Bell's Palsy Treatment
Bell's Palsy 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|
- 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]