What is the recommended treatment for Bell's palsy (facial paralysis) in a pregnant woman using prednisone (corticosteroid)?

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

Recommended Treatment Approach

• Oral corticosteroids should be prescribed within 72 hours of symptom onset for Bell's palsy patients, including pregnant women, to significantly improve facial nerve recovery 2, 1
• The recommended regimen is prednisolone 50 mg daily for 10 days or prednisone 60 mg daily for 5 days followed by a 5-day taper 1
• Treatment with corticosteroids has shown significant improvement in outcomes, with 83% recovery at 3 months with prednisolone vs 63.6% with placebo, and 94.4% recovery at 9 months with prednisolone vs 81.6% with placebo 1
• Antiviral therapy alone should NOT be prescribed for Bell's palsy, as it is ineffective as monotherapy 2, 1

Special Considerations for Pregnant Women

• Bell's palsy has a higher incidence and potentially worse outcomes in pregnant women, particularly in the third trimester 3, 4
• In a retrospective study, the estimated incidence among pregnant and postpartum women was 60.5/100,000 person-years 4
• Pregnant women with Bell's palsy showed poorer facial function outcomes compared to non-pregnant controls, with lower Sunnybrook scores at both 3 and 12 months 4
• Pre-eclampsia is a common comorbidity in pregnant women who develop Bell's palsy 5

Combination Therapy Considerations

• Oral antiviral therapy may be offered in addition to oral steroids within 72 hours of symptom onset 2, 1
• Some evidence shows higher complete recovery rates with combination therapy (96.5%) compared to steroids alone (89.7%) 2
• The benefit of combination therapy is small but the risks are minimal 2, 6

Eye Protection (Critical Component)

• Eye protection is strongly recommended for all Bell's palsy patients with impaired eye closure to prevent corneal damage 2, 1
• Implement the following measures based on severity:
  • Lubricating ophthalmic drops for daytime protection 1
  • Ophthalmic ointments for more effective moisture retention, particularly at night 1
  • Moisture chambers using polyethylene covers for nighttime protection 1
  • Eye patching or taping with careful instruction on proper technique 1
  • Sunglasses for outdoor protection against foreign particles and irritants 1

Timing of Treatment

• Treatment should be initiated within 72 hours of symptom onset for maximum effectiveness 2, 1, 7
• Starting treatment after the 72-hour window provides minimal benefit and exposes patients to medication risks without clear evidence of efficacy 7
• Early treatment within 3 days of symptom onset is associated with better recovery outcomes 3

Monitoring and Follow-up

• Most patients begin showing signs of recovery within 2-3 weeks of symptom onset 1
• Complete recovery typically occurs within 3-4 months for most patients 1
• Patients should be reassessed or referred to a specialist if:
  • New or worsening neurologic findings develop at any point 1
  • Ocular symptoms develop at any point 1
  • Incomplete facial recovery persists 3 months after initial symptom onset 1

Common Pitfalls to Avoid

• Delaying treatment beyond 72 hours reduces effectiveness of therapy 1, 7
• Using antiviral therapy alone is ineffective and not recommended 2, 1
• Inadequate eye protection can lead to corneal damage in patients with impaired eye closure 2, 1
• Failing to recognize that pregnant women may have worse outcomes and require closer monitoring 3, 4
• Not referring patients with incomplete recovery after 3 months for specialist evaluation 1