Ring the Bell for Steroids!

http://www.neurology.org/content/early/2012/11/07/WNL.0b013e318275978c.abstract

Above is a current nice meta analysis abstract from the American Academy of Neurology summarizing that for Bell's palsy, the treatment of choice definitively should include steroids, and at best, antivirals should be an adjunct. I lack access to the full article, but being a meta  analysis I assume one set dose and period of steroids was not agreed upon. A rough survey of older texts though seems to avoid the "Medrol Dose Pak" in favor of higher, constant doses to battle Bells. While there is some literature disagreement, most authorities concur that no steroid taper is required for 5 days of therapy, and I have seen quotes ranging from 7 to 9 days before a taper is required. A few other tips:
1. Again, this 2012 analysis emphasizes steroids for Bells. As the abstract states, antivirals can be used, but the proven benefit is modest- 7% at best.
2. DOCUMENT in your note how long the patient has noted symptoms, as most bad outcomes are linked to patients presenting over 3 days from symptom appearance. As such, a lack of response to therapy (ie- a patient saying "you horrible provider, you have not cured me yet!") is often due to late presentation-not your improper therapy.
3. Make it clear in your discharge instructions for diabetics about hypergylcemia issues, including the need for primary care follow up for possible monitoring, before you embark on the steroids. Ditto for history of severe/bleeding GI ulcers.
4. In a busy clinic it is easy to do, but recall- per my recollection- that this "Bells/steroids emphasis" is different from zoster/shingles, where the focus is more on prompt antivirals. Per my reading there is less conclusive data on the benefits of steroids in zoster, including post herpetic neuralgia. Please comment if you know of a renewed or newly proven emphasis on steroids for zoster.
5. DON'T FORGET THE EYE! In Bell's palsy people wil sleep and the eye cannot/will not completely shut. Without the constant stream of germ diluting eye secretions from the tear ducts, people with poor eye management in Bells have had devastasting corneal ulcers. Give written instructions to use sterile saline ad lib during the day and at night to "tape" the eyelid shut with paper tape. Eye irritation or discomfort should prompt an ophthalmology evaluation.
6. For what it's worth, I usually go with Prednisone 50mg tablets, one a day with food for 5 days, no taper. Do you all have any other "favorite" regimens?
7. Lastly, infectious disease specialists rant about considering Lyme disease in a patient with Bells palsy. While I see no problem with documenting a tick exposure history, I would kindly refer one to the legion articles in the past on this blog about the limits and pitfalls of Lyme testing. As I often say, "any fool can ordrer a test- the medical skill comes in proper interpretation."