What is the treatment for Bell's (Bell's) palsy?

From the Guidelines

The treatment for Bell's palsy is oral steroids within 72 hours of symptom onset for patients 16 years and older.

Key Points

• The recommended treatment is based on high-quality randomized controlled trials with a preponderance of benefit over harm 1.
• Oral steroids, such as prednisolone, should be prescribed within 72 hours of symptom onset to decrease recovery time and improve facial nerve functional recovery 1.
• The dosage of prednisolone can vary, but common regimens include 25 mg twice daily for 10 days or 60 mg per day for 5 days, then tapered over 5 days 1.
• Antiviral therapy may be offered in addition to oral steroids within 72 hours of symptom onset, but its benefit is not well established and should be decided on a case-by-case basis with shared decision making 1.
• Other treatments, such as electrodiagnostic testing, surgical decompression, acupuncture, and physical therapy, are not recommended or have no clear benefit in the treatment of Bell's palsy 1.

Important Considerations

• Patients with certain conditions, such as diabetes, morbid obesity, and previous steroid intolerance, should be treated with caution and on an individualized basis 1.
• Pregnant women should also be treated on an individualized basis 1.
• Eye protection should be implemented for patients with impaired eye closure to prevent complications 1.

From the Research

Treatment Overview

The treatment for Bell's palsy typically involves the use of oral corticosteroids, with or without antiviral agents, depending on the severity of the condition and the timing of treatment initiation 2, 3, 4, 5, 6.

First-Line Treatment

• Oral corticosteroid regimen, such as prednisone (50 to 60 mg per day for five days followed by a five-day taper), is the first-line treatment for Bell's palsy 2.
• High-dose corticosteroids (≥80 mg) may be more effective than standard-dose corticosteroids (40-60 mg) in reducing nonrecovery rates at 6 months follow-up 3.

Combination Therapy

• Combination therapy with an oral corticosteroid and antiviral may reduce rates of synkinesis (misdirected regrowth of facial nerve fibers) 2.
• Antiviral agents, such as valacyclovir or acyclovir, may be added to corticosteroid therapy in severe cases or when viral involvement is strongly suspected 2, 5.
• However, the efficacy of combination therapy remains controversial, and current guidelines recommend selective use of antiviral agents 5.

Timing of Treatment

• Early administration of corticosteroids, preferably within 72 hours of symptom onset, considerably improves outcomes 5, 6.
• Initiating treatment beyond 72 hours may still be associated with a higher recovery rate than starting treatment within 72 hours, depending on individual factors 6.

Additional Therapies

• Physical therapy may be beneficial in patients with more severe paralysis 2.
• Electroneurography (ENoG) and electromyography (EMG) results, as well as comorbid conditions, may affect recovery rates and should be considered in treatment planning 6.