Corticosteroid and antiviral therapy for Bell's palsy: A network meta-analysis

Numthavaj, Pawin; Thakkinstian, Ammarin; Dejthevaporn, Charungthai; Attia, John

doi:10.1186/1471-2377-11-1

Cited by 100 publications

(102 citation statements)

References 34 publications

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“…73 It is estimated that 26 patients would require treatment with the combination therapy to achieve 1 better facial nerve outcome than with steroid therapy alone. 78 In summary, antiviral therapy in addition to steroid therapy has not been proven to be of benefit in the treatment of Bell's palsy in large, high-quality clinical trials, although a small benefit cannot be completely excluded. Due to the potential of a small benefit in facial nerve functional recovery and the relatively low risk of antiviral therapy, the GDG concluded that patients may be offered combination therapy if treated within 72 hours of onset of Bell's palsy, with a large role for shared decision making.…”

Section: -78mentioning

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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Section: -78mentioning

confidence: 99%

Clinical Practice Guideline: Bell's Palsy

Baugh

Basura

Ishii

et al. 2013

Otolaryngol.--head neck surg.

373

114

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“…Since most of these forms in childhood recover spontaneously, aim of the drug therapy is to minimize the possibility of incomplete resolutions and reduce the risk of sequelae, such synkinesis, autonomic dysfunctions (e.g., crocodile tears), facial spasms [26] . When Bell's palsy occurs in adults, it is well known that glucocorticoids in combination with antiviral therapy (acyclovir or valacyclovir) are recommended [27][28][29][30] . In children, the use of oral corticosteroids is recommended preferably within 3 d from onset of symptoms (the suggested treatment regimen is prednisone 1-2 mg/kg per day for 10 d, gradually decreasing the dose) [13,31] as the majority of patients improves in the first three weeks [32] , although several studies did not find significant differences between the outcomes of children treated with corticosteroids and not [20,[33][34][35] .…”

Section: Drug Therapymentioning

confidence: 99%

Facial Nerve Paralysis in Children

Licameli¹,

Tunkel²

2013

Pediatric Otorhinolaryngology

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Facial nerve palsy is a condition with several implications, particularly when occurring in childhood. It represents a serious clinical problem as it causes significant concerns in doctors because of its etiology, its treatment options and its outcome, as well as in little patients and their parents, because of functional and aesthetic outcomes. There are several described causes of facial nerve paralysis in children, as it can be congenital (due to delivery traumas and genetic or malformative diseases) or acquired (due to infective, inflammatory, neoplastic, traumatic or iatrogenic causes). Nonetheless, in approximately 40%-75% of the cases, the cause of unilateral facial paralysis still remains idiopathic. A careful diagnostic workout and differential diagnosis are particularly recommended in case of pediatric facial nerve palsy, in order to establish the most appropriate treatment, as the therapeutic approach differs in relation to the etiology.

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“…A recent network meta-analysis aimed to overcome the difficulties in pooling results from studies with different treatment regimens by combining direct and indirect comparisons 11. The systematic review identified six studies (published up to September 2010) involving 1,805 subjects.…”

Section: Drug Treatmentmentioning

confidence: 99%

Antivirals for Bell's palsy?

2013

DTB

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Each year in the UK around 1 in 5,000 people develop Bell's palsy-idiopathic unilateral lower motor neurone facial weakness of rapid onset. Although about 70% recover spontaneously, the remaining 30% are at risk of complications;(1) 13% have residual slight weakness and about 16% have persistent moderate to severe weakness if not treated.(2) As we have discussed in two previous articles there has been longstanding controversy about the best form of treatment.(2,3) In 2006 we concluded that published trials on the efficacy of drug treatments have been poor and no firm conclusions can be drawn about the benefit of any single drug;(2) in 2008 we noted that evidence suggests oral prednisolone started within 72 hours of symptom onset makes recovery more likely and that there was little good evidence that an antiviral drug helps.(3) The place of antivirals in the management of Bell's palsy remains a controversial issue. In this article we review the evidence for antiviral therapy alone or in conjunction with corticosteroid treatment.

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Corticosteroid and antiviral therapy for Bell's palsy: A network meta-analysis

Cited by 100 publications

References 34 publications

Clinical Practice Guideline: Bell's Palsy

Clinical Practice Guideline: Bell's Palsy

Facial Nerve Paralysis in Children

Antivirals for Bell's palsy?

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