Bell's Palsy To Treat or Not to Treat

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

US Pharmacist

Epidemiology

Worldwide, the incidence of Bell's palsy ranges from 20.2 (United Kingdom) to 53.3 (Italy) per 100,000 population.^[4,5] About 40,000 people in the United States (13 per 100,000) receive this diagnosis, making it one of the most common causes of facialnerve palsy.^[6,7] The disease affects men and women in equal numbers and without a predilection for either side of the face.^[2] Pregnant women, individuals with diabetes, and those with upper respiratory ailments are more commonly affected.^[2,6] Although Bell's palsy occurs at all ages (uncommonly in ages <15 and >60 years), individuals aged 30 to 45 years have the highest incidence.^[2,6,8] Roughly 71% of patients with Bell's palsy recover completely without treatment; however, in the U.S., more than 8,000 patients each year are left with some permanent facial weakness.^[9]

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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

Epidemiology

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Tables

References

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