Bell`s palsy - BMJ Best Practice

Patient information from the BMJ Group
Bell's palsy
If you wake up one morning and find your face droops on one side, you may have
Bell's palsy. This can be alarming, but most people recover completely.
We've looked at the best and most up-to-date research to produce this information.
You can use it to talk to your doctor and decide which treatments are right for you.
What happens?
With Bell's palsy, the muscles of your face suddenly become weak. It happens because
a nerve sending messages from your brain to your face muscles stops working. It almost
always happens on just one side of the face.
We don't know for certain what causes Bell's palsy. It may be caused by swelling around
the nerve, due to a virus.
Not everyone who has weak face muscles has Bell's palsy. About 3 in 10 people have
another condition, like an injury or an ear disease. Your doctor will check for these
conditions. You won't be diagnosed with Bell's palsy until other problems have been
ruled out.
Some people who have a stroke get weakness in the muscles of the face. But this is
different from Bell's palsy. If you have a stroke, other parts of your body are usually
affected too. You might need some tests, such as an MRI scan or a CT scan, to rule out
problems other than Bell's palsy.
About 1 in 60 people get Bell's palsy at some time in their life. Pregnant women seem
more likely to get it.
What are the symptoms?
You might find your face droops on one side and it's hard to close or open one eye. You
may not be able to frown or smile properly and your speech may be slurred. It's hard to
keep saliva (spit) inside your mouth. So you might dribble.
Some people get an ache behind their ear for a few days. But Bell's palsy isn't usually
painful. You may find noise uncomfortable. You may lose your sense of taste on the
affected side of your tongue.
These things might make you feel anxious or self-conscious.
The symptoms come on quickly. They might get worse over two days.
If you can't close your eye properly, it could get dry and damaged. You may need to use
moisturising eye drops, or surgical tape to keep it closed.
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Bell's palsy
Bell's palsy only affects the face. If you feel weak or numb in other parts of your body,
you should tell your doctor immediately.
What treatments work?
Most people recover from Bell's palsy, whether or not they have treatment. Many people
don't have treatment, but there are some you can try.
Medicines
Taking steroid tablets can help you recover completely from Bell's palsy. They seem to
work best if you take them within three days of your symptoms starting. You'll probably
need to take the tablets for a week.
The full name for these medicines is corticosteroids. These are not the same as the
anabolic steroids used by some bodybuilders. They are similar to natural chemicals made
in your body that damp down inflammation. You'll probably take a steroid called
prednisolone (brand name Deltacortril).
Doctors sometimes prescribe antiviral tablets too. Antiviral tablets work on the virus
that may be causing the problem. Antiviral drugs include aciclovir (Zovirax) and valaciclovir
(Valtrex). However, the research suggests that antiviral drugs may not offer any extra
benefit to steroids. Antiviral drugs don't help on their own.
Antiviral medicines can have mild side effects. Some people feel sick and get diarrhoea.
Taking steroids for a long time at a high dose can be harmful. Side effects include high
blood pressure, diabetes and thinning of the bones.You're unlikely to get these problems
if you take steroids for only a week.
Other treatments you might need
If your Bell's palsy doesn't go away completely, you may need more treatment.
You could try physiotherapy, where you work with a therapist to strengthen your face
muscles. This may help you move your face more normally.
If Bell's palsy leaves you with one eye that does not close properly, you might consider
an operation. A surgeon can put a weight into your eyelid to help it close more easily.
What will happen to me?
You have a good chance of recovering completely from Bell's palsy. This means your
face goes back to normal and your muscles work properly again. But about 3 in 10 people
are left with some muscle weakness.
About 2 in 10 people also get other long-term problems. Your face may look different
because your face muscles have shortened. And different parts of your face may move
together. So your chin may dimple when you blink. That happens when the nerve in the
face grows back in a different way.
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Bell's palsy
These problems can be distressing.You can talk to your doctor about further treatments.
You may also find counselling helps you cope with changes to your face.
You're more likely to have long-term problems if:
•
You have no movement at all in the affected side of your face
•
You are older than 60
•
You have high blood pressure or diabetes, or you're pregnant
•
You haven't started to recover after six weeks.
Where to get more help
You might want to talk to other people who have Bell's palsy. The Bell's Palsy Association
is a charity that may be able to help. Its website is at http://www.bellspalsy.org.uk.
This information is aimed at a UK patient audience. This information however does not replace medical advice.
If you have a medical problem please see your doctor. Please see our full Conditions of Use for this content. These
leaflets are reviewed annually.
© BMJ Publishing Group Limited 2015. All rights reserved.
Last published: Sep 16, 2015
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