Contemporary pharmacological strategies for acute peripheral facial palsy: a narrative review with clinical decision considerations

Acute peripheral facial palsy (APFP) sometimes known as Bell’s palsy is a common neurological condition and is marked by the acute onset of lower motor weakness on one side of the face. Whereas spontaneous recovery is widespread, there is a significant rate of incomplete recovery, synkinesis, or enduring functional and psychosocial disability of patients. The past decades witnessed the improvement of the diagnostic and therapeutic plans, particularly the pharmacological and adjunctive ones, due to the developments in pathophysiological and clinical trials and the creation of guidelines. This narrative review summarizes the existing evidence on the classification, diagnosis, and treatment of APFP, particularly corticosteroid disease treatment, antiviral medication, combination therapy, adjunct, and rehabilitative therapies, and the future of precision medicine. Randomised controlled trials and high-quality systematic reviews have shown evidence in support of the early initiation of systemic corticosteroids within 72 h of symptom onset as the foundation of treatment practice, improving the likelihood of achieving full facial nerve recovery and less morbidity in the long run. Conversely, antiviral monotherapy has not demonstrated significant clinical benefit with combination therapy with antivirals potentially presenting some benefit to older patients and with severe cases of paralysis. New data highlight the significance of risk stratification, electrophysiological testing, and focal rehabilitation to maximize the results and reduce the sequelae. The developments in artificial intelligence, the work on biomarkers and adaptive clinical trial designs will likely enable more personalized prognostication and treatment choice. In general, a shift towards precision risk-based approaches to the management of acute peripheral facial palsy is also being considered and emerging diagnostic strategies, promotion of the use of corticosteroids as early as possible and focused adjunctive operations that are tailored to a child are becoming the key to improving functional outcomes in the long term.