Management of Bell’s Palsy
Bell’s Palsy is an acute onset of lower motor neuron syndrome, typically impacting one side of the face. The cause of Bell’s Palsy is not well understood but it is thought that inflammation, oedema, or irritation of the facial nerves can result in the presentation that is Bell’s Palsy.
The authors of this article examined the impact of steroid medication, such as prednisolone and antiviral drugs, as well as the combination of both drugs on the recovery rate of Bell’s Palsy.
When prednisolone alone was used, it was noted that those who received corticosteroids had a rate of 94% recovery 9 months post-onset, as compared to those with a recovery rate of 81.6% of those who had not taken any corticosteroid treatment.
When compared to groups who had only been offered an antiviral as part of trials to note if this aided in the recovery of Bell’s Palsy, and it was noted that that antivirals such acyclovir or valaciclovir did not aid in the recovery of Bell’s Palsy symptoms any more than placebos.
When a combination of the drugs was used, the outcomes were not as clear as to whether a combination of drugs provided a higher benefit. Some of the randomised control trials the authors reviewed, noted that no benefit was found by adding an antiviral, whereas a Cochrane review noted some benefit of antivirals, but this was of low quality.
Other therapies briefly discussed in this article include physiotherapy as well as acupuncture to be used adjunctively with the management of symptoms. The aim of facial exercises is to aid in the recovery of facial movements, but according to the authors low quality of evidence has been found to support this.
While it is noted that 70% of Bell’s Palsy cases resolve without intervention, the debilitation and inconvenience it causes can be limited by early intervention with prednisolone treatment.
People suffering from Bell’s Palsy may present at any level of triaging care: to their general practitioners, physiotherapist, acupuncturist, etc. Thus, it is important for all clinicians to be aware that early intervention with steroids may aid in chances of a full recovery. However, given the high percentage of cases with full recovery without intervention, the risks of steroid use may be a necessary consideration for some populations.
Click here for more info about the epidemiologic aspects of Bell's palsy.
> From: Somasundara et al., Aust Prescr 39 (2017) 96-100. All rights reserved to Aust Prescr. Click here for the online summary.