Although the incidence of stroke in young people is rising, some of these "strokes" can still be clinically diagnosed with Bell's Palsy.
However, once the diagnosis is made, the practice variation is extensive. In light of this, the American Academy of Neurology has published an update to their evidence-based guidelines for the treatment of Bell's Palsy.
- Steroids are good, with a 12 to 15% increased chance of functional recovery.
- Antivirals have no consistent evidence of benefit.
- Only ~4% of Bell's Palsy sufferers are left with severe residual deficits, with the remainder fully recovering or with slight/mild deficits. Some folks would pose the question whether any of these treatments are necessary, considering the minimal absolute benefits, even if relative benefits are consistent.
Another risk/benefit decision to discuss with patients.
"Evidence-based guideline update: Steroids and antivirals for Bell palsy : Report of the Guideline Development Subcommittee of the American Academy of Neurology"