Idiopathic facial palsy, also known as Bell’s palsy, is the most common cause of facial paralysis. The exact cause of the disease is unknown, but it may be related to viral infection or inflammatory reactions. Early and reasonable treatment can speed up the recovery of facial paralysis and reduce complications and sequelae.
Today we are going to talk about a few questions about Bell’s palsy medication.
1 How are glucocorticoids used?
Studies show that glucocorticoids have a significant therapeutic effect on Bell’s palsy. The current international consensus guidelines recommend the early application of glucocorticoids in the acute phase. Although Bell’s palsy is self-limiting, the use of corticosteroids can be more effective in improving patient outcomes.
Which glucocorticoid is used? how to use? What time to use? How long does it take?
Regardless of textbooks or international guidelines, prednisone or prednisolone is currently recommended for treatment. The dosage, usage and course of treatment are not exactly the same, but the differences are not large:
Neurology 9th Edition
30～60 mg/d, once a day for 5 days, then stop gradually within 7 days.
Guidelines for Diagnosis and Treatment of Idiopathic Facial Palsy in China 2016
30-60 mg/d for 5 days, and then gradually reduce the dose to stop within 5 days. The benefit of oral corticosteroids after 3 days of onset is unclear.
American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) Guidelines
1 mg/kg or 60 mg/day for 6 days, then tapered for 10 days.
2 When does prednisone work best?
There are few studies on the effect of timing of glucocorticoid initiation on prognosis. Some scholars have divided the course of Bell’s palsy into three stages: acute stage (1-7 days of onset), persistent period (8-20 days of onset), and recovery period (21-90 days of onset).
Due to the onset of 7 days, the immune system-mediated facial nerve inflammatory response was in a progressive stage, and the inflammation did not worsen after 7 days, but because the facial nerve was in a narrow bony channel, the surrounding Although the edema was no longer aggravated, there was still persistent compression of the facial nerve; the inflammation gradually eased after about 20 days.
So in theory, the effect of administration in the acute phase should be better than that in the continuous period, and the administration in the continuous period is also helpful for the recovery of the disease. The significance of administration in the recovery period Not much. Clinical studies have also proved that the acute phase application is the best, and the continuous phase application is still effective. Therefore, it is currently recommended in the world to apply glucocorticoids as soon as possible within 72 hours of the onset of the disease.
3 Prednisone “qd” or “bid”?
Prednisone has a half-life of only 1 hour, so taking it twice a day is reasonable. Taking it once a day in the morning is because the human physiological glucocorticoid secretes more every morning, and taking it at this time can reduce the feedback inhibition of exogenous glucocorticoid on the pituitary-adrenal axis of the human body, usually during long-term hormone replacement therapy. Recommended usage.
For the treatment of Bell’s palsy, glucocorticoids are only used for a short period of time, and there is no need to consider the inhibition of the pituitary-adrenergic axis, so from the perspective of drug efficacy, It is recommended to use twice a day. Take.
4 Does prednisone discontinuation require dose titration?
Sudden discontinuation of long-term high-dose corticosteroids may lead to withdrawal reactions and rebound phenomena, so discontinuation requires gradual dose reduction.
Glucocorticoids are only used in low doses (< 0.5 mg/kg/d) to moderate doses (0.5-1.0 mg/kg/d) in the treatment of Bell's palsy, and the course of treatment is usually not For more than two weeks, it generally does not cause withdrawal reactions and rebound phenomena, and there is no need to gradually reduce the dose, but it is reasonable to gradually reduce the dose for safety reasons.
5 Do I need a combination of antiviral drugs?
The cause of the disease is currently unknown, and the need for antiviral treatment remains controversial. It is necessary to be cautious about whether or not to treat antiviral drugs in clinical practice. Some studies have shown that glucocorticoids combined with antiviral drugs may reduce the sequelae of Bell’s palsy, compared with placebo.
There was no significant increase in adverse effects of antiviral drugs compared with placebo or corticosteroids. It is suggested that for severe patients in the acute stage, antiviral drugs and glucocorticoids can be combined as soon as possible according to the situation, which may benefit, especially for those with severe facial weakness or complete paralysis (HB grade Ⅳ and above).
Antiviral medication alone is not recommended. Antiviral drugs can choose acyclovir (oral, 0.2-0.4 g, 3-5 times a day) or valaciclovir (0.5-1 g each time, 2-3 times a day).
6 When should glucocorticoids be used with caution?
Patient with tuberculosis, compromised immune system, active infection, sarcoidosis, sepsis, peptic ulcer disease, diabetes mellitus, renal or hepatic dysfunction, malignant hyperthyroidismGlucocorticoids should be used with caution in diseases such as blood pressure and during pregnancy, and if they are used, the pros and cons should be fully weighed.
7 Does Nutritional Nerve Really Work?
Neurotrophic is an idealized term, as no neurotrophic drug has been shown to be effective in clinical studies to date. Even with the widely used methylcobalamin, there is very little high-quality evidence that it is effective in treating Bell’s palsy.
Therefore, clinicians must have a correct understanding of this, focus on improving the patient’s systemic immunity, help patients develop correct rest and eating habits, and remove some disease-prone diseases. risk factors.
References:
[1] Neurology Branch of Chinese Medical Association, Neuromuscular Disease Group of Neurological Branch of Chinese Medical Association, Electromyography and Clinical Neurophysiology Group of Neurological Branch of Chinese Medical Association. China Special Guidelines for the diagnosis and treatment of idiopathic facial paralysis[J]. Chinese Journal of Neurology, 2016(2):84-86.
[2]Baugh RF, Basura GJ, Ishii LE, Schwartz SR, Drumheller CM, Burkholder R, Deckard NA, Dawson C, Driscoll C, Gillespie MB, Gurgel RK, Halperin J, Khalid AN, Kumar KA, Micco A, Munsell D, Rosenbaum S, Vaughan W. Clinical practice guideline: Bell’s palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-27. doi: 10.1177/0194599813505967. PMID: 24189771.
[3] Jiang, Zhang Xiaojie, Xia Feng, et al. Observation on the clinical efficacy of hormones in the treatment of Bell’s palsy at different onset times [J]. Journal of Brain and Neurological Diseases, 2014, 22(3 ):4.
[4]Gagyor I, Madhok VB, Daly F, Sullivan F. Antiviral treatment for Bell’s palsy (idiopathic facial paralysis). Cochrane Database Syst Rev. 2019 Sep 5;9(9): CD001869.
Planning｜Time Capsule
Title map｜Zhanku Hailuo
This article was first published on the professional platform of Lilac Garden: Nervous Time