Antiviral treatment for Bell's palsy (idiopathic facial paralysis)

Abstract

BACKGROUND: Corticosteroids are widely used in the treatment of idiopathic facial paralysis (Bell's palsy), but the effectiveness of additional treatment with an antiviral agent is uncertain. Significant morbidity can be associated with severe cases of Bell's palsy. OBJECTIVES: To assess the effects of antiviral treatments alone or in combination with any other therapy for Bell's palsy. METHODS:Search methods: On 7 October 2014 we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE, EMBASE, LILACS, DARE, NHS EED, and HTA. We also reviewed the bibliographies of the identified trials and contacted trial authors and known experts in the field and relevant drug companies to identify additional published or unpublished data. We searched clinical trials registries for ongoing studies. Selection criteria: We considered randomised controlled trials or quasi-randomised controlled trials of antivirals with and without corticosteroids versus control therapies for the treatment of Bell's palsy. We excluded trials that had a high risk of bias in several domains. Data collection and analysis: Pairs of authors independently assessed trials for relevance, eligibility, and risk of bias, using standard Cochrane procedures. MAIN RESULTS: Eleven trials, including 2883 participants, met the inclusion criteria and are included in the final analysis. We added four studies to the previous review for this update. Some of the trials were small, and a number were at high or unclear risk of bias. Other trials did not meet current best standards in allocation concealment and blinding. Incomplete recovery: We found no significant benefit from adding antivirals to corticosteroids in comparison with corticosteroids alone for people with Bell's palsy (risk ratio (RR) 0.69, 95% confidence interval (CI) 0.47 to 1.02, n = 1715). For people with severe Bell's palsy (House Brackmann scores of 5 and 6 or the equivalent in other scales), we found a reduction in the rate of incomplete recovery at month six when antivirals plus corticosteroids were used (RR 0.64, 95% CI 0.41 to 0.99, n = 478). The outcome for the participants receiving corticosteroids alone was significantly better than for those receiving antivirals alone (RR 2.09, 95% CI 1.36 to 3.20, n = 1169). The treatment effect of placebo was significantly lower than that of antivirals plus corticosteroids (RR 0.56, 95% CI 0.41 to 0.76, n = 658). Antivirals alone had a non-significant detrimental effect on the outcome compared with placebo (RR 1.10, 95% CI 0.87 to 1.40, n = 658). Motor synkinesis or crocodile tears:In three trials comparing antivirals and corticosteroids with corticosteroids and placebo that assessed this outcome, we found a significant difference in long-term sequelae in favour or antivirals plus corticosteroids (RR 0.73, 95% CI 0.54 to 0.99, n = 869). Three trials comparing antivirals alone with corticosteroids alone investigating this outcome showed fewer sequelae with corticosteroids (RR 1.44, 95% CI 1.11 to 1.85, n = 873). We foun...

Cutaneous Sensibility Changes in Bell’s Palsy Patients

“…16,17 Bilateral paralysis is unlikely to occur, since it is evident in only 0.3% to 2.0% of facial palsy cases. 18 Corticosteroids 19 and antiviral agents, 20 alone or in combination, 21,22 have been used in the treatment of Bell's palsy. Additional treatments include electrical stimulation, 23 surgery, 24,25 physical therapy, 26 and acupuncture.…”

Facial paralysis as a presenting symptom of infant leukemia

“…In terms of Bell paralysis, the use of corticosteroids in adult patients may improve the prognosis by reducing inflammation and edema in the myelin sheath of facial nerves. [16,17] However, currently, the use of corticosteroids for children remains controversial. Babl et al affirmed the effectiveness of hormones in treating Bell paralysis in children in a multicenter, randomized, controlled trial study.…”

Tipo de terapêutica e fatores de prognóstico na paralisia de Bell: estudo retrospectivo de cinco anos em um hospital português

“…Os resultados deste estudo relativamente à terapêutica antiviral estão de acordo com a revisão Cochrane de 2015 [18], que incluiu 11 ensaios controlados, com um total de 2883 pacientes com paralisia de Bell. A revisão concluiu não haver benefício na combinação de corticosteroides com antivirais, comparados aos corticosteroides isolados ou associados a placebo, assim como nenhum benefício foi encontrado no uso de antivirais isoladamente quando comparados a placebo [17].…”