Are corticosteroid and antiviral treatments effective for bell palsy? A critically appraised topic

Greg M. Thaera, Kay E. Wellik, David M. Barrs, Erika D.Driver Dunckley, Dean M. Wingerchuk, Bart M. Demaerschalk

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

Background: Bell palsy is idiopathic peripheral facial weakness that typically resolves without severe clinical sequelae. Treatment with corticosteroids and antiviral drugs is often initiated to improve the likelihood of a favorable outcome. Objective: Are corticosteroid and antiviral medications effective in the treatment of Bell palsy? Methods: The objective was addressed through the development of a structured critically appraised topic. This included a clinical scenario with a structured question, search strategy, critical appraisal, results, evidence summary, commentary, pre- and postassessment, and bottom-line conclusions. Participants included consultant and resident neurologists, a medical librarian, clinical epidemiologists, and a clinical content expert in the field of Otolaryngology. Results: The largest (18 trials involving 2786 patients) current systematic review and meta-analysis for pharmacologic treatment of Bell palsy was selected for appraisal. The meta-analysis demonstrated a clear benefit of oral corticosteroids, alone, in preventing unsatisfactory recovery of facial weakness (relative risk, 0.69 [95% confidence interval {CI}, 0.55-0.87], number needed to treat 11 [95% CI, 8-25]). Treatment with antiviral medication, alone, was not associated with a reduced risk of unsatisfactory recovery. When administered concurrently with corticosteroids, antiviral treatments displayed a trend toward reduced risk of unsatisfactory recovery, compared with corticosteroids alone (relative risk, 0.75 [95% CI, 0.56-1.00]). Conclusion: Corticosteroids effectively reduce the risk of an unfavorable outcome in Bell palsy. Antiviral agents, when administered concurrently with corticosteroids, may result in additional benefit.

Original languageEnglish (US)
Pages (from-to)138-140
Number of pages3
JournalNeurologist
Volume16
Issue number2
DOIs
StatePublished - Mar 1 2010

Keywords

  • Adrenal cortex hormones
  • Antiviral agents
  • Bell palsy
  • Critically appraised topic
  • Evidencebased medicine
  • Facial paralysis
  • Steroids
  • Treatment

ASJC Scopus subject areas

  • Clinical Neurology

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