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

• Published in: The Neurologist (Baltimore, Md.) Vol. 16; no. 2; p. 138
• Main Authors: Thaera, Greg M, Wellik, Kay E, Barrs, David M, Dunckley, Erika D Driver, Wingerchuk, Dean M, Demaerschalk, Bart M
• Format: Journal Article
• Language: English
• Published: United States 01.03.2010
• Subjects: Adrenal Cortex Hormones - adverse effects; Adrenal Cortex Hormones - therapeutic use; Antiviral Agents - therapeutic use; Bell Palsy - drug therapy; Drug Therapy, Combination; Humans; Meta-Analysis as Topic; Review Literature as Topic; Risk; Treatment Outcome
• ISSN: 2331-2637
• DOI: 10.1097/NRL.0b013e3181d35775

: 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. : Are corticosteroid and antiviral medications effective in the treatment of Bell palsy? : 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. : 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]). : Corticosteroids effectively reduce the risk of an unfavorable outcome in Bell palsy. Antiviral agents, when administered concurrently with corticosteroids, may result in additional benefit.