Steroid/Antiviral for the treatment of Bell’s palsy: Double blind randomized clinical trial

Khedr, Eman M.; Badry, Reda; Ali, Azza M. M.; El-Fetoh, Noha Abo; El-Hammady, Dina H.; Ghandour, Abeer M.; Abdelhaleem, Ahmed

doi:10.3233/rnn-150605

Cited by 9 publications

(9 citation statements)

References 22 publications

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“…Of these, 3,228 were excluded and 190 records passed for full‐text screening, of which 167 lacked the eligibility criteria. Finally, we included 23 records 10,13,20‐41 in the review. A total of 21 studies, 10,13,20–22,24,25,27,29–41 comprising 2,839 participants, were included in NMA (Fig.…”

Section: Resultsmentioning

confidence: 99%

Pharmacological Treatments of Bell's Palsy in Adults: A Systematic Review and Network Meta‐Analysis

et al. 2021

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Objective We aimed to simultaneously compare all available medical treatments for Bell's palsy using both direct and indirect data. Methods The literature was searched from January 1, 1990, until March 1, 2020, with no language restrictions. Randomized clinical trials comparing pharmacological interventions were included in the current network meta‐analysis. We estimated summary risk ratios (RRs), 95% credible interval (CrI), and the surface under the cumulative ranking curve (SUCRA) using network meta‐analyses with random effects in a Bayesian framework. The primary outcomes were complete recovery in short‐term (≤3 months) and intermediate/long‐term (>3 months) after randomization. The secondary outcome was synkinesis. Results In total, 21 trials comprising 2,839 participants were retrieved. In terms of good recovery, corticosteroids plus antivirals were the most effective treatment compared to placebo, with RRs ranging between 1.25 (95% CrI: 1.10, 1.43) for the short‐term and 1.26 (95% CrI: 1.11, 1.45) for the intermediate/long‐term recovery. For synkinesis, only corticosteroids plus antivirals (RR 0.35; 95% CrI: 0.19, 0.65) were associated with fewer synkinesis rates than placebo. The certainty of the evidence for good recovery and synkinesis was very low‐low and moderate‐high, respectively. Conclusions This network meta‐analysis showed that combined therapy remains the best regimen for a good recovery outcome and the only efficacious regimen for synkinesis. More research is needed to confirm these findings. Laryngoscope, 131:1615–1625, 2021

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Section: Resultsmentioning

confidence: 99%

Pharmacological Treatments of Bell's Palsy in Adults: A Systematic Review and Network Meta‐Analysis

et al. 2021

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“…According to the previous studies [ 34 ], the difference between the SFGS score before and after treatment in the oral administration of prednisolone tablets group was 32.3, with a standard deviation of 8.1. The SFGS score before and after treatment for oral administration of prednisolone tablets combined with electroacupuncture intervention group reached up to 38.3, and the standard deviation was recorded 1.…”

Section: Method/designmentioning

confidence: 93%

Efficacy evaluation and mechanism study of electroacupuncture intervention in acute phase of IFP: study protocol for a randomized controlled trial

QIN

Yang

Zhang

et al. 2021

Trials

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Background Previous studies had already reported the efficacy of electroacupuncture treatment for idiopathic facial nerve palsy (IFP) in a recovery phase; however, the initial use of electroacupuncture in the acute phase remains controversial. Hence, in the present study, we will add electroacupuncture intervention based on oral prednisone tablets in the acute phase of IFP and compare the clinical effects with simple oral prednisone tablets. Besides, the prognosis and safety will be evaluated. The present study aims to evaluate the clinical efficacy, prognosis, and safety of electroacupuncture combined with oral prednisone tablets in the acute phase of IFP, using surface electromyography (sEMG) to objectively observe the recovery of facial expression muscle function. In addition, the morphological changes of the facial nerve were observed dynamically by magnetic resonance imaging (MRI) in the acute phase to reveal the effect mechanism of this therapy. Methods Randomized controlled trials will be conducted in the first teaching hospital of Tianjin University of Traditional Chinese Medicine in China from September 2020 to April 2021. The treatment will be carried out in two phases, including the acute phase and the recovery phase. Eighty IFP patients will be recruited and randomized into two groups with a 1:1 ratio. Subjects in the acute phases of the control group will be given oral prednisone tablets, based on the control group, and subjects of the experimental group will be given electroacupuncture therapy simultaneously in the acute phase. Both groups will be stopped taking prednisone tablets and turn to electroacupuncture therapy in a recovery phase. Patients in the experimental group will receive treatment at least 6 times in the acute phase and both groups will receive treatment 9 times in the recovery phase, and there will be a follow-up period of 15 days after the treatment. The primary outcome is supposed to be related to the changes observed in the Sunnybrook (Toronto) Facial Grading System (SFGS) on the baseline and day 30 after the onset. Secondary outcome measures will include House-Brackmann Facial Nerve Grading System (H-B), measurement of Numerical Rating Scale (NRS), Facial Disability Index scale (FDI, including physical function subscore, FDIP, and social functioning and well-being subscore, FDIS), surface electromyogram (sEMG), and magnetic resonance imaging (MRI). Adverse events will be recorded for safety assessment. Discussion The results of this trial will allow the present study to compare the difference in efficacy and prognosis between the strategy of combined electroacupuncture in the acute phase and only oral prednisone tablets. The findings from this trial will be published in peer-reviewed journals. Trial registration CHICTR ChiCTR2000038472. Registered on 23 September 2020

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“…The analysis (eight trials, 1,365 participants) suggests that antivirals plus corticosteroids reduces the incidence of incomplete recovery when compared either to corticosteroids alone (RR = 0.61, 95% confidence interval [CI] = 0.39 to 0.97, absolute risk difference [ARD] = 6.5%, number needed to treat [NNT] = 15; quality of evidence = low) or to placebo or no treatment (RR = 0.56, 95% CI = 0.41 to 0.76, ARD = 12%, NNT = 8, quality of evidence = low) . Antivirals alone did not improve the risk of incomplete recovery rates when compared to placebo/no treatment (RR = 1.10, 95% CI = 0.87 to 1.40; quality of evidence = low) and increased rates of incomplete recovery when compared to corticosteroids alone (RR = 1.52, 95% CI = 1.08 to 2.12, quality of evidence = low) …”

Section: Narrativementioning

confidence: 99%

“…Unfortunately, the analysis does not control for antiviral type or administration route. Our search identified two clinical trials not reported in the Cochrane analysis that compared either antivirals alone or with corticosteroids to corticosteroids alone. The study by Khedr et al .…”

Section: Caveatsmentioning

confidence: 99%

“…Our search identified two clinical trials not reported in the Cochrane analysis that compared either antivirals alone or with corticosteroids to corticosteroids alone. The study by Khedr et al . supports the Cochrane analysis findings that the combination of antiviral plus corticosteroid decreases incomplete recovery in patients with moderately severe to complete acute Bell's palsy.…”

Section: Caveatsmentioning

confidence: 99%

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Antivirals With Corticosteroids for the Treatment of Acute Bell's Palsy

Portela

Miller

2018

Academic Emergency Medicine

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Steroid/Antiviral for the treatment of Bell’s palsy: Double blind randomized clinical trial

Abstract: The combination of steroid and antiviral treatment increases the possibility of recovery in moderately severe to complete acute Bell's palsy.

Cited by 9 publications

References 22 publications

Pharmacological Treatments of Bell's Palsy in Adults: A Systematic Review and Network Meta‐Analysis

Pharmacological Treatments of Bell's Palsy in Adults: A Systematic Review and Network Meta‐Analysis

Efficacy evaluation and mechanism study of electroacupuncture intervention in acute phase of IFP: study protocol for a randomized controlled trial

Antivirals With Corticosteroids for the Treatment of Acute Bell's Palsy

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