From the Guidelines
Bell's palsy treatment should involve prescribing oral steroids within 72 hours of symptom onset for patients 16 years and older, as this has been shown to significantly improve facial nerve function and reduce the risk of permanent nerve damage 1. The primary goal of treatment is to reduce inflammation of the facial nerve and prevent permanent damage.
- Corticosteroids, such as prednisone, are the primary intervention, with a recommended dose of 60-80mg daily for 7 days, started within 72 hours of symptom onset.
- Antiviral medications like valacyclovir may be added, especially if herpes infection is suspected, though evidence for their benefit is less robust than for steroids 1.
- Eye protection is crucial for patients who cannot close their affected eye completely, with artificial tears during the day and lubricating ointment with eye taping at night to prevent corneal damage.
- Physical therapy, including facial exercises and massage, may help maintain muscle tone during recovery, although its effectiveness is not well established 1.
- Patients should seek immediate medical attention if symptoms worsen or don't improve after treatment, as this could indicate an alternative diagnosis requiring different management 1. Key considerations in treatment include:
- Reducing inflammation of the facial nerve to prevent permanent damage
- Protecting the eye from corneal damage
- Maintaining muscle tone through physical therapy
- Monitoring for potential complications, such as incomplete facial nerve recovery, and referring patients to specialists as needed 1.
From the Research
Bell's Palsy Treatment Overview
- Bell's palsy is a condition characterized by acute onset of unilateral facial weakness or paralysis, and its treatment typically involves oral corticosteroids as the first-line treatment 2.
- The overall prognosis for Bell's palsy is good, with more than two-thirds of patients experiencing complete spontaneous recovery, and the rate of complete recovery is up to 90% for children and pregnant women 2.
Treatment Options
- Oral corticosteroid regimens, such as prednisone, are the primary treatment for Bell's palsy, with a recommended dosage of 50 to 60 mg per day for five days followed by a five-day taper 2.
- Combination therapy with an oral corticosteroid and antiviral, such as valacyclovir or acyclovir, may reduce rates of synkinesis, a potential complication of Bell's palsy 2, 3, 4.
- Treatment with antivirals alone is ineffective and not recommended 2.
- Physical therapy may be beneficial for patients with more severe paralysis 2.
Efficacy of Treatment Options
- Studies have shown that treatment with valacyclovir and prednisone can lead to significantly better outcomes in patients with Bell's palsy compared to no medical treatment or treatment with prednisone alone 3, 4.
- A randomized controlled trial found that prednisolone treatment resulted in higher complete recovery rates, regardless of the severity of the palsy at baseline, and that valaciclovir did not add any significant effect to prednisolone regarding recovery rate or synkinesis at 12 months 5.
- A retrospective analysis suggested that steroid monotherapy initiated within 72 hours of symptom onset may be the most effective treatment approach, although combined therapy may have potential advantages in patients with more severe disease 6.