Bell's palsy medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
[[Pharmacologic|Pharmacologic medical therapy]] is recommended among all patients with Bell's palsy. Most patients with Bell's palsy recover fully without treatment. [[Corticosteroid]]<nowiki/>s may reduce the risk of unsatisfactory recovery in patients with Bell palsy and are highly recommended for treatment of Bell's palsy. [[Antiviral Therapy|Antiviral agents]], when administered with [[Corticosteroid|corticosteroids]], may be associated with additional benefit. Pharmacologic medical therapy in adults include: [[prednisolone]] 60 mg PO q24h for 5 days then reduced by 10 mg per day (for a total treatment time of 10 days) and 50 mg per day (in two divided doses) for 10 days and [[acyclovir]] 2000 mg PO q24h for 7-10 days. Pharmacologic medical therapy in children include: [[prednisolone]] 1 mg/kg PO per day q24h for 10 days . There is low quality evidence that tailored facial exercises can help to improve facial function in patients with bell's palsy. There is low quality evidence that facial exercise reduces [[sequelae]] in acute cases of bell's palsy. | [[Pharmacologic|Pharmacologic medical therapy]] is recommended among all patients with [[Bell's palsy CT|Bell's palsy]]. Most patients with [[Bell's palsy (patient information)|Bell's palsy]] recover fully without treatment. [[Corticosteroid]]<nowiki/>s may reduce the risk of unsatisfactory recovery in patients with [[Bell palsy]] and are highly recommended for treatment of [[Bell's palsy (patient information)|Bell's palsy]]. [[Antiviral Therapy|Antiviral agents]], when administered with [[Corticosteroid|corticosteroids]], may be associated with additional benefit. Pharmacologic [[Medical therapy for lower extremity peripheral arterial disease|medical therapy]] in adults include: [[prednisolone]] 60 mg PO q24h for 5 days then reduced by 10 mg per day (for a total treatment time of 10 days) and 50 mg per day (in two divided doses) for 10 days and [[acyclovir]] 2000 mg PO q24h for 7-10 days. Pharmacologic [[Medical therapy for lower extremity peripheral arterial disease|medical therapy]] in children include: [[prednisolone]] 1 mg/kg PO per day q24h for 10 days . There is low quality evidence that tailored facial exercises can help to improve facial function in patients with [[Bell's palsy (patient information)|bell's palsy]]. There is low quality evidence that facial exercise reduces [[sequelae]] in acute cases of [[Bell's Palsy|bell's]] [[Palsy|palsy.]] | ||
==Medical Therapy== | ==Medical Therapy== | ||
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* 1.1.1 '''Adult''' | * 1.1.1 '''Adult''' | ||
** [[prednisolone]] 60 mg PO q24h for 5 days then reduced by 10 mg per day (for a total treatment time of 10 days) and 50 mg per day (in two divided doses) for 10 days.<ref name="pmid18849193">{{cite journal| author=Engström M, Berg T, Stjernquist-Desatnik A, Axelsson S, Pitkäranta A, Hultcrantz M et al.| title=Prednisolone and valaciclovir in Bell's palsy: a randomised, double-blind, placebo-controlled, multicentre trial. | journal=Lancet Neurol | year= 2008 | volume= 7 | issue= 11 | pages= 993-1000 | pmid=18849193 | doi=10.1016/S1474-4422(08)70221-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18849193 }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19306494 Review in: Ann Intern Med. 2009 Mar 17;150(6):JC3-12] </ref><ref name="pmid17942873">{{cite journal| author=Sullivan FM, Swan IR, Donnan PT, Morrison JM, Smith BH, McKinstry B et al.| title=Early treatment with prednisolone or acyclovir in Bell's palsy. | journal=N Engl J Med | year= 2007 | volume= 357 | issue= 16 | pages= 1598-607 | pmid=17942873 | doi=10.1056/NEJMoa072006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17942873 }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18311859 Review in: ACP J Club. 2008 Mar-Apr;148(2):29] [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18171565 Review in: J Fam Pract. 2008 Jan;57(1):22-5] [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18375697 Review in: Evid Based Med. 2008 Apr;13(2):44] </ref><ref name="pmid21847333">{{cite journal| author=Murthy JM, Saxena AB| title=Bell's palsy: Treatment guidelines. | journal=Ann Indian Acad Neurol | year= 2011 | volume= 14 | issue= Suppl 1 | pages= S70-2 | pmid=21847333 | doi=10.4103/0972-2327.83092 | pmc=3152161 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21847333 }} </ref> | **[[prednisolone]] 60 mg PO q24h for 5 days then reduced by 10 mg per day (for a total treatment time of 10 days) and 50 mg per day (in two divided doses) for 10 days.<ref name="pmid18849193">{{cite journal| author=Engström M, Berg T, Stjernquist-Desatnik A, Axelsson S, Pitkäranta A, Hultcrantz M et al.| title=Prednisolone and valaciclovir in Bell's palsy: a randomised, double-blind, placebo-controlled, multicentre trial. | journal=Lancet Neurol | year= 2008 | volume= 7 | issue= 11 | pages= 993-1000 | pmid=18849193 | doi=10.1016/S1474-4422(08)70221-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18849193 }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19306494 Review in: Ann Intern Med. 2009 Mar 17;150(6):JC3-12] </ref><ref name="pmid17942873">{{cite journal| author=Sullivan FM, Swan IR, Donnan PT, Morrison JM, Smith BH, McKinstry B et al.| title=Early treatment with prednisolone or acyclovir in Bell's palsy. | journal=N Engl J Med | year= 2007 | volume= 357 | issue= 16 | pages= 1598-607 | pmid=17942873 | doi=10.1056/NEJMoa072006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17942873 }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18311859 Review in: ACP J Club. 2008 Mar-Apr;148(2):29] [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18171565 Review in: J Fam Pract. 2008 Jan;57(1):22-5] [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18375697 Review in: Evid Based Med. 2008 Apr;13(2):44] </ref><ref name="pmid21847333">{{cite journal| author=Murthy JM, Saxena AB| title=Bell's palsy: Treatment guidelines. | journal=Ann Indian Acad Neurol | year= 2011 | volume= 14 | issue= Suppl 1 | pages= S70-2 | pmid=21847333 | doi=10.4103/0972-2327.83092 | pmc=3152161 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21847333 }} </ref> | ||
** [[acyclovir]] 2000 mg PO q24h for 7-10 days | ** [[acyclovir]] 2000 mg PO q24h for 7-10 days | ||
* 1.1.2 '''Pediatric''' | * 1.1.2 '''Pediatric''' | ||
** [[prednisolone]] 1 mg/kg PO per day q24h for 10 days.<ref name="pmid28193257">{{cite journal| author=Babl FE, Mackay MT, Borland ML, Herd DW, Kochar A, Hort J et al.| title=Bell's Palsy in Children (BellPIC): protocol for a multicentre, placebo-controlled randomized trial. | journal=BMC Pediatr | year= 2017 | volume= 17 | issue= 1 | pages= 53 | pmid=28193257 | doi=10.1186/s12887-016-0702-y | pmc=5307816 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28193257 }} </ref> | **[[prednisolone]] 1 mg/kg PO per day q24h for 10 days.<ref name="pmid28193257">{{cite journal| author=Babl FE, Mackay MT, Borland ML, Herd DW, Kochar A, Hort J et al.| title=Bell's Palsy in Children (BellPIC): protocol for a multicentre, placebo-controlled randomized trial. | journal=BMC Pediatr | year= 2017 | volume= 17 | issue= 1 | pages= 53 | pmid=28193257 | doi=10.1186/s12887-016-0702-y | pmc=5307816 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28193257 }} </ref> | ||
=== Physical therapy === | === Physical therapy === | ||
Revision as of 14:30, 10 April 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]
Overview
Pharmacologic medical therapy is recommended among all patients with Bell's palsy. Most patients with Bell's palsy recover fully without treatment. Corticosteroids may reduce the risk of unsatisfactory recovery in patients with Bell palsy and are highly recommended for treatment of Bell's palsy. Antiviral agents, when administered with corticosteroids, may be associated with additional benefit. Pharmacologic medical therapy in adults include: prednisolone 60 mg PO q24h for 5 days then reduced by 10 mg per day (for a total treatment time of 10 days) and 50 mg per day (in two divided doses) for 10 days and acyclovir 2000 mg PO q24h for 7-10 days. Pharmacologic medical therapy in children include: prednisolone 1 mg/kg PO per day q24h for 10 days . There is low quality evidence that tailored facial exercises can help to improve facial function in patients with bell's palsy. There is low quality evidence that facial exercise reduces sequelae in acute cases of bell's palsy.
Medical Therapy
- Pharmacologic medical therapy is recommended among all patients with Bell's palsy.[1]
- Most patients with Bell's palsy recover fully without treatment.[2]
- Corticosteroids may reduce the risk of unsatisfactory recovery in patients with Bell palsy and are highly recommended for treatment of Bell's palsy.[3]
- Antiviral agents, when administered with corticosteroids, may be associated with additional benefit.[3]
Pharmacologic medical therapy
- 1.1.1 Adult
- prednisolone 60 mg PO q24h for 5 days then reduced by 10 mg per day (for a total treatment time of 10 days) and 50 mg per day (in two divided doses) for 10 days.[4][5][6]
- acyclovir 2000 mg PO q24h for 7-10 days
- 1.1.2 Pediatric
- prednisolone 1 mg/kg PO per day q24h for 10 days.[7]
Physical therapy
- There is low quality evidence that tailored facial exercises can help to improve facial function in patients with bell's palsy.[8]
- There is low quality evidence that facial exercise reduces sequelae in acute cases of bell's palsy.[8]
References
- ↑ de Almeida JR, Guyatt GH, Sud S, Dorion J, Hill MD, Kolber MR; et al. (2014). "Management of Bell palsy: clinical practice guideline". CMAJ. 186 (12): 917–22. doi:10.1503/cmaj.131801. PMC 4150706. PMID 24934895.
- ↑ Holland NJ, Bernstein JM (2014). "Bell's palsy". BMJ Clin Evid. 2014. PMC 3980711. PMID 24717284.
- ↑ 3.0 3.1 de Almeida JR, Al Khabori M, Guyatt GH, Witterick IJ, Lin VY, Nedzelski JM; et al. (2009). "Combined corticosteroid and antiviral treatment for Bell palsy: a systematic review and meta-analysis". JAMA. 302 (9): 985–93. doi:10.1001/jama.2009.1243. PMID 19724046.
- ↑ Engström M, Berg T, Stjernquist-Desatnik A, Axelsson S, Pitkäranta A, Hultcrantz M; et al. (2008). "Prednisolone and valaciclovir in Bell's palsy: a randomised, double-blind, placebo-controlled, multicentre trial". Lancet Neurol. 7 (11): 993–1000. doi:10.1016/S1474-4422(08)70221-7. PMID 18849193. Review in: Ann Intern Med. 2009 Mar 17;150(6):JC3-12
- ↑ Sullivan FM, Swan IR, Donnan PT, Morrison JM, Smith BH, McKinstry B; et al. (2007). "Early treatment with prednisolone or acyclovir in Bell's palsy". N Engl J Med. 357 (16): 1598–607. doi:10.1056/NEJMoa072006. PMID 17942873. Review in: ACP J Club. 2008 Mar-Apr;148(2):29 Review in: J Fam Pract. 2008 Jan;57(1):22-5 Review in: Evid Based Med. 2008 Apr;13(2):44
- ↑ Murthy JM, Saxena AB (2011). "Bell's palsy: Treatment guidelines". Ann Indian Acad Neurol. 14 (Suppl 1): S70–2. doi:10.4103/0972-2327.83092. PMC 3152161. PMID 21847333.
- ↑ Babl FE, Mackay MT, Borland ML, Herd DW, Kochar A, Hort J; et al. (2017). "Bell's Palsy in Children (BellPIC): protocol for a multicentre, placebo-controlled randomized trial". BMC Pediatr. 17 (1): 53. doi:10.1186/s12887-016-0702-y. PMC 5307816. PMID 28193257.
- ↑ 8.0 8.1 Teixeira LJ, Valbuza JS, Prado GF (2011). "Physical therapy for Bell's palsy (idiopathic facial paralysis)". Cochrane Database Syst Rev (12): CD006283. doi:10.1002/14651858.CD006283.pub3. PMID 22161401.