Treatment for Bell’s Palsy

Bell's Palsy shows improvement when treated with prednisolone

(RxWiki News) Waking up one morning to facial paralysis can be quite a shock. The best bet is to get to the doctor for steroid treatment as quickly as possible.

A new study shows that antiviral treatments for Bell’s Palsy are not as effective as steroid treatments.

Beginning treatment as soon as onset occurs is key to recovery.

"Unilateral facial numbness and weakness are typical signs of onset."

Dr. Thomas Berg, MD, PhD, from the Oslo University Hospital Rikshospitalet in Norway, and colleagues provided data from a Swedish and Finnish Scandinavian Bell’s Palsy Study on the effects of the steroid prednisolone and the antiviral valacyclovir" data-scaytid="55">valacyclovir on Bell’s Palsy.

Bell’s Palsy is a sudden onset facial paralysis that can affect one or both sides of the face. How severe the paralysis appears depends on the case: some patients have mild weakness or slack on one side, while others have complete paralysis where they cannot blink the affected eye and have major difficulty eating, drinking and even speaking clearly.

There are several theories on what causes Bell’s Palsy but none of them are proven. The most common belief is that the paralysis is a result from a viral infection of herpes simplex one, the cold sore virus.

Swelling from the inflammation of the virus is believed to cause damage to the facial nerve and ‘pinch’ or restrict messages from the brain to the face.

If this were 100 percent true, better results from antiviral medication for treatment should be seen. The majority of cases achieve a full recovery within three to six months. It is extremely important to see a doctor and begin treatment within 72 hours of onset—the sooner, the better.

Dr. Berg’s team looked at 829 Bell’s Palsy patients from the ages of 18-75 who were treated with prednisolone, valacyclovir, a placebo or a combination of two out of the three. Each patient was evaluated with the Sunnybrook and House-Brackmann grading systems after 12 months of treatment.

The authors say of their findings: “To conclude, treatment with prednisolone significantly reduced mild and moderate sequelae (negative aftereffect) in Bell’s Palsy at 12 months.  Prednisolone did not reduce the number of patients with severe sequelae. Valacyclovir alone did not affect the severity of sequelae. The combination of prednisolone plus valacyclovir did not reduce the number of patients with sequelae compared with prednisolone alone.”

Of 829 patients, 184 had a Sunnybrook score less than 90 at 12 months, 71 treated with prednisolone and 113 were not. This means that 645 of the patients almost or completely recovered after 12 months.  The higher the score, the more recovered the patient was from symptoms.  98 patients scored less that 70 on the Sunnybrook scale, 33 treated with prednisolone and 65 were not.

Those patients scoring below 50 on the Sunnybrook scale showed no difference between prednisolone-treated patients and those who were not treated with prednisolone.  This indicates that their cases were severe enough that medication did not help them recover at all or hardly at all.  

This study was published in the Archives of Otolaryngology, May 2012.  

Funding was provided by Uppsala University and Acta Otolaryngologica Foundation, no conflicts of interest were found.

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Review Date: 
May 23, 2012