Neurology
Bell's Palsy
لقوہ
Deviation of the angle of the mouth and drooping of the eyelid from facial nerve palsy. Treated with physiotherapy, an oral prednisolone taper, B12, a PPI and eye care.
- ICD-10
- —
- Source
- OPD handbook pp.149–151
- Status
- Draft
Not yet reviewed by a clinician. Check doses and brands against current national guidelines before use.
Symptoms
- Deviation of angle of mouth
- Drooping of eyelid
Diagnosis
- Examine the facial nerve
- Absence of nasolabial fold
- Dry mouth
- Unable to frown
- Unable to whistle
Treatment
Step 1 of 5
1. Physiotherapy (Urdu notes)
- Chew chewing gum, about 4 times a day
- Try to raise the eyebrows / frown
- Try to whistle and puff the cheeks
Step 2 of 5
2. Oral steroids (1 mg/kg)
- Tab Rapicort EC 5 mg (prednisolone): 4+4+0 for 3 days; 3+3+0 for 3 days; 3+2+0 for 3 days; 2+1+0 for 3 days; 1+0+0 for 3 days (a 15-day course)
Prescription
PrednisoloneCorticosteroid
Dose4+4+0 × 3 d; 3+3+0 × 3 d; 3+2+0 × 3 d; 2+1+0 × 3 d; 1+0+0 × 3 d
Brand Tab Rapicort EC 5 mg
15 days
Also sold as Deltacortril, Rapicort, Rapicort EC, Prednisolone 5 mg
Step 3 of 5
3. B12 (nervine tonic)
- Vitamin B12 is recommended as a nervine tonic
- Inj Neuromet 500 mcg IM stat in the sample
Prescription
Methylcobalamin (vitamin B12)Nervine tonic / B12
Dose1 daily (tablet) for 15 days; Inj 500 mcg IM stat
Brand Tab Neuromet 500 mcg; Inj Neuromet 500 mcg
Also sold as Neuromet, Mexamine, Cobalamin, Mexamin, Methycobal
Step 4 of 5
4. PPI
- To avoid steroid-induced gastropathy
Prescription
OmeprazoleProton pump inhibitor
Dose1+1 (morning, evening)
Brand Cap Ruling 20 mg
Also sold as Risek, Teph, Ruling, Ruling sachet, Omega
Step 5 of 5
5. Care of the eyeball
- Tear Plus eye drops 4 times a day (1+1+1+1); 2 drops in the eye 4 times a day
- Wear dark glasses on the affected eye (Urdu note)
Prescription
Sample prescription from the book (patient details removed)
- Female, 40 y, drooping of eyelids and deviation of angle of mouth; deviated angle of mouth with lacrimation: Inj Neuromet 500 mcg IM stat; Tab Rapicort EC 5 mg taper as above; Tab Neuromet 500 mcg daily for 15 days; Cap Ruling 20 mg 1+1; Tear Plus eye drops 1+1+1+1; wear dark glasses on the affected eye; chew gum; try to raise the eyebrows and whistle.