Stubborn Facial Paralysis from Bell’s Palsy Effectively Relieved By Steroids
New guidelines recommend adding steroids for a more effective treatment.
-- by Joann Jovinelly
Bell’s palsy—a temporary weakness of facial muscles on one side that comes on quickly and can produce dramatic distortions of the face—is a common, yet frightening, condition.
People experiencing Bell’s palsy cannot smile or close the eye on the affected side of their face. Symptoms of the condition include chronic headaches, pain around the ear on the affected side, changes in hearing, taste, and even a slowed production of tears and saliva. Worse, people with Bell’s palsy may go weeks to months with lingering symptoms.
Bell’s palsy can occur at any age. Though its cause is not completely understood, it is thought to be the result of inflammation of the nerves that govern the facial muscles. In some cases, Bell’s palsy is a side effect of a viral infection, such as mononucleosis, meningitis, or herpes simplex virus type I, which is why antiviral medications are often used for treatment.
However, some cases of Bell’s palsy are not as easily resolved. Although the condition can disappear as suddenly as it appeared, degrees of facial paralysis can be long lasting. In fact, a small percentage of patients never fully recover muscle strength afterwards.
For those patients and others, new guidelines published today in the medical journal Neurology may shed some light on how to more effectively treat the disorder. Based on a consensus of several studies, the guidelines suggest that the short-term use of steroids to reduce swelling of the inflamed facial nerves may be a useful addition to other medications used for treatment.
The Expert Take
“Although most cases of Bell’s palsy resolve without treatment, about 15 percent of those affected never fully recover muscle strength,” said study author Gary Gronseth, M.D. with the University of Kansas Medical Center in Kansas City and a fellow of the American Academy of Neurology. “There are now several well-designed studies that show [steroid] treatments can increase the chances of a good recovery in such cases.”
In Gronseth’s experience, short-term use of steroids is tolerable in most patients, though those with uncontrolled diabetes may not be good candidates for their use. Also, obese persons and those who have experienced complications from prior steroid use should refrain from taking them.
“Because of the possibility of modest recovery with combination treatment, people might be offered both steroid pills and antiviral medications,” Gronseth explained. “However, they should be aware that the benefit of adding antiviral [medications] to steroid treatment is likely slight.”
Source and Method
This guideline was based on a consensus of several studies that showed that steroid treatments can increase the likelihood of an effective recovery from Bell's palsy.
For those experiencing Bell’s palsy, antiviral medications may not be enough to fully recover muscle strength following recovery. For that reason, it is recommended that, for patients who can tolerate them, steroids be added to other medications used to treat the condition. Short-term steroid use has been proven effective for Bell’s palsy patients seeking increased muscle flexibility and sensation over others treated only with antiviral medications.
Other studies conclude that antiviral drugs were not always effective in relieving Bell’s palsy symptoms.
In 2009, the British Medical Journal published this analysis of six trials covering 1,145 patients. Out of this group, 574 received steroids alone and 571 were treated with a combination of antiviral and steroid medications. Results showed that the drugs used in combination showed “no benefit compared with steroid use alone.” However, authors concluded that newer or more targeted antiviral medications along with steroid use might be more effective.
How immediate treatment is sought for Bell’s palsy may also affect outcomes; most physicians recommend taking medications within the first 72 hours of symptoms.
Another study, this one published in 2008 in the Journal of Family Practice, also noted the best outcomes in patients treated only with steroids and not antiviral medications.