Is there benefit adding antivirals to corticosteroids for Bells palsy in adults?
Bells palsy is the first cause of unilateral facial palsy. The likely etiologic mechanism is facial nerve inflammation secondary to viral reactivation, most probably due to herpes simplex and Varicella Zoster. Corticosteroids are considered the mainstay of treatment, but it is not clear whether adding antivirals would further increase the benefit. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified 10 systematic reviews including 15 pertinent randomized controlled trials overall. We combined the evidence and generated a summary of findings following the GRADE approach. We concluded that adding antivirals to the treatment with corticosteroids probably reduces the risk of incomplete recovery in patients with Bells palsy.
Departamento Urgencias, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Proyecto Epistemonikos. Address: Facultad de Medicina, Pontificia Universidad Católica de Chile, Lira 63, Santiago Centro, Chile. Email: radagabriel@gmail.com.
Benjamín
B
Walbaum
Proyecto Epistemonikos; Programa de Salud Basada en Evidencia, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; GRADE working group; The Cochrane Collaboration.
Gabriel
G
Rada
D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D020330:Bell Palsy / Q000188:drug therapy* / Q000503:physiopathology / Q000821:virology; D004359:Drug Therapy, Combination; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000627:therapeutic use; D014645:Herpesvirus 3, Human / Q000302:isolation & purification; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D018139:Simplexvirus / Q000302:isolation & purification; D014775:Virus Activation
D000998:Antiviral Agents; D005938:Glucocorticoids