Acute facial nerve palsy best management? Physiotherapy, steroid, acyclovir, vit b12.
I agree too!
In my opinion there are not differences between os and i.v. because the effect of steroids that hepls nerve recovery is the antiedema (that starts late, after a couple of days), not the antinflammatory (that is sudden) one. In theory, neuroprotective agents (B12, LAC, PEA, etc) could be helpfull but only if started very early, bevore the nerve damnage.
I aggree too, usually i used for adults prednisone 50 mg max 75 mg day for 7 days then tapering and stop, antiviral therapy should be used if there is a suspiciuos of viral infections.
Be carefull in using steroids if a patients has diabete mellitus or hypertension : is mandatory check glicaemia and blood pressure, because they can worse also for a short therapy with steroids.
if a patients is using ASA usually I add sulcrafate for gastric protection
Important is ocular protection (from powder light infections) with closure of the eye and or use of artificial tears or other oftalmic therapies.
Physiotherapy could be useful and has no adverse effects
vit B12 can be useful and has no adverse effect
In my emergency dept we have a form with instructions for GP and for patients for Bell's palsy ( in Italy patients whith Bell's palsy usually go to emergency dept for neurological visit and therapy because GP are not able o are afraid to diagnose and treat Bell's palsy...)
Uso prednisona hasta 60 mgs diarrios por 5 dias y despues hago reduccion gradual. Indico Vitamina B12 ,B1 y B6 inyectables 3 veces por semana por 1 mes y Nucleo CMP Forte 1 capsula cada 8 horas por 1 mes , El corticoides siempre en los 5 primeros dias de inicio de la paralisis.
Uso B1 ,B6 y B12 ,porque contribuyen a la regenaracion del nervio facial.
i agree with most of the above.
i use prednisolone PO 1 mg/kgBW/day for 5 days and tappeing of 10 mg daily. there is no good evidense that antiviral agent to added to steroides. i don`t use vitamines (B) as there is no studies supportinig thats.
it is very important to use lubricants to the cornea and sometimes even closure of the eye to avoid complication of corneal erossions.
I use prednisona 1mg/kg/day for 7 days and physioterapy and lubricants to protect the eye
Hello,facial mimic exercises in mirror,specific massage each one muscle paralyzed,electrical stimulation only when muscular contraction active is present if necessary.I have recived patients without corticosteroid treatment and I no have seen difference,the natural course os FP depend of etiology and magnitud of nerve injury
Regards
I've never seen any significant difference in adding vitamins to steroid...however, they have no harmful effects and a pathogenetic link does exist, so...
may be we should diagnose facial palsy etiology to know the subset of patients who would benefit from vitamins? the same for antiviral therapy; how many of you send a patient back to the family physician with a precise diagnosis?
in my experience this happen only if a zoster is concomitant (so reasonable to add acyclovir) and - in our northern italy region - if a tick bite is reported (so, after Borrelia antibodies were detected, ceftriaxon would be useful)
I presume you are referring to LMN facial paresis.In my practice I treat them with a 5 day course of oral prednisolone and oral acyclovir 800mg five times a day followed by physiotherapy. patients do respond over a period of 2-3 months. there doesnot seem to be any role for parenteral steroids
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