Bell's Palsy Treatment — RACP Adult Medicine MCQ

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EasyNeurologyBell's Palsy TreatmentRACP Adult Medicine

A 50-year-old man with longstanding type 2 diabetes develops a facial nerve palsy (Bell's palsy). His HbA1c is 69 mmol/mol. The palsy is unilateral with incomplete eye closure. What is the recommended treatment?

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Correct answer: B — Prednisolone 50 mg daily for 10 days plus valaciclovir

For Bell's palsy presenting within 72 hours of onset, oral prednisolone (50 mg daily for 10 days, or 60 mg for 5 days then tapered over 5 days) is the mainstay of treatment and significantly improves complete recovery rates. The addition of antiviral therapy (valaciclovir 1 g TDS for 7 days) is recommended by most guidelines for moderate-severe palsy (incomplete eye closure), though the evidence for antivirals is less robust than for corticosteroids. Eye protection (artificial tears, taping at night) is essential to prevent exposure keratopathy.

Reference: eTG – 2025 – Neurology; AAN – 2012 – Bell's Palsy Practice Parameter