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Suggest Treatment For Bell's Palsy
Question: Hi, my daughter was diagnosed with Bells Palsy this past Monday. She is at college and went to the ER and they prescribed nothing. Today, she saw a Dr. and he prescribed a corticosteroid and anti-microbial, and said if it doesn't go away in 4-6 weeks, she will never heal. Is there something else we should be doing at this time?
Brief Answer:
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
Bell's palsy generally has a good outcome with over 80 % of patients recuperating even without treatment. Treatment like corticosteroids and antivirals do improve the chances of a good outcome, but only by about 5-10% since as I said most patients do improve by themselves anyway. In a 20 years old individual the chances of improvement are even higher.
So while I personally do prescribe steroids and antivirals as well, I also understand the point of view of some colleagues like those in the ER who in a young healthy individual may choose to not prescribe much at all, not to give medication with potential for side effects. It is a debatable issue.
As for the 4-6 weeks issue I wouldn't be so absolute, while it is true that most recovery happens in the first 4-6 weeks improvement may continue for up to 6 or even 12 months is some patients. However I would like to repeat that shouldn't panic, the prognosis is good in general and even better in young patients.
Regarding whether there is something else to do, medication wise there is nothing else needed, but physiotherapy may also be of help in some patients, where you will learn to do facial exercises.
In the worst case scenario that there is no improvement, after about 3 weeks you can also discuss with your doctor the possibility of doing nerve conduction test, which can give an indication on the degree of damage and prognosis. I wouldn't do it at this stage because changes on the exam need some time to take place, at least 10 days up to 3 weeks. It doesn't change treatment in any way so there is no sense in having it too soon.
I remain at your disposal for other questions.
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
Bell's palsy generally has a good outcome with over 80 % of patients recuperating even without treatment. Treatment like corticosteroids and antivirals do improve the chances of a good outcome, but only by about 5-10% since as I said most patients do improve by themselves anyway. In a 20 years old individual the chances of improvement are even higher.
So while I personally do prescribe steroids and antivirals as well, I also understand the point of view of some colleagues like those in the ER who in a young healthy individual may choose to not prescribe much at all, not to give medication with potential for side effects. It is a debatable issue.
As for the 4-6 weeks issue I wouldn't be so absolute, while it is true that most recovery happens in the first 4-6 weeks improvement may continue for up to 6 or even 12 months is some patients. However I would like to repeat that shouldn't panic, the prognosis is good in general and even better in young patients.
Regarding whether there is something else to do, medication wise there is nothing else needed, but physiotherapy may also be of help in some patients, where you will learn to do facial exercises.
In the worst case scenario that there is no improvement, after about 3 weeks you can also discuss with your doctor the possibility of doing nerve conduction test, which can give an indication on the degree of damage and prognosis. I wouldn't do it at this stage because changes on the exam need some time to take place, at least 10 days up to 3 weeks. It doesn't change treatment in any way so there is no sense in having it too soon.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Dr. Olsi Taka,
Thank you for very informative response. I have one more question. The Dr. put my daughter on a anti-microbial. However, my husband is wondering if she should be put on an anti-viral for her herpes simplex virus. She doesn't currently have any cold sores.
Thank you for very informative response. I have one more question. The Dr. put my daughter on a anti-microbial. However, my husband is wondering if she should be put on an anti-viral for her herpes simplex virus. She doesn't currently have any cold sores.
Brief Answer:
Read below.
Detailed Answer:
It is thought that a large percentage of Bell's palsy is caused by a viral infection. The fact that she doesn't have cold sores doesn't exclude the possibility that a herpes zoster infection is a cause. The virus may be contracted years ago, residing in the ganglions and in a period of lowered immunity (the stress you mentioned may play a role) it may be reactivated.
This hypothesis is supported by autopsy studies who have found the virus in the geniculate ganglion of people who have had Bell's palsy, as well as from studies who have found viral DNA in the perineural fluid.
One can't verify whether that is the case in your daughter, there is no routine test for that, but antivirals are often used based on this theory of a good percentage being due to a virus.
Whether the antivirals have shown any significant effect....studies have shown their benefit to be modest at best, many question their benefit at all. So wouldn't really hurt much if it is elected not to take it. Actually to be honest even the corticosteroids are more useful if started in the first 72 hours, so since it has been at least since Monday they shouldn't play much of a role really, it will be mostly down to her regeneration capabilities.
Let me know if I can further assist you.
Read below.
Detailed Answer:
It is thought that a large percentage of Bell's palsy is caused by a viral infection. The fact that she doesn't have cold sores doesn't exclude the possibility that a herpes zoster infection is a cause. The virus may be contracted years ago, residing in the ganglions and in a period of lowered immunity (the stress you mentioned may play a role) it may be reactivated.
This hypothesis is supported by autopsy studies who have found the virus in the geniculate ganglion of people who have had Bell's palsy, as well as from studies who have found viral DNA in the perineural fluid.
One can't verify whether that is the case in your daughter, there is no routine test for that, but antivirals are often used based on this theory of a good percentage being due to a virus.
Whether the antivirals have shown any significant effect....studies have shown their benefit to be modest at best, many question their benefit at all. So wouldn't really hurt much if it is elected not to take it. Actually to be honest even the corticosteroids are more useful if started in the first 72 hours, so since it has been at least since Monday they shouldn't play much of a role really, it will be mostly down to her regeneration capabilities.
Let me know if I can further assist you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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