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


CONCLUSIONS
: Corticosteroids effectively reduce the risk of an unfavorable outcome in Bell palsy. Antiviral agents, when administered concurrently with corticosteroids, may result in additional benefit.
Thaera
Greg M
GM
Department of Neurology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA.
Wellik
Kay E
KE
Barrs
David M
DM
Dunckley
Erika D Driver
ED
Wingerchuk
Dean M
DM
Demaerschalk
Bart M
BM
D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use*; D020330:Bell Palsy / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D006801:Humans; D015201:Meta-Analysis as Topic; D012196:Review Literature as Topic; D012306:Risk; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000998:Antiviral Agents