Prednisolone in Bell's Palsy Treatment
Oral prednisolone should be prescribed within 72 hours of symptom onset for all Bell's palsy patients 16 years and older at a dose of 50 mg daily for 10 days or 60 mg daily for 5 days followed by a 5-day taper. 1, 2
Evidence for Prednisolone Effectiveness
- Strong evidence from high-quality randomized controlled trials supports prednisolone use within 72 hours of symptom onset 1
- Prednisolone significantly improves recovery rates: 83% recovery at 3 months with prednisolone versus 63.6% with placebo 1, 3
- Long-term outcomes are also improved: 94.4% recovery at 9 months with prednisolone versus 81.6% without prednisolone 3
- The number needed to treat (NNT) to achieve one additional complete recovery is only 6 4
- Prednisolone significantly reduces mild and moderate sequelae in Bell's palsy, including synkinesis 5
Dosing and Timing
- Treatment must be initiated within 72 hours of symptom onset for maximum effectiveness 1, 6, 2
- Recommended regimen: prednisolone 50 mg daily for 10 days OR prednisone 60 mg daily for 5 days followed by a 5-day taper 1, 2
- The benefit of treatment after 72 hours is less clear and not supported by high-quality evidence 6
- Early treatment aims to reduce facial nerve inflammation before permanent damage occurs 6
Special Populations
Children
- Children have better prognosis with higher rates of spontaneous recovery than adults 1, 7
- Evidence for steroid use in children is less conclusive 8
- A 2022 randomized controlled trial did not show significant improvement with prednisolone in children at 1 month, though the study was underpowered 8
Pregnant Women
- Treatment should be individualized with careful assessment of benefits and risks 7
- The same dosing regimen applies when benefits outweigh risks 7
Additional Management Considerations
Eye protection is essential for patients with impaired eye closure to prevent corneal damage 6, 7
Antiviral monotherapy should NOT be prescribed for Bell's palsy 1, 2
Combination therapy with antivirals provides minimal additional benefit over steroids alone 2, 4, 3
Follow-up and Monitoring
- Most patients begin showing signs of recovery within 2-3 weeks of symptom onset 6
- Complete recovery typically occurs within 3-4 months for most patients 7
- Patients should be reassessed or referred to a facial nerve specialist if 2, 7:
- New or worsening neurologic findings develop
- Ocular symptoms develop
- Incomplete facial recovery persists 3 months after initial symptom onset
Common Pitfalls to Avoid
- Delaying treatment beyond 72 hours reduces effectiveness significantly 6, 2
- Using antiviral therapy alone is ineffective and not recommended 1, 2
- Failing to provide adequate eye protection for patients with impaired eye closure can lead to corneal damage 6, 7
- Not referring patients with incomplete recovery after 3 months for specialist evaluation 6, 7
Prognosis
- Approximately 70% of Bell's palsy patients with complete paralysis recover facial function completely within 6 months even without treatment 6
- Patients with incomplete paralysis have higher recovery rates, up to 94% 6, 7
- Early deterioration in Bell's palsy is a negative prognostic factor, but prednisolone treatment significantly improves outcomes even in these cases 9