Bell's Palsy To Treat or Not to Treat

Edward M. Desimone ii, RPh, PhD, FaPha; Jason W. tatsak, PharmD

US Pharmacist

Etiology

Bell's palsy is often described as idiopathic. However, current evidence suggests a possible viral pathogenesis with herpes simplex virus type 1 (HSV-1).^[2,7] Recent molecular analyses by means of polymerase chain reaction have shown latent HSV genome in the geniculate ganglia, as well as active HSV segments in the endoneural fluid of the facial nerve (FIGURE 1).^[7] Therefore, it is believed that patients experience inflammation because of reactivated HSV causing mechanical compression and possible demyelination and ischemia of the facial (seventh cranial) nerve in the geniculate ganglion.^[2,10] This results in paralysis of all the muscles involved in facial expression on the affected side of the face.^[2] The seventh cranial nerve innervates the salivary and lacrimal glands and is involved with taste to the anterior two-thirds of the tongue.^[2]

(Enlarge Image)

Figure 1.

Facial nerve intervation

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Table 1. Strength of Recommendation Rating Scale
Recommendation Definitions
Level A: Established as effective, ineffective, or harmful for the given condition in the specified population.
Level B: Probably effective, ineffective, or harmful for the given condition in the specified population.
Level C: Possibly effective, ineffective, or harmful for the given condition in the specified population.
Level U: Data inadequate or conflicting. Given current knowledge, treatment is unproven and an evidence-based recommendation cannot be made.

Source: Reference 9.

Table 2. Prescription Medication Dosing
Medication	Dosage (Or al)	Duration
Corticosteroid
Prednisone	A dults: 1 mg/kg daily (max 80 mg) C hildren: generally not recommended	7–14 days
Antivirals
Acyclovir	A dults: 400–800 mg 5 times daily with prednisone C hildren >2 y: 80 mg/kg/day in 4 divided doses (3,200 mg max)	7 days 5 days
Famciclovir	A dults: 750 mg 3 times daily with prednisone C hildren: safety not established	7 days
Valacyclovir	A dults: 1,000 mg twice daily with prednisone C hildren >12 y: 1 g/day in 3 divided doses	7 days 7 days

max: maximum.
Source: References 2, 3, 13, 18.

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Bell's Palsy To Treat or Not to Treat

Etiology

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Tables

References

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Authors and Disclosures

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