Fast Five Quiz: Bell Palsy and Other Facial Paralysis

Helmi L. Lutsep, MD


February 27, 2020

People with true Bell palsy generally have an excellent prognosis, and spontaneous recovery is fairly common, so treatment of Bell palsy is still controversial. The goals of treatment are to improve facial nerve (seventh cranial nerve) function and reduce neuronal damage. Treatment of Bell palsy should be conservative and guided by the severity and probable prognosis in each particular patient. Studies have shown the benefit of high-dose corticosteroids for patients with acute disease.

Guidelines from the American Academy of Otolaryngology–Head and Neck Surgery Foundation support the American Academy of Neurology guidelines. They recommend the use of corticosteroids within 72 hours from the onset of symptoms. The recommended dose of prednisone for the treatment of Bell palsy is 1 mg/kg or 60 mg/day for 6 days, followed by a taper, for a total of 10 days. Caution should be used in patients with these diseases or conditions:

  • Tuberculosis

  • Compromised immune system

  • Pregnancy

  • Active infection

  • Sarcoidosis

  • Sepsis

  • Peptic ulcer disease

  • Diabetes mellitus

  • Renal or hepatic dysfunction

  • Malignant hypertension

Antiviral agents (eg, acyclovir, valacyclovir) may be considered if a viral etiology is suspected but only in combination with corticosteroids. High-dose steroids (> 120 mg/day of prednisone) have been safely used to treat Bell palsy in patients with diabetes; however, optimal dosing has not been established. Caution should be used in these patients because of the risk for hyperglycemia.

Read more about the treatment of Bell palsy.

This Fast Five Quiz was excerpted and adapted from the Medscape Drugs & Diseases articles Facial Nerve Paralysis, Bell Palsy, Lyme Disease, Ramsay Hunt Syndrome, Ischemic Stroke, and A 24-Year-Old Man With Ear Pain, Dizziness, and a Rash.

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