What is the treatment for Bell's palsy in a 9-month pregnant female?

From the Guidelines

For Bell's palsy in a 9-month pregnant female, treatment should include oral corticosteroids, such as prednisone, within 72 hours of symptom onset, as it significantly improves outcomes and recovery, with benefits outweighing potential risks 1.

Treatment Approach

The treatment approach for Bell's palsy in pregnant women is similar to that in non-pregnant women, with a focus on reducing inflammation and promoting recovery.

• Oral corticosteroids, specifically prednisone 60-80 mg daily for 5-7 days, followed by a taper over the next 5-7 days, are considered relatively safe during pregnancy, especially in the third trimester.
• Eye protection is crucial, so artificial tears during the day and lubricating eye ointment at night should be used, along with taping the eyelid closed if unable to close completely.
• Physical therapy with facial exercises and gentle massage may help maintain muscle tone.
• Antiviral medications like acyclovir are generally not recommended routinely in pregnancy unless there's strong evidence of herpes zoster involvement.

Monitoring and Reassurance

Close monitoring by both a neurologist and obstetrician is important, as is reassurance that most cases resolve within 3-6 months with proper treatment.

• The patient should be informed that Bell's palsy doesn't affect labor or delivery capabilities.
• Prompt treatment (ideally within 72 hours of symptom onset) significantly improves outcomes and recovery, as shown in studies such as those by Sullivan et al and Engstrom et al 1.

From the Research

Treatment of Bell's Palsy in a 9-Month Pregnant Female

• The treatment of Bell's palsy in pregnant women, particularly those in their third trimester, is crucial due to the increased incidence and severity of the condition during this period 2.
• Early treatment with corticosteroids for 10 days is highly recommended, as it has been shown to improve outcomes and reduce the risk of persistent nerve palsy 2, 3.
• The simultaneous use of antiviral therapy with corticosteroids may be considered, although the evidence supporting its effectiveness is limited 2, 4, 5, 6.
• A study published in the American Family Physician recommends an oral corticosteroid regimen, such as prednisone, 50 to 60 mg per day for five days, followed by a five-day taper 3.
• Another study suggests that the combination of antivirals and corticosteroids may reduce the rate of incomplete recovery and long-term sequelae, such as motor synkinesis or crocodile tears 4.
• The prognosis of Bell's palsy in pregnancy is generally worse than in non-pregnant individuals, emphasizing the importance of prompt and effective treatment 2.

Key Considerations

• Treatment should be initiated within 72 hours of symptom onset to optimize the likelihood of recovery 5.
• The use of antiviral therapy alone is not recommended, as it has been shown to be ineffective in improving outcomes 4, 6.
• Physical therapy may be beneficial in patients with more severe paralysis, although the evidence is limited 3.
• The risk of adverse events associated with antiviral therapy is uncertain, and further research is needed to fully understand its safety profile 4.