adult Treatment Protocol

• Oral corticosteroids are the first-line treatment for Bell's palsy patients 16 years and older, with strong evidence supporting their use 2, 3
• Treatment should be initiated within 72 hours of symptom onset for maximum effectiveness 2, 3, 4
• The recommended regimen is either:
  • Prednisolone 50 mg daily for 10 days, OR
  • Prednisone 60 mg daily for 5 days followed by a 5-day taper 1, 2
• Early treatment significantly improves outcomes, with studies showing 83% recovery at 3 months with prednisolone versus 63.6% with placebo 1, 2
• Long-term outcomes also favor steroid treatment, with 94.4% recovery at 9 months with prednisolone versus 81.6% with placebo 1, 2

Evidence Quality and Treatment Efficacy

• High-quality randomized controlled trials demonstrate that corticosteroid treatment significantly reduces the risk of incomplete recovery 5
• The number needed to treat (NNT) with corticosteroids to avoid one incomplete recovery is 10 5
• Recent meta-analysis suggests that high-dose corticosteroids (≥80 mg) may be more effective than standard doses (40-60 mg) in reducing non-recovery at 6 months 6
• Delayed treatment beyond 7 days significantly increases the risk of unfavorable outcomes (RR = 18.87) 4

Special Populations

• Children with Bell's palsy have better prognosis with higher rates of spontaneous recovery than adults 1, 2
• Evidence for steroid use in children is less conclusive, though oral steroids may be considered based on the presumed similar disease process and favorable benefit-harm ratio 1, 2
• Pregnant women should receive oral corticosteroids within 72 hours of symptom onset, with individualized assessment of benefits and risks 2

Combination Therapy Considerations

• Antiviral monotherapy should NOT be prescribed for Bell's palsy 1, 2, 3
• Oral antiviral therapy may be offered in addition to oral steroids within 72 hours of symptom onset as an option 1, 2
• Some evidence shows slightly higher complete recovery rates with combination therapy (96.5%) compared to steroids alone (89.7%) 1, 2

Follow-up and Monitoring

• Patients should be reassessed or referred to a facial nerve specialist if:
  • New or worsening neurologic findings develop
  • Ocular symptoms develop
  • Incomplete facial recovery persists 3 months after initial symptom onset 2, 3
• Eye protection is essential for patients with impaired eye closure to prevent corneal damage 2, 3

Common Pitfalls to Avoid

• Delaying treatment beyond 72 hours significantly reduces effectiveness of therapy 2, 3, 4
• Using antiviral therapy alone is ineffective and not recommended 2, 3
• Failing to provide adequate eye protection for patients with impaired eye closure can lead to corneal damage 2, 3
• Routine laboratory testing and imaging are not required for typical presentations of Bell's palsy 2, 3