The use of steroids in bell's palsy: A prospective controlled study

May, Mark; Wette, Reimut; Hardin, William B.; Sullivan, John A.

doi:10.1288/00005537-197608000-00003

Cited by 82 publications

(30 citation statements)

References 9 publications

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“…Table 1 summarizes these studies and includes 2 of the studies reviewed in the original guideline that attained a grading of Class II or better. 16,17 Only Class I and Class II studies are discussed further. The 2 Class I studies 8,11 randomized patients to steroids vs placebo and described concealed allocation.…”

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confidence: 99%

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Evidence-based guideline update: Steroids and antivirals for Bell palsy

2012

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confidence: 99%

“…The 3 Class II studies [15][16][17] did not describe concealed allocation. These studies enrolled fewer than 100 patients each and described complete follow-up and masked outcome assessment.…”

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confidence: 99%

Evidence-based guideline update: Steroids and antivirals for Bell palsy

2012

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“…7 " Your colleague, however, might find this quote to contradict the first expert: "Bell's palsy remains without a proven efficacious treatment. 8 " It is often possible to find credible experts with conflicting opinions.…”

Section: The Evidence-practice Gapmentioning

confidence: 99%

“…In it she has an article from May et al, 8 published in 1975, in which the authors randomly assigned patients with Bell's palsy to receive steroids or placebo. 8 There was no significant difference in facial functional outcomes between the two groups. The authors concluded steroids were ineffective.…”

Section: The Evidence-practice Gapmentioning

confidence: 99%

From evidence to action

Gronseth

2004

Neurotherapeutics

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Summary: Despite the availability of vast quantities of evidence from basic biomedical and clinical studies, a gap often exists between the optimal practice suggested by the evidence and actual practice. For many clinical situations, however, evidence is unavailable, of poor quality or contradictory. Out of necessity, clinicians have become accustomed to relying on non-evidence-based tools to make decisions. Out of habit, they rely on these tools even when high-quality evidence becomes available. Growing out of an increasing awareness of this problem, the evidence-based medicine (EBM) movement sought to empower clinicians to find the evidence most relevant to a specific clinical question. Various organizations have used EBM techniques to develop systematic reviews and practice guidelines to aid physicians in making evidence-based decisions. A systematic review follows a process of asking a clinical question, finding the relevant evidence, critically appraising the evidence and formulating conclusions and recommendations. Results are mixed on whether educating physicians about evidence-based recommendations is sufficient to change physician behavior. Barriers to adopting evidencebased best practice remain, including physician skepticism, patient expectations, fear of legal action, and distorted reimbursement systems. Additionally, despite enormous research efforts there remains a lack of high-quality evidence to guide care for many clinical situations. Key Words: Diffusion of innovation, clinical practice guidelines, systematic reviews, quality of care. THE EVIDENCE-PRACTICE GAPPhysicians have at their disposal vast quantities of evidence from basic biomedical research and clinical studies. As discussed in other articles in this issue of NeuroRx , much of this evidence is potentially useful for guiding clinicians' actions in patient care. Despite the availability of this evidence, however, a gap often exists between the optimal practice suggested by the evidence and actual practice.One need not look hard to find examples of this evidence-practice gap. Many physicians still routinely use acute anticoagulation to treat noncardiogenic stroke, despite ample evidence that anticoagulation is not helpful, and indeed potentially harmful, in this setting. 1 Some physicians, including neurologists, fail to prescribe antiplatelet medications for the secondary prevention of stroke despite evidence of efficacy. 2 Patients with atrial fibrillation at high risk for stroke (e.g., those presenting with transient ischemic attacks or stroke) often do not receive warfarin for secondary stroke prevention even when there are no contraindications. 3 A more systematic look at the evidence-practice gap was provided by Schuster et al. 4 These authors demonstrated that only 70% of patients receive recommended acute care and 30% of patients receive contraindicated acute care. 4 This study and others provide ample evidence for the existence of an evidence-practice gap.Many reasons for the existence of the gap have been postulated. 5 The most...

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“…In IFNP, it has been proven that using steroids is more effective than placebo [2] . Although steroid therapy, which will be given at an early stage in IFNP, slows the spontaneous progress in paralysis and accelerates recovery [3] , some studies reported that steroids do not provide beneficial effects [4] . Steroids are also used in the treatment of PFNP.…”

Section: Introductionmentioning

confidence: 99%

The Effects of Methylprednisolone and Vitamin A on the Healing of Traumatic Peripheral Nerve Paralysis

Sevük¹,

Vayısoğlu²,

Korlu³

et al. 2015

Int Adv Otol

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OBJECTIVE:This study planned to evaluate the effects of vitamin A (VA) and steroid treatment on nerve healing. Study design: we investigated electrophysiological, electron microscopic (EM), immunohistochemical, and biochemical findings in rat sciatic nerve model. MATERIALS and METHODS:In total, 112 female rats were divided into 16 groups, each consisting of 7 animals. Subjects were evaluated according to compound muscle action potential (CMAP) findings, ultrastructural staging of myelinated axons with EM, nitric oxide (NO) and malondialdehyde (MDA) findings in serum and tissue, and immunohistochemical findings in the first week and first month. RESULTS:NO and MDA levels in serum and tissue were found to be statistically lower after high-dose methylprednisolone (MP), normal-dose MP, high-dose MP+VA, normal-dose, and MP+VA treatment modalities compared to controls (p<0.05). The most similar EM findings compared to control animals were seen in the normal-dose MP and high-dose MP+VA treatment groups. The best amplitude values were seen in the high-dose MP and continuous normal-dose MP therapy groups in the first month. In the normal-dose MP and high-dose MP+VA treatment groups, intense staining was found compared to the control and sham groups according to the sciatic nerve immunohistochemical examination. CONCLUSION:This study revealed noticeable VA effects on the inflammatory process during the healing of traumatic nerve paralysis by electron microscopy and immunohistochemistry. However, similar findings were not established by electrophysiology. Therefore, more experimental studies are needed to further investigate the efficacy and the mechanism of action of VA on steroid administration and the inflammatory process.

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The use of steroids in bell's palsy: A prospective controlled study

Cited by 82 publications

References 9 publications

Evidence-based guideline update: Steroids and antivirals for Bell palsy

Evidence-based guideline update: Steroids and antivirals for Bell palsy

From evidence to action

The Effects of Methylprednisolone and Vitamin A on the Healing of Traumatic Peripheral Nerve Paralysis

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