From the Guidelines
Bell's palsy treatment typically involves the administration of corticosteroids, such as prednisone, at a dose of 50-60 mg per day for 5-7 days, followed by a tapering course over the next 7-10 days, as supported by high-quality randomized controlled trials, including those by Sullivan et al and Engstrom et al 1.
Treatment Options
- Oral Steroids: Clinicians should prescribe oral steroids within 72 hours of symptom onset for Bell’s palsy patients 16 years and older, as strongly recommended by the clinical practice guideline 1.
- Antiviral Medications: Antiviral medications, like valacyclovir or acyclovir, may also be prescribed, particularly if the condition is suspected to be related to a viral infection, at a dose of 1000 mg per day for 7-10 days, although the evidence for their effectiveness is not as strong 1.
- Physical Therapy and Facial Exercises: While there is no strong evidence to support the benefit of physical therapy in Bell’s palsy, it may be recommended to improve facial function and prevent synkinesis, as some small studies suggest it may result in some level of improvement in patients experiencing prolonged symptoms 1.
Important Considerations
- Eye Protection: Clinicians should implement eye protection for Bell’s palsy patients with impaired eye closure, as strongly recommended by the clinical practice guideline 1.
- Electrodiagnostic Testing: Clinicians may offer electrodiagnostic testing to Bell’s palsy patients with complete facial paralysis, although there is no strong evidence to support its effectiveness 1.
- Surgical Decompression, Acupuncture, and Patient Follow-up: No recommendation can be made regarding surgical decompression, acupuncture, or the effect of physical therapy in Bell’s palsy patients, and clinicians should reassess or refer to a facial nerve specialist those patients with new or worsening neurologic findings, ocular symptoms, or incomplete facial recovery 3 months after initial symptom onset 1.
From the Research
Treatment Options for Bell's Palsy
The treatment options for Bell's palsy include:
- Oral corticosteroid regimen, such as prednisone, as the first-line treatment 2
- Combination therapy with an oral corticosteroid and antiviral, such as valacyclovir or acyclovir, to reduce rates of synkinesis 2, 3
- High-dose corticosteroids, which may be more effective than standard-dose corticosteroids in reducing nonrecovery rates 4
- Physical therapy, which may be beneficial in patients with more severe paralysis 2, 5
- Antiviral treatment alone is not recommended, as it has been shown to be ineffective 2, 3
- Low-level laser therapy combined with facial expression exercises, which is being studied as a potential treatment option 6
Patient-Specific Treatment Options
Treatment options may vary depending on the severity of the Bell's palsy and the patient's individual needs. For example:
- Patients with severe Bell's palsy (House-Brackmann scores of 5 and 6) may benefit from combination therapy with antivirals and corticosteroids 3
- Patients with moderate-to-severe Bell's palsy may benefit from low-level laser therapy combined with facial expression exercises 6
- Children and pregnant women may have a higher rate of complete recovery with corticosteroid treatment 2
Treatment Outcomes
The outcomes of treatment for Bell's palsy may vary depending on the treatment option and the severity of the condition. For example:
- More than two-thirds of patients with typical Bell's palsy have a complete spontaneous recovery 2
- Combination therapy with antivirals and corticosteroids may reduce rates of synkinesis and improve outcomes 2, 3
- High-dose corticosteroids may reduce nonrecovery rates compared to standard-dose corticosteroids 4