Bell’s Palsy

Stephen G. Reich, MD, FAAN Selected Topics in Outpatient Neurology p. 447-466 April 2017, Vol.23, No.2 doi: 10.1212/CON.0000000000000447
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Purpose of Review: Bell’s palsy is a common outpatient problem, and while the diagnosis is usually straightforward, a number of diagnostic pitfalls can occur, and a lengthy differential diagnosis exists. Recognition and management of Bell’s palsy relies on knowledge of the anatomy and function of the various motor and nonmotor components of the facial nerve. Avoiding diagnostic pitfalls relies on recognizing red flags or features atypical for Bell’s palsy, suggesting an alternative cause of peripheral facial palsy.

Recent Findings: The first American Academy of Neurology (AAN) evidence-based review on the treatment of Bell’s palsy in 2001 concluded that corticosteroids were probably effective and that the antiviral acyclovir was possibly effective in increasing the likelihood of a complete recovery from Bell’s palsy. Subsequent studies led to a revision of these recommendations in the 2012 evidence-based review, concluding that corticosteroids, when used shortly after the onset of Bell’s palsy, were “highly likely” to increase the probability of recovery of facial weakness and should be offered; the addition of an antiviral to steroids may increase the likelihood of recovery but, if so, only by a very modest effect.

Summary: Bell’s palsy is characterized by the spontaneous acute onset of unilateral peripheral facial paresis or palsy in isolation, meaning that no features from the history, neurologic examination, or head and neck examination suggest a specific or alternative cause. In this setting, no further testing is necessary. Even without treatment, the outcome of Bell’s palsy is favorable, but treatment with corticosteroids significantly increases the likelihood of improvement.

Address correspondence to Dr Stephen G. Reich, University of Maryland School of Medicine, 110 S Paca St, 3rd Floor, Baltimore, MD 21201, [email protected].

Relationship Disclosure: Dr Reich serves as associate editor of the Journal of Clinical Movement Disorders and on the editorial board of Parkinsonism & Related Disorders. Dr Reich has received publishing royalties from Informa, has received research support as an investigator for studies from the National Institute of Neurological Disorders and Stroke, and has given expert medical testimony in legal cases related to malpractice.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Reich discusses the use of acyclovir and valacyclovir for the treatment of Bell’s palsy.

Supplemental digital content: Videos accompanying this article are cited in the text as Supplemental Digital Content. Videos may be accessed by clicking on links provided in the HTML, PDF, and app versions of this article; the URLs are included in the print version. Video legends begin on page 464.

Copyright © 2017 by the American Academy of Neurology.