|EVIDENCE-BASED MEDICINE: SUMMARY OF STUDY
|Year : 2016 | Volume
| Issue : 4 | Page : 123-124
Antivirals in Bell's Palsy
Tony Abraham Thomas M.Ch. Neurosurgery
CMC, Vellore, India
|Date of Web Publication||22-Nov-2016|
Source of Support: Gagyor I, Madhok VB, Daly F, Somasundara D, Sullivan M, Gammie F, Sullivan F. Antiviral treatment for Bellís palsy (idiopathic facial paralysis) (Review). Cochrane Database of Systematic Reviews 2015, Issue 7., Conflict of Interest: None
|How to cite this article:|
Thomas TA. Antivirals in Bell's Palsy. Curr Med Issues 2016;14:123-4
Clinical Question: Are antiviral agents useful in treating Bell′s palsy when given with corticosteroids?
Authors′ Conclusions: Antiviral plus corticosteroids show no additional benefit when compared to corticosteroids alone in the treatment of mild-to-moderate Bell′s palsy (moderate quality evidence). However, there was a benefit in the subgroup with severe facial weakness.
| Introduction|| |
Bell's palsy (idiopathic facial paralysis) is the most common cause of unilateral facial weakness and is commonly seen in the outpatient department. Bell's palsy is an acute, generally unilateral paralysis or weakness of facial musculature consistent with peripheral nerve dysfunction of no detectable cause.  Patients may also have associated symptoms such as pain in and around the ear on the side of the facial paresis, impaired tolerance of normal sounds, and alteration in taste perception. It affects both sexes equally and shows peak incidence in the 30-45 age group and in those over 70 years of age. , It is also more common in those who have diabetes, the pregnant, and those who have other viral illnesses such as a cold or influenza. Bell's palsy is thought to have a viral etiology, and Herpes simplex virus is considered to be a causative organism. This association has not been conclusively proved but has led to the use of antivirals such as acyclovir along with corticosteroids in the treatment of this condition. Inflammation of the facial nerve leading to nerve swelling and dysfunction is the pathology behind the symptoms of Bell's palsy, and for this reason, corticosteroids have been the mainstay of treatment. Whether added antivirals contribute to the resolution of symptoms is controversial and not well established. To clarify this issue, the authors conducted a meta-analysis of available literature to assess the effectiveness of antiviral treatment alone or in combination with other therapies.
| Methods|| |
The authors searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE, EMBASE, LILACS, DARE, NHS EED, and HTA databases for randomized controlled trials, and 11 trials including 2883 participants were selected for the analysis. The antivirals in the study included acyclovir, famciclovir, and valacyclovir.
| Results|| |
- The investigators found no significant benefit from giving antivirals along with corticosteroids when compared to giving corticosteroids alone (risk ratio [RR]: 0.69, 95% confidence interval [CI]: 0.47-1.02, n = 1715)
- In severe Bell's palsy (House and Brackmann score 5 or 6), there was some reduction in the rate of incomplete recovery at 6 months in the antiviral + corticosteroid group versus corticosteroids alone (RR: 0.64, 95% CI: 0.41-0.99, n = 478)
- When only corticosteroids were given, the outcome was better than in those who received antivirals alone (RR: 2.09, 95% CI: 1.36-3.20, n = 1169)
- There was no significant difference in adverse effects reported between the antiviral + steroids and steroids alone groups. There was moderate quality evidence that antivirals plus corticosteroids reduced long-term sequelae of Bell's palsy (motor synkinesis/crocodile tears) when compared to corticosteroids alone.
| References|| |
Niparko JK, Mattox DE. Bell's palsy and herpes zoster oticus. In: Johnson RT, Griffin JW, editors. Current Therapy in Neurologic Disease. 4 th
ed. St Louis, Missouri: BC Decker; 1993. p. 355-61.
Peitersen E. The natural history of Bell's palsy. Am J Otol 1982;4:107-11.
Morales DR, Donnan PT, Daly F, Staa TV, Sullivan FM. Impact of clinical trial findings on Bell's palsy management in general practice in the UK 2001-2012: interrupted time series regression analysis. BMJ Open 2013;3. pii: e003121.