Seventy-two hours max

Most people with Bell palsy will recover completely, but up to 30% of sufferers will have some remaining degree of facial disfigurement, pain, or psychological problems. Corticosteroids and antiviral agents are commonly prescribed for treatment within 72 hours of symptom onset. Do they work?

A large double-blind randomized placebo-controlled primary care study in Scotland looked at the efficacy of prednisolone or acyclovir in treating early Bell palsy. Adults 16 years of age or older with unilateral idiopathic facial-nerve weakness who presented to emergency rooms or to primary care physicians were recruited into the study, as long as they could be assessed by a collaborating otorhinolaryngologist within 72 hours of symptom onset. More than 550 patients were randomized into 4 treatment groups (placebo, prednisolone, acyclovir, or prednisolone and acyclovir) for 10 days of treatment. Final outcomes were available for 496 patients.

Baseline assessment was done shortly after randomization. Recovery was assessed at 3 months and again at 9 months if recovery was incomplete. Facial photographs were assessed independently by 3 experts using a standardized measure to determine the primary outcome of facial-nerve function. Secondary outcomes included health-related quality of life, facial appearance, and pain. Adverse events were also recorded. Pill containers (and unused pills) were collected.

Almost 65% of those treated with placebo were fully recovered at 3 months and 85% at 9 months. Treatment with prednisolone within 72 hours of symptom onset increased these rates to 83% at 3 months and almost 95% at 9 months. Acyclovir treatment alone was no better than placebo and there was no additional benefit when added to prednisolone. The number needed to treat to achieve 1 additional complete recovery was 6 at 3 months and 8 at 9 months. There were no clinically significant differences between the treatment groups in secondary outcomes and no serious adverse events in any group.

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