Bell's palsy medical therapy: Difference between revisions

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==Overview==
==Overview==
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
[[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.
 
OR
 
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
 
OR
 
The majority of cases of [disease name] are self-limited and require only supportive care.
 
OR
 
[Disease name] is a medical emergency and requires prompt treatment.
 
OR
 
The mainstay of treatment for [disease name] is [therapy].
 
OR
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
 
OR
 
[Therapy] is recommended among all patients who develop [disease name].
 
OR
 
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
 
OR
 
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
 
OR
 
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
 
OR
 
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].


==Medical Therapy==
==Medical Therapy==


== Treatment ==
*[[Pharmacologic|Pharmacologic medical therapy]] is recommended among all patients with Bell's palsy.<ref name="pmid24934895">{{cite journal| author=de Almeida JR, Guyatt GH, Sud S, Dorion J, Hill MD, Kolber MR et al.| title=Management of Bell palsy: clinical practice guideline. | journal=CMAJ | year= 2014 | volume= 186 | issue= 12 | pages= 917-22 | pmid=24934895 | doi=10.1503/cmaj.131801 | pmc=4150706 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24934895  }} </ref>
*Most patients with Bell's palsy recover fully without treatment.<ref name="pmid24717284">{{cite journal| author=Holland NJ, Bernstein JM| title=Bell's palsy. | journal=BMJ Clin Evid | year= 2014 | volume= 2014 | issue=  | pages=  | pmid=24717284 | doi= | pmc=3980711 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24717284  }} </ref>
*[[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.<ref name="pmid19724046">{{cite journal| author=de Almeida JR, Al Khabori M, Guyatt GH, Witterick IJ, Lin VY, Nedzelski JM et al.| title=Combined corticosteroid and antiviral treatment for Bell palsy: a systematic review and meta-analysis. | journal=JAMA | year= 2009 | volume= 302 | issue= 9 | pages= 985-93 | pmid=19724046 | doi=10.1001/jama.2009.1243 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19724046  }} </ref>
*[[Antiviral Therapy|Antiviral agents]], when administered with [[Corticosteroid|corticosteroids]], may be associated with additional benefit.<ref name="pmid19724046">{{cite journal| author=de Almeida JR, Al Khabori M, Guyatt GH, Witterick IJ, Lin VY, Nedzelski JM et al.| title=Combined corticosteroid and antiviral treatment for Bell palsy: a systematic review and meta-analysis. | journal=JAMA | year= 2009 | volume= 302 | issue= 9 | pages= 985-93 | pmid=19724046 | doi=10.1001/jama.2009.1243 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19724046  }} </ref>
===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.<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
* 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>


=== Physical therapy ===
=== Physical therapy ===
* There is low quality evidence that tailored facial exercises can help to improve facial function in patients with bell's palsy.<ref name="pmid22161401">{{cite journal| author=Teixeira LJ, Valbuza JS, Prado GF| title=Physical therapy for Bell's palsy (idiopathic facial paralysis). | journal=Cochrane Database Syst Rev | year= 2011 | volume=  | issue= 12 | pages= CD006283 | pmid=22161401 | doi=10.1002/14651858.CD006283.pub3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22161401  }} </ref>
* There is low quality evidence that tailored facial exercises can help to improve facial function in patients with bell's palsy.<ref name="pmid22161401">{{cite journal| author=Teixeira LJ, Valbuza JS, Prado GF| title=Physical therapy for Bell's palsy (idiopathic facial paralysis). | journal=Cochrane Database Syst Rev | year= 2011 | volume=  | issue= 12 | pages= CD006283 | pmid=22161401 | doi=10.1002/14651858.CD006283.pub3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22161401  }} </ref>


* There is low quality evidence that facial exercise reduces sequelae in acute cases of bell's palsy.<ref name="pmid22161401">{{cite journal| author=Teixeira LJ, Valbuza JS, Prado GF| title=Physical therapy for Bell's palsy (idiopathic facial paralysis). | journal=Cochrane Database Syst Rev | year= 2011 | volume=  | issue= 12 | pages= CD006283 | pmid=22161401 | doi=10.1002/14651858.CD006283.pub3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22161401  }} </ref>
* There is low quality evidence that facial exercise reduces [[sequelae]] in acute cases of bell's palsy.<ref name="pmid22161401" />
 
== Lifestyle and home remedies ==
Home treatment may include:
* '''Protecting the eye you can't close.''' Using lubricating eyedrops during the day and an eye ointment at night will help keep your eye moist. Wearing glasses or goggles during the day and an eye patch at night can protect your eye from getting poked or scratched.
* '''Taking over-the-counter pain relievers.''' Aspirin, ibuprofen (Advil, Motrin IB, others) or acetaminophen (Tylenol, others) may help ease your pain.
* '''Doing your physical therapy exercises.''' Massaging and exercising your face according to your physical therapist's advice may help relax your facial muscles.
 
== Alternative medicine ==
Although there's little scientific evidence to support the use of alternative medicine for people with Bell's palsy, some people with the condition may benefit from the following:
* '''Acupuncture.''' Placing thin needles into a specific point in your skin helps stimulate nerves and muscles, which may offer some relief.
* '''Biofeedback training.''' By teaching you to use your thoughts to control your body, you may help gain better control over your facial muscles.
 
 


*Pharmacologic medical therapy is recommended among all patients with Bell's palsy.<ref name="pmid24934895">{{cite journal| author=de Almeida JR, Guyatt GH, Sud S, Dorion J, Hill MD, Kolber MR et al.| title=Management of Bell palsy: clinical practice guideline. | journal=CMAJ | year= 2014 | volume= 186 | issue= 12 | pages= 917-22 | pmid=24934895 | doi=10.1503/cmaj.131801 | pmc=4150706 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24934895  }} </ref>
*Most patients with Bell's palsy recover fully without treatment.<ref name="pmid24717284">{{cite journal| author=Holland NJ, Bernstein JM| title=Bell's palsy. | journal=BMJ Clin Evid | year= 2014 | volume= 2014 | issue=  | pages=  | pmid=24717284 | doi= | pmc=3980711 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24717284  }} </ref>
*Corticosteroids may reduce the risk of unsatisfactory recovery in patients with Bell palsy and are highly recommended for treatment of Bell's palsy.<ref name="pmid19724046">{{cite journal| author=de Almeida JR, Al Khabori M, Guyatt GH, Witterick IJ, Lin VY, Nedzelski JM et al.| title=Combined corticosteroid and antiviral treatment for Bell palsy: a systematic review and meta-analysis. | journal=JAMA | year= 2009 | volume= 302 | issue= 9 | pages= 985-93 | pmid=19724046 | doi=10.1001/jama.2009.1243 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19724046  }} </ref>
*Antiviral agents, when administered with corticosteroids, may be associated with additional benefit.<ref name="pmid19724046">{{cite journal| author=de Almeida JR, Al Khabori M, Guyatt GH, Witterick IJ, Lin VY, Nedzelski JM et al.| title=Combined corticosteroid and antiviral treatment for Bell palsy: a systematic review and meta-analysis. | journal=JAMA | year= 2009 | volume= 302 | issue= 9 | pages= 985-93 | pmid=19724046 | doi=10.1001/jama.2009.1243 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19724046  }} </ref>
===Bell's palsy===


@@@@@@@@@@@@@@@@@@@@@@@@@@@@@he prednisolone dose used was 60 mg per day for 5 days
* 1.1.1 '''Adult'''
** Preferred regimen (1): [[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>
** Preferred regimen (2): [[acyclovir]]  (2000 mg PO q24h for 7-10 days
* 1.1.2 '''Pediatric'''
** Preferred regimen (1):[[prednisolone]] 1 mg/kg PO per day q24h for 10 days  oral prednisolone.<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>
** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
* Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
**1.1.2.2 (Specific population e.g. '<nowiki/>'''''children < 8 years of age'''''')
*** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
*** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
*** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose) 
*** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
:
* 2.1.1 '''Adult'''
** Parenteral regimen
*** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
*** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
*** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
** Oral regimen
*** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
*** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
*** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
*** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
*** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
*** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
* 2.1.2 '''Pediatric'''
** Parenteral regimen
*** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
*** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
*** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '<nowiki/>'''''(Contraindications/specific instructions)''''''
** Oral regimen
*** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
*** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
*** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
*** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
*** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
*** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
** 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.2.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.2.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)


==References==
==References==
Line 157: Line 35:




==Medical Therapy==
===Eye Care=== 
In severe cases, the cornea may be at risk because of poor eyelid closure and reduced tearing, which may result in drying and abrasion.
*The risk for blindness due to [[corneal]] trauma is significant, especially if there is [[5th nerve]] concomitant damage.
*The use of [[artificial tear]]s, every hour while awake, and ophthalmic ointments at night is recommeneded.
*Protective glasses or goggles during the day.
*Patches can be used at night, not to be placed directly on the eyelid since the patch can slip and scratch the cornea.
*Rarely tarsorrhaphy or temporary implantation of a gold weight into the upper lid can be used to close the eye and protect the cornea.
===Glucocorticoid and Antiviral Therapy===
The mainstay of pharmacologic therapy is early short-term oral glucocorticoid treatment
*It is established as effective by randomized controlled trials: [[Prednisone]] 1mg/kg up to 60mg PO daily for 10 days
*The suspicion that Bell's palsy is caused by herpes simplex virus in most patients led to trials of antiviral therapy
*Compared with placebo, these trials found no benefit for antiviral therapy alone.
*The data is conflicting with regard to the possibility of additional benefit when antiviral agents are administered with glucocorticoids.
*In a meta-analysis involving 18 trials and 2786 patients, treatment with glucocorticoids alone was associated with a reduced risk of unfavorable recovery (relative risk [RR] 0.69, 95% CI 0.55-0.87), while treatment with antiviral agents alone was not (RR 1.14, 95% CI 0.80-1.62).
*In a pooled data from eight trials, the same meta-analysis found a trend towards a reduced risk of unfavorable recovery for combined antiviral and glucocorticoid treatment compared with glucocorticoid treatment alone; however, the outcome barely missed statistical significance (RR 0.75, 95% CI 0.56-1.0).
*In a second meta-analysis of six trials and 1145 patients, there was no significant benefit of combined antiviral and glucocorticoid treatment for achieving at least partial facial muscle recovery (odds ratio 1.5, 95% CI 0.83-2.69).
*Neither excludes the possibility of marginal benefit when antiviral therapy is combined with [[glucocorticoids]].
*Some authorities recommend antiviral therapy in addition to steroids for severe complete lesions.  Choices include:
:*[[Acyclovir]] 2000-4000 mg/24 h PO divided 5 times a day for 7-10 d
:*[[Acyclovir]] 2000-4000 mg/24 h PO divided 5 times a day for 7-10 d
:*[[Valcyclovir]] 1000-3000 mg/24 h PO for 5 d
:*[[Valcyclovir]] 1000-3000 mg/24 h PO for 5 d

Revision as of 14:58, 21 May 2018

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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

  • 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

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

  1. ↑ 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.
  2. ↑ Holland NJ, Bernstein JM (2014). "Bell's palsy". BMJ Clin Evid. 2014. PMC 3980711. PMID 24717284.
  3. ↑ 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.
  4. ↑ 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
  5. ↑ 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
  6. ↑ 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.
  7. ↑ 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. ↑ 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.

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  • Acyclovir 2000-4000 mg/24 h PO divided 5 times a day for 7-10 d
  • Valcyclovir 1000-3000 mg/24 h PO for 5 d

References


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