What's the treatment for Bell's palsy?
Many doctors prescribe an antiviral and/or a steroid for Bell's palsy, but there is some controversy about whether these drugs actually help. The consensus opinion seems to be that, although drugs might not be necessary, they are not dangerous, and they may help in some cases, especially if there is complete paralysis. If drugs are used, they need to be taken as soon as possible following the onset of symptoms. Antiviral drugs, such as acyclovir, famciclovir, or valacyclovir,
are prescribed to destroy actively replicating viruses and prevent further damage to the facial nerve. Steroids, such as prednisone, are thought to be useful in reducing swelling and, therefore, compression on the nerve.
Prednisone treatment is thought to speed recovery and reduce the frequency of a bad result. Prednisone must be given within the first week of facial weakness, in order to be effective. Usually a dose of about 60 mg is given per day in a single morning dose. This dose is usually continued for about a week, and then tapered off to nothing at about 10 days. In persons at risk, blood pressure, blood glucose and electrolytes should be monitored.
In the past, surgery was performed to relieve the compression on the nerve. However, this treatment option is now used very infrequently because it does not guarantee recovery, and it carries the risk of permanent nerve damage.
The need to protect the affected eye is universally promoted. Since the individual may not be able to lower the affected eyelid, the eye may become dry, particularly at night. Excessive dryness can damage the cornea. Daytime treatment includes artificial tears and may include an eye patch or other protective measures. Nighttime treatment involves a more intense effort at keeping the eye protected. Eye lubricants or viscous ointments, along with taping the eye shut, are frequently recommended.
In cases of permanent nerve damage, cosmetic treatment options, such as therapeutic injections of botulism toxin or surgery, may be sought or suggested.
Practitioners of traditional Chinese medicine have historically used acupuncture to treat Bell's palsy. There are also some indications that facial massage and chiropractic manipulation may help treat the symptoms and improve the outcome. There are also claims of therapeutic value for local injections or ingestion of vitamin B12 supplements.