Intended for healthcare professionals

Rapid response to:

Practice Change Page

Prescribe prednisolone alone for Bell’s palsy diagnosed within 72 hours of symptom onset

BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b255 (Published 06 February 2009) Cite this as: BMJ 2009;338:b255

Rapid Response:

Treatment for Bell's Palsy

As for Herpes Zoster, where there is "demyelination" of the affected
nerve fibres, so Injections of Vitamin B.12 are indicated, at once in
Bell's Palsy.

Vitamin B.12 is known to be essential for the formation of Myelin.

In Herpes Zoster early administration within three weeks anyway will
stop the pain and begin healing of the vesicles. The missing Myelin is
then apparently restored

Bell's Palsy may or may not have a visible Geniculate Herpes but let
it be presumed and so instantly prescribe and administer intramuscular
Vitamin B.12 daily (2,500 micrograms).

This should be automatic in all other suspected cases of
Demyelination, for example, in exacerbations of Disseminated "Multiple"
Sclerosis, Motor Neurone Syndrome, Idiopathic Vestibular neuritis and the
others..

This has been usual in General Practice for the past fifty years.
Physiotherapy may be started with Galvanic Stimulation a week later.

Indeed Prednisolone will ease some discomfort, but B.12 seems to get
Bell's palsy better sooner.

Competing interests:
None declared

Competing interests: No competing interests

28 February 2009
George Y. Caldwell
General Practitioner
Singapore 259858.
31 Balmoral Park, #18-33