Do you recommend changing the treatment approach for Bell's palsy, given the use of high-dose steroids, such as prednisolone (corticosteroid)?

High-Dose Steroids in Bell's Palsy Treatment

High-dose corticosteroids are more effective than standard-dose regimens for treating Bell's palsy and should be used as first-line therapy within 72 hours of symptom onset. 1, 2

Recommended Treatment Protocol

• A 10-day course of oral steroids with at least 5 days at high dose should be initiated within 72 hours of symptom onset for optimal outcomes 3, 4
• The recommended high-dose regimen is either:
  • Prednisolone 50-60 mg daily for 5 days followed by a 5-day taper 4, 5, or
  • Prednisolone 100-200 mg daily (high-dose) which shows significantly better recovery rates compared to standard doses 1, 2
• Recent meta-analysis demonstrates that high-dose corticosteroids (≥80 mg) significantly decrease non-recovery rates at 6 months compared to standard doses (40-60 mg) (OR = 0.17,95% CI = 0.05-0.56) 1

Evidence Supporting High-Dose Steroids

• High-dose corticosteroids are associated with significantly better recovery rates at 6 months compared to standard doses 2
• The safety profile remains favorable with high-dose regimens, with minimal serious adverse effects reported 1, 2
• Treatment should be initiated within 72 hours of symptom onset for maximum effectiveness 4, 5
• Recovery rates with prednisolone treatment are 83% at 3 months and 94.4% at 9 months, compared to 63.6% and 81.6% with placebo, respectively 3, 4

Special Considerations

• For adults, high-dose corticosteroids should be the standard of care 1, 2
• For children, evidence for steroid use is less conclusive as they show higher rates of spontaneous recovery than adults 3, 4
• Antiviral therapy alone is ineffective and not recommended 3, 4, 6
• Combination therapy with antivirals may be considered but provides only minimal additional benefit over steroids alone 4, 7

Treatment Algorithm

1. Confirm diagnosis of Bell's palsy (acute unilateral facial weakness/paralysis with forehead involvement) 4, 7
2. Initiate high-dose corticosteroids within 72 hours of symptom onset 4, 1
3. Use prednisolone 100-200 mg daily for optimal outcomes 1, 2
4. Implement eye protection measures for patients with impaired eye closure 4, 5
5. Consider adding antiviral therapy only as an adjunct to steroids, not as monotherapy 4, 7
6. Follow up at 3 months; refer to specialist if incomplete recovery 4, 5

Common Pitfalls to Avoid

• Delaying treatment beyond 72 hours significantly reduces effectiveness 4, 5
• Using standard-dose instead of high-dose corticosteroids results in lower recovery rates 1, 2
• Using antiviral therapy alone is ineffective and not recommended 3, 4, 6
• Failing to provide adequate eye protection for patients with impaired eye closure 4, 5
• Not referring patients with incomplete recovery after 3 months to specialists 4, 5

Alternative Administration Methods

• Single-dose intravenous methylprednisolone (500 mg) shows equivalent benefit to oral prednisolone in acute Bell's palsy and may be considered as an alternative 8