Hi frnds...Pt having Bells palsy LMN..No response to any antivirals, Steroids or supplementary drugs...Regular physiotherapy practice perfomed. ..No result Having DM and under control No hypertensive still no response still last 25 days....Pt took physician and Neurophysician reference still no improvement. .Any one know any advanced therapy plz suggest

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Dr. Modi, It is said that steroids given within 72hrs of onset always have better prognosis than others. Since he is Diabetic, it will take time. Please wait because as from clinical pic he is doing well. Meanwhile keep continuing physical therapy, Prednisolone and multivitamins including fish oils. It is said Diabetics require higher dose of steroids than normal pt. Also, please rule out Neoplastic causes of FNP in head and neck region using MRI. If stays unresolved after 9 months to 1 year, surgical interventions like nerve decompression, electrical stimulation, Botox etc can be opted for. We know there are residual effects and at times not complete recovery, just keep trying your best!

Thanks mam
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Dr.Sagar recovery is considerable . continue a same/bigger dose of corticosteroid. Supplement with Evion-L.C , multivitamins and multiminerals. cholecalciferol 60,000 I.U physiotherapy in form of facial PNF, facial muscle exercises less repitations and increased frequency will help. avoid facial muscle stimulation in initial phase to be started after initial 15-20 days. self limiting condition usually takes 3 weeks to resolve

Dr.Sagar,,Not every body improves,, If it's axonal variant then don't expect much improvement Please don't push steroids It's not worth it Recommendations say,, treatment with acyclovir and steroids for 10 days You can do facial nerve conductions ,, and look if it's demyelinating or axonal variant

Thank you sir
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It is bells palsy just leave alone there is no role for any medication or physiotherapy. It generally these 6to8wks. To resolve or there for life. Can carry out a M R I to rule out any tumour involving facial nerve. Depending on pt financial condition To satisfy the pt.

Thank you sir
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At his age, the recovery is excellent and probably no medicine will help. Anyway U can give a course of CHYMORAL FORTE DS for a period of two weeks along with continued physiotherapy and cynocobalamin.Do not despair the time will heal it to near normalsy

Thank you sir
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Once again Methylprednisolone 16 mg BD Tab Methylcobalamine 1500 od Tab Ranitidine 150 mg BD. Physiotherapy and hot fomentation on face . Gabapentin od . wait for 21 days more. 100 % recovery in all cases is possible . but you have to give assurance .

not possible
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Dear Sagar, About 10% of this type of cases remain unresponsive. You have tried all the measures on the earth. But this stays for life time. Initial care is bad, the results would be disastrous only like this case. Sorry dear Sagar

Thank u sir
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Stimulation on the motor points of the facial muscles ....facial muscles massage like efflorage tapping hacking and kneeding....facial muscle exercises like puffing of cheeks raising of eye brows ,blowing of balloons......

Thanks
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Well how will physiotherapy help it not a muscular involvement. It is always involvement of facial nerve in the middle ear or further up. Occasionly injury. Of corticotrophin helps in reducing the swelling of facial nerve.

electrical stimulation in physiotherapy is used to prevent muscle atropy, proprioceptive neuromusculer facilitation techniques facilitate muscle contractions.
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continue with prednisone 60 mg, wait till 6 weeks of treatment...strict control of sugar with insulin. In my experience isolated bells palsy show gradual and complete recovery with 10 mg prednisone & methylcobalamine, wait

it may take as long as 6 months
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