Bell's palsy: Treatment and prognosis in adults
- Michael Ronthal, MD
Michael Ronthal, MD
- Professor of Neurology
- Harvard Medical School
Bell's palsy is the appellation commonly used to describe an acute peripheral facial palsy of unknown cause. However, the terms "Bell's palsy" and "idiopathic facial paralysis" may no longer be considered synonymous. A peripheral facial palsy is a clinical syndrome of many causes, and evaluation requires more than a superficial examination.
This review will discuss the treatment and prognosis of Bell's palsy (ie, idiopathic facial nerve palsy or facial nerve palsy of suspected viral etiology). Other clinical aspects of this disorder are reviewed separately. (See "Bell's palsy: Pathogenesis, clinical features, and diagnosis in adults".)
The treatment of facial nerve palsy related to Lyme disease is discussed elsewhere. (See "Treatment of Lyme disease", section on 'Facial nerve palsy'.)
The mainstay of pharmacologic therapy for acute idiopathic facial nerve palsy (Bell's palsy) or facial nerve palsy of suspected viral etiology is early short-term oral glucocorticoid treatment. In severe acute cases, combining antiviral therapy with glucocorticoids may improve outcomes. Eye care is important for patients with incomplete eye closure (algorithm 1).
Glucocorticoid and antiviral therapy — We recommend early treatment with oral glucocorticoids for all patients with idiopathic facial nerve palsy (Bell's palsy) or facial nerve palsy of suspected viral etiology, consistent with current guidelines [1-4]. Treatment should preferably begin within three days of symptom onset. Our suggested regimen is prednisone (60 to 80 mg/day) for one week.
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