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Medical Treatment
Bell’s Palsy
Steroids
Steroids, such as prednisone, prednisolone, and methylprednisolone, work
by reducing the inflammatory reaction of the body, since it is felt that
the inflammatory reaction can be more harmful than the disease process
itself.
Antiviral medications
Antiviral medications, such as valacyclovir, have been shown to provide
a benefit in Bell’s palsy. They work by inhibiting viral replication,
and the fact that they show a small improvement in recovery from Bell’s
palsy gives strength to the argument that viral infection plays a role
in the disease.
Botulinum Therapy
In cases where selected muscles of the face are overactive, clenched,
or “hypertonic”, one way to achieve more facial balance is
to intentionally weaken the selected muscles. Botulinum, a substance produced
by the bacterium Clostridium Botulinum, has the ability to temporarily
paralyze muscles into which it is injected. It works by blocking the release
of neurotransmitters from the nerve fibers to the muscle cells, which
are responsible for triggering muscle action. The botulinum is selectively
injected only into the areas that are overactive, and begins working within
several days. It is an extremely effective therapy for facial synkinesis,
spasm, and contracture. It is also used to weaken the normal side of the
face in facial paralysis, providing more symmetry to the two sides.
The effects of botulinum administration last for a period of three to
six months. This can be advantageous for patients that do not like the
achieved results because it is not permanent. The drawback is that if the
effect achieved is desirable, the therapy needs to be repeated on a semi-annual
basis. The development of antibodies to botulinum toxin can occur, though
it is rare. This results in a loss of effectiveness in this subgroup of
patients.
Sometimes, botulinum therapy is utilized to see what the effect of selective
myectomy would be. If the effect is acceptable, myectomy (excision or
weakening of a muscle) can be performed in selected situations to achieve
the permanent result.
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