Bell's Palsy: A Review of Treatment Using Antiviral Agents

Alberton, Dario L; Zed, Peter J.

doi:10.1345/aph.1h077

Cited by 26 publications

(13 citation statements)

References 17 publications

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“…This study described the aetiological factors and prevalence of facial palsy in Kano over a five year period. The findings of this study revealed that the prevalence of facial palsy in this sub-region (9.1%) is relatively higher compared to those previously reported in other sub-regions in Nigeria and other parts of the world (Doner & Kuthuhan, 2000;Grose et al, 2002;Morris et al, 2002;Shmorgun et al, 2002;Alberton & Zed, 2006;Chukwuezi & Nwosu, 2007) who had earlier reported prevalence rates of less than one percent among their study populations. The high prevalence in this study can be attributed to high road traffic accident, higher prevalence of stroke as well as the harsh weather in this region.…”

Section: Discussioncontrasting

confidence: 62%

“…The muscles affected are determined by the type of lesion; infra nuclear lesion affect all the muscles of facial expression while supra nuclear lesion causes weakness of lower two-third part of the facial muscles on the opposite side of the lesion (Grose et al, 2002). The paralysis may include all the muscles and modalities affected by the facial nerve like mimetic facial movement, taste, cutaneous sensation, hearing ability, salivation and drooping on the affected half (Grose et al, 2002;Axellsson et al, 2003;Alberton & Zed, 2006).…”

Section: Introductionmentioning

confidence: 99%

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Untitled

2013

JCHS

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Nurse practice in today's world requires that nurses be adept at directing a multi-skilled and diverse workforce. In the U.S. the registered nurse must be clinically competent while simultaneously be knowledgeable of their practice guidelines to ensure safe and effective patient care delivery. In South Africa nurses practice under the South Africa Nursing Council Nursing Act guidelines; in the United States the National Council for State Board of Nursing provides rules and regulations for nurse practice. Nursing care practice guidelines, including delegation, are regulated by individual state boards of nursing with written nurse practice acts in the United States of America. The shortage of nurses may have an impact on safe and effective care to individuals with complex, acute, and chronic health care. Delegation of nursing procedures must be done in both countries to facilitate prudent use of the nurses' time for higherlevel duties. In the United States increased longevity and expensive interventions directed toward preventable disease, and in South Africa the Acquired Immune Deficiency Syndrome epidemic are taxing health delivery resources in our respective countries. Clearly, the nurse must include management expertise, and especially nurse delegation in their practice skills repertoire. This article will share delegation via patient care management and decision-making models; review the nurses' role in specialty nursing areas; and offer strategies to best use the existing workforce, which includes unlicensed health care workers.

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Section: Discussioncontrasting

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Untitled

2013

JCHS

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“…The meta-analyses do have heterogeneity due to differences in antiviral drugs used, drug dosing, and timing of therapy initiation but are nevertheless consistent and unequivocal in their finding of no benefit from antiviral therapy as a singlemodality treatment for Bell's palsy. 2,[70][71][72][73][74] The recommendation against antiviral monotherapy offers the benefit of avoiding the cost and side effects of ineffective antiviral therapy for Bell's palsy. The most commonly observed side effects of antiviral therapy are gastrointestinal related and include nausea, vomiting, and diarrhea, with rare severe reactions, including hives, bronchospasm, angioedema, and hepatic or renal failure.…”

Section: Supporting Textmentioning

confidence: 99%

Clinical Practice Guideline: Bell's Palsy

Baugh

Basura

Ishii

et al. 2013

Otolaryngol.--head neck surg.

373

114

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Objective Bell’s palsy, named after the Scottish anatomist, Sir Charles Bell, is the most common acute mono-neuropathy, or disorder affecting a single nerve, and is the most common diagnosis associated with facial nerve weakness/paralysis. Bell’s palsy is a rapid unilateral facial nerve paresis (weakness) or paralysis (complete loss of movement) of unknown cause. The condition leads to the partial or complete inability to voluntarily move facial muscles on the affected side of the face. Although typically self-limited, the facial paresis/paralysis that occurs in Bell’s palsy may cause significant temporary oral incompetence and an inability to close the eyelid, leading to potential eye injury. Additional long-term poor outcomes do occur and can be devastating to the patient. Treatments are generally designed to improve facial function and facilitate recovery. There are myriad treatment options for Bell’s palsy, and some controversy exists regarding the effectiveness of several of these options, and there are consequent variations in care. In addition, numerous diagnostic tests available are used in the evaluation of patients with Bell’s palsy. Many of these tests are of questionable benefit in Bell’s palsy. Furthermore, while patients with Bell’s palsy enter the health care system with facial paresis/paralysis as a primary complaint, not all patients with facial paresis/paralysis have Bell’s palsy. It is a concern that patients with alternative underlying etiologies may be misdiagnosed or have unnecessary delay in diagnosis. All of these quality concerns provide an important opportunity for improvement in the diagnosis and management of patients with Bell’s palsy. Purpose The primary purpose of this guideline is to improve the accuracy of diagnosis for Bell’s palsy, to improve the quality of care and outcomes for patients with Bell’s palsy, and to decrease harmful variations in the evaluation and management of Bell’s palsy. This guideline addresses these needs by encouraging accurate and efficient diagnosis and treatment and, when applicable, facilitating patient follow-up to address the management of long-term sequelae or evaluation of new or worsening symptoms not indicative of Bell’s palsy. The guideline is intended for all clinicians in any setting who are likely to diagnose and manage patients with Bell’s palsy. The target population is inclusive of both adults and children presenting with Bell’s palsy. Action Statements The development group made a strong recommendation that (a) clinicians should assess the patient using history and physical examination to exclude identifiable causes of facial paresis or paralysis in patients presenting with acute-onset unilateral facial paresis or paralysis, (b) clinicians should prescribe oral steroids within 72 hours of symptom onset for Bell’s palsy patients 16 years and older, (c) clinicians should not prescribe oral antiviral therapy alone for patients with new-onset Bell’s palsy, and (d) clinicians should implement eye protection for Bell’s palsy patients with impaired eye closure. The panel made recommendations that (a) clinicians should not obtain routine laboratory testing in patients with new-onset Bell’s palsy, (b) clinicians should not routinely perform diagnostic imaging for patients with new-onset Bell’s palsy, (c) clinicians should not perform electrodiagnostic testing in Bell’s palsy patients with incomplete facial paralysis, and (d) clinicians should reassess or refer to a facial nerve specialist those Bell’s palsy patients with (1) new or worsening neurologic findings at any point, (2) ocular symptoms developing at any point, or (3) incomplete facial recovery 3 months after initial symptom onset. The development group provided the following options: (a) clinicians may offer oral antiviral therapy in addition to oral steroids within 72 hours of symptom onset for patients with Bell’s palsy, and (b) clinicians may offer electrodiagnostic testing to Bell’s palsy patients with complete facial paralysis. The development group offered the following no recommendations: (a) no recommendation can be made regarding surgical decompression for patients with Bell’s palsy, (b) no recommendation can be made regarding the effect of acupuncture in patients with Bell’s palsy, and (c) no recommendation can be made regarding the effect of physical therapy in patients with Bell’s palsy.

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“…51 When valacyclovir is given in conjunction with prednisone, there is a significant improvement in outcome especially in the elderly than when compared with no treatment at all. 52 According to a recent meta-analysis of prospective, randomized controlled trials, 53 even though the use of antivirals in Bell's palsy remains controversial, the use of acyclovir and prednisone is supported if commenced within the first 72 hours of symptom onset. The 72-hour period of treatment initiation was also supported by a multicenter, randomized, placebo-controlled study 54 that prospectively looked at 221 Bell's palsy patients who were treated with combination therapy within 7 days of symptom onset.…”

Section: Management Of Facial Paralysismentioning

confidence: 99%

Overview of Facial Paralysis: Current Concepts

Melvin

Limb

2008

Facial plast Surg

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Facial paralysis represents the end result of a wide array of disorders and heterogeneous etiologies, including congenital, traumatic, infectious, neoplastic, and metabolic causes. Thus, facial palsy has a diverse range of presentations, from transient unilateral paresis to devastating permanent bilateral paralysis. Although not life-threatening, facial paralysis remains relatively common and can have truly severe effects on one's quality of life, with important ramifications in terms of psychological impact and physiologic burden. Prognosis and outcomes for patients with facial paralysis are highly dependent on the etiologic nature of the weakness as well as the treatment offered to the patient. Facial plastic surgeons are often asked to manage the sequelae of long-standing facial paralysis. It is important, however, for any practitioner who assists this population to have a sophisticated understanding of the common etiologies and initial management of facial paralysis. This article reviews the more common causes of facial paralysis and discusses relevant early treatment strategies.

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Bell's Palsy: A Review of Treatment Using Antiviral Agents

Cited by 26 publications

References 17 publications

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Clinical Practice Guideline: Bell's Palsy

Overview of Facial Paralysis: Current Concepts

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