The neurologist's dilemma: a comprehensive clinical review of Bell's palsy, with emphasis on current management trends.
BACKGROUND
Recent advances in Bell's palsy (BP) were reviewed to assess the current trends in its management and prognosis.


METHODS
We retrieved the literature on BP using the Cochrane Database of Systematic Reviews, PubMed, and Google Scholar. Key words and phrases used during the search included 'Bell's palsy', 'Bell's phenomenon', 'facial palsy', and 'idiopathic facial paralysis'. Emphasis was placed on articles and randomized controlled trails (RCTs) published within the last 5 years.


RESULTS
BP is currently considered the leading disorder affecting the facial nerve. The literature is replete with theories of its etiology, but the reactivation of herpes simplex virus isoform 1 (HSV-1) and/or herpes zoster virus (HZV) from the geniculate ganglia is now the most strongly suspected cause. Despite the advancements in neuroimaging techniques, the diagnosis of BP remains one of exclusion. In addition, most patients with BP recover spontaneously within 3 weeks.


CONCLUSIONS
Corticosteroids are currently the drug of choice when medical therapy is needed. Antivirals, in contrast, are not superior to placebo according to most reliable studies. At the time of publication, there is no consensus as to the benefit of acupuncture or surgical decompression of the facial nerve. Long-term therapeutic agents and adjuvant medications for BP are necessary due to recurrence and intractable cases. In the future, large RCTs will be required to determine whether BP is associated with an increased risk of stroke.
Department of Anatomical Sciences, School of Medicine, St. George's University, St. George's, Grenada.
Anthony
A
Zandian
Department of Anatomical Sciences, School of Medicine, St. George's University, St. George's, Grenada.
Stephen
S
Osiro
Department of Anatomical Sciences, School of Medicine, St. George's University, St. George's, Grenada.
Ryan
R
Hudson
Department of Anatomical Sciences, School of Medicine, St. George's University, St. George's, Grenada.
Irfan M
IM
Ali
Department of Anatomy, Victor Babes University of Medicine and Dentistry, Timisoara, Romania.
Petru
P
Matusz
Pediatric Neurosurgery, Children's Hospital, Birmingham, USA.
Shane R
SR
Tubbs
Department of Anatomical Sciences, School of Medicine, St. George's University, St. George, Grenada.
Marios
M
Loukas
D020330:Bell Palsy / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000503:physiopathology* / Q000821:virology; D019468:Disease Management; D005260:Female; D017405:Herpes Simplex Virus Protein Vmw65 / Q000378:metabolism; D018259:Herpesvirus 1, Human; D014645:Herpesvirus 3, Human; D006801:Humans; D006889:Hydroxycorticosteroids / Q000627:therapeutic use; D008297:Male; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic
D017405:Herpes Simplex Virus Protein Vmw65; D006889:Hydroxycorticosteroids