Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.See all posts »
Steroids for Bell's Palsy
Bell’s palsy is a form of facial paralysis caused by a problem with a specific nerve (the seventh [facial] cranial nerve) that supplies the face. It is rapid in onset, and can cause the muscles of one side of the face to be completely paralyzed less than two days after the first weakness is noted. There is usually no pain except perhaps a slight discomfort behind the ear on the affected side. This pain may appear a day or two before the weakness. Bell’s palsy may mimic a stroke.
With Bell’s palsy, the muscles of the forehead are affected. If they are not, the victim should be immediately taken for a full medical evaluation. The cause of Bell’s palsy may be involvement of the nerve with the herpes virus. The current recommendation is to treat with prednisone 1 mg/kg (2.2 lb) of body weight by mouth per day for 7 to 10 days. It is somewhat more controversial (e.g., some people believe that they do not work in this condition) to also treat with the antiviral drug acyclovir (800 mg by mouth 5 times a day for 7 days). It is also important to protect the eye if the victim cannot close his eye or blink. The eye can be patched or gently taped closed to protect the cornea. Other symptoms on the affected side of the face can include hypersensitive hearing, diminished tearing, and loss of taste on the anterior two-thirds of the tongue.
As with most of medicine, therapies are often questioned. In this case, the use of corticosteroids (“steroids”) for treating Bell’s palsy was evaluated in a review of many clinical trials in a recent issue of Annals of Emergency Medicine. The conclusion was that corticosteroids are safe and effective in treating Bell’s palsy patients with incomplete paralysis, especially if they are started within 48 hours of the onset of symptoms. The conclusions did not indicate that steroids would be effective in reducing cosmetically disabling residual effects or in preventing partial resolution (only) of initially complete facial paralysis. However, the conclusion is that steroids are effective and should be used, the sooner the better.
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