Bell's Palsy Treatment

Author: Michelle Lin, MD
Updated: 2/21/2013

Bell's Palsy Treatment

Treatment

  • Corticosteroids, if onset within 72 hours
  • 1 in 11 were helped (to complete recovery) - NNT.com
  • Prednisone: 60 mg daily x 1 week. May consider taper for days #8-10
  • Artificial tears in daytime and lubricating eye ointment at night to prevent corneal drying and exposure
  • Tape eyelid shut while asleep.

Controversial benefit of antivirals (at most risk difference of 7%):

  • American Academy of Neurology (2012), JAMA (2009), and UpToDate suggest giving for severe cases such as for Grade IV and higher
  • Cochrane review (2009): No antivirals indicated.
  • Valacylovir 1000 mg TID or Acyclovir 400 mg 5x daily x 1 week
  • Also prescribe corticosteroids, if antivirals given.

House-Brackmann grading for severity of facial nerve weakness

Grade Dysfunction Gross weakness At rest Motion
I None No weakness No weakness Normal function all groups
II Mild Slight weakness noticeable on close inspection. May have very slight synkinesis Normal symmetry and tone Forehead: Moderate-to-good function Mouth: Slight asymmetry
III Moderate Obvious but not disfiguring difference; noticeable but not severe synkinesis, contracture, and/or hemifacial spasm Normal symmetry and tone Forehead: Slight-to-moderate movement Mouth: Slightly weak with maximum effort
IV Moderately severe Obvious weakness and/or disfiguring asymmetry Normal symmetry and tone Forehead: None Mouth: Asymmetric with maximum effort
V Severe Only barely perceptible motion Asymmetry Forehead: None Mouth: Slight movement
VI Total paralysis No movement Asymmetry None for all groups

References

  • Gronseth GS, Paduga R; American Academy of Neurology. Evidence-based guideline update: steroids and antivirals for Bell palsy: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2012 Nov 27;79(22):2209-13. doi: 10.1212/WNL.0b013e318275978c. Epub 2012 Nov 7. [PubMed]
  • de Almeida JR, Al Khabori M, Guyatt GH, Witterick IJ, Lin VY, Nedzelski JM, Chen JM. Combined corticosteroid and antiviral treatment for Bell palsy: a systematic review and meta-analysis. JAMA. 2009 Sep 2;302(9):985-93. doi: 10.1001/jama.2009.1243. [PubMed]
  • Lockhart P, Daly F, Pitkethly M, Comerford N, Sullivan F. Antiviral treatment for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev. 2009 Oct 7;(4):CD001869. doi: 10.1002/14651858.CD001869.pub4. [PubMed]