16 - Bell Palsy Flashcards
What is Bell palsy?
lower motor neuron paralysis of the facial nerve
Bell palsy is often caused by what virus
HSV-1
Who does it occur more frequently in?
pregnant women, diabetics, those with migraine or HTN
Up to ___% achieve spontaneous recovery without treatment
85
Why is eye care important?
if the eye cannot be closed voluntarily, it is at risk for corneal abraisions
What eye care is recommended?
- Lubricate with eye drops or ointment
- Tape eyelid closed at night and protect with glasses during the day
What analgesics are recommended and when?
- ibuprofen or acetaminophen are occasionally required for first 1-2 days
- opioids such as morphine are rarely needed
Why are corticosteriods recommended?
- have been shown to reduce rates of incomplete recovery as well as synkinesias and autonomic dysfunction in ADULTS
- anti-inflammatory action of corticosteroids minimizes nerve damage, and reduces pain
- corticosteroid-treated patients are less likely to develop denervation (loss of nerve supply)
Early treatment with corticosteroids is recommended, within ____ hours of symptom onset = max benefit
72
What corticosteroid is recommended?
oral prednisone
Do we give corticosteroids to children with bell palsy?
No - risk of incomplete recovery from Bell palsy is very small & there is no benefit from corticosteroid therapy
Which antivirals may be used?
- acyclovir
- famciclovir
- valacyclovir
Should antivirals be used alone for bell palsy?
No - when used alone, they provide no benefit over placebo
Can antivirals be added to corticosteroid therapy?
Yes - whether antivirals add additional benefit to corticosteroids is controversial, but because s/e of antivirals is minimal, they can be offered to be added to corticosteroid therapy, esp for those who have severe case of bell palsy or who are immunocompromised
What do we do for pregnancy?
- supportive care, most recover spontaneously
- corticosteroids can be used (consider risk vs benefit)
- the effects of corticosteroids on the fetus is unclear
