Antiviral treatment for Bell's palsy (idiopathic facial paralysis).
BACKGROUND
Antiviral agents against herpes simplex virus are widely used in the treatment of idiopathic facial paralysis (Bell's palsy), but their effectiveness is uncertain. Significant morbidity can be associated with severe cases.


OBJECTIVE
This review addresses the effect of antiviral therapy on Bell's palsy.


METHODS
We updated the search of the Cochrane Neuromuscular Disease Group Trials Register (December 2008), MEDLINE (from January 1966 to December 8 2008), EMBASE (from January 1980 to December 8 2008) and LILACS (from January 1982 to December 2008).


METHODS
Randomized trials of antivirals with and without corticosteroids versus control therapies for the treatment of Bell's palsy.


METHODS
Twenty-three papers were selected for consideration.


RESULTS
Seven trials including 1987 participants met the inclusion criteria, adding five studies to the two in the previous review.Incomplete recovery at one year. There was no significant benefit in the rate of incomplete recovery from antivirals compared with placebo (n = 1886, RR 0.88, 95% CI 0.65 to 1.18). In meta-analyses with some unexplained heterogeneity, the outcome with antivirals was significantly worse than with corticosteroids (n = 768, RR 2.82, 95% CI 1.09 to 7.32) and the outcome with antivirals plus corticosteroids was significantly better than with placebo (n = 658, RR 0.56, 95% CI 0.41 to 0.76).Motor synkinesis or crocodile tears at one year. In single trials, there was no significant difference in long term sequelae comparing antivirals and corticosteroids with corticosteroids alone (n = 99, RR 0.39, 95% CI 0.14 to 1.07) or antivirals with corticosteroids (n = 101, RR 1.03, 95% CI 0.51 to 2.07).Adverse events.There was no significant difference in rates of adverse events between antivirals and placebo (n = 1544, RR 1.06, 95% CI 0.81 to 1.38), between antivirals and corticosteroids (n = 667, RR 0.96, 95% CI 0.65 to 1.41) or between the antiviral-corticosteroid combination and placebo (n = 658, RR 1.15, 95% CI 0.79 to 1.66).


CONCLUSIONS
High quality evidence showed no significant benefit from anti-herpes simplex antivirals compared with placebo in producing complete recovery from Bell's palsy. Moderate quality evidence showed that antivirals were significantly less likely than corticosteroids to produce complete recovery.
Lockhart
Pauline
P
Centre for Primary Care and Population Research, Division of Clinical and Population Sciences and Education, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee, UK, DD2 4BF.
Daly
Fergus
F
Pitkethly
Marie
M
Comerford
Natalia
N
Sullivan
Frank
F
D000212:Acyclovir / Q000031:analogs & derivatives / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use*; D020330:Bell Palsy / Q000188:drug therapy* / Q000821:virology; D004359:Drug Therapy, Combination / Q000379:methods; D006561:Herpes Simplex / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D011239:Prednisolone / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D000077483:Valacyclovir; D014633:Valine / Q000031:analogs & derivatives / Q000627:therapeutic use
D000893:Anti-Inflammatory Agents; D000998:Antiviral Agents; D011239:Prednisolone; D014633:Valine; D000077483:Valacyclovir; D000212:Acyclovir