Bell's Palsy — Sudden Facial Paralysis: What It Is, Why It Happens and Treatment

Bell's palsy is one of the most dramatic neurological presentations that people encounter: waking in the morning to find that one entire side of the face is paralysed — unable to close the eye, raise the eyebrow, or smile on that side. The first instinct is "I am having a stroke." In most cases, it is not — it is Bell's palsy, and the prognosis with prompt treatment is generally excellent.

Bell's Palsy vs Stroke: The Critical Distinction

Both cause facial weakness on one side. The key difference involves the forehead:

Bell's palsy: The ENTIRE side of the face is paralysed — including the FOREHEAD. The person cannot raise their eyebrow or wrinkle their forehead on the affected side. This is because Bell's palsy affects the facial nerve itself (peripheral), which supplies all the facial muscles including the forehead.

Stroke: In stroke, the forehead is typically SPARED — the person can still raise their eyebrow normally. This is because the forehead muscles have bilateral cortical representation (both sides of the brain control the forehead), so a one-sided stroke affects the lower face more than the forehead. Stroke also typically causes arm weakness and speech difficulty — not usually present in Bell's palsy.

If you are unsure: go to hospital. Do not wait. If the forehead is involved and there are no other neurological symptoms, it is likely Bell's palsy. If the forehead is spared, or there are arm/speech symptoms — treat as stroke until proven otherwise.

Cause of Bell's Palsy

Bell's palsy is caused by inflammation and swelling of the facial nerve — most likely triggered by viral reactivation, particularly Herpes Simplex Virus type 1. The inflamed nerve swells within its bony canal (the facial canal), compressing itself and disrupting nerve conduction. Why it reactivates in some people at certain times is not fully understood — stress, recent viral illness, pregnancy, and cold exposure have been suggested as triggers.

Treatment — Why 72 Hours Matters

Prednisolone (oral steroids): Starting within 72 hours of onset improves the rate of full recovery significantly. Steroids reduce the nerve inflammation and swelling. The window closes after 72 hours — late treatment is less effective. Dosing: typically prednisolone 60 mg daily for 5 days, then tapered over 5 days.

Antiviral medication: Acyclovir or valacyclovir added to steroids — modest additional benefit, particularly in severe cases.

Eye care: Inability to close the eye is the most dangerous aspect of Bell's palsy — the cornea dries and can ulcerate. Use eye lubricant drops hourly during the day and tape the eye closed at night. See an ophthalmologist if eye redness or pain develops.

Physiotherapy: Facial exercises during recovery help prevent synkinesis (abnormal muscle movement patterns during recovery).

Prognosis: 70–85% of patients achieve full recovery. Severe initial paralysis, diabetes, and age above 60 are associated with less complete recovery.

For Bell's palsy treatment and follow-up: Sri Anand CNC, Chanda Nagar, Hyderabad. Call +91 90633 66983.