a systematic review of four randomised controlled trials by Williamson and Whelan (BJGP, 1996) has revealed that (compared with placebo) steroid therapy improves the complete facial recovery rate in patients with Bell's palsy (1)
two systematic reviews concluded that Bell's palsy could be effectively treated with corticosteroids in the first seven days, providing up to a further 17% of patients with a good outcome in addition to the 80% that spontaneously improve (2,3)
Key points (4):
facial palsy improves after treatment with oral prednisolone:
for people presenting within 72 hours of the onset of symptoms, consider prescribing prednisolone
no consensus regarding the optimum dosing regimen, but options include (1):
prednislone 25 mg twice daily for 10 days, or
prednisolone 60 mg daily for five days followed by a daily reduction in dose of 10 mg (for a total treatment time of 10 days) if a reducing dose is preferred
around a fifth of patients will progress from partial palsy, so these patients should also be treated
no supportive evidence has been found for use of steroids or antivirals in children with Bell's palsy
with respect to combined oral antiviral therapy and prednisolone in adults this review stated
"...there is support for the use of oral prednisolone with aciclovir in patients presenting with moderate to severe facial palsy, ideally within 72 hours.."
however more recent studies (5,6) have not shown benefit for antiviral therapy in combination with prednisolone in this condition
treatment of partial Bell's palsy is controversial; a few patients don't recover if left untreated
treatment is probably more effective before 72 hours and less effective after seven days
inabilty to close the eye on the affected side, can lead to irritation and corneal ulceration
requires urgent consultation with an ophthalmologist
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