The benefits of steroids versus steroids plus antivirals for treatment of Bell's palsy: a meta-analysis

Abstract

Objective To determine whether steroids plus antivirals provide a better degree of facial muscle recovery in patients with Bell’s palsy than steroids alone.Design Meta-analysis.Data sources PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials were searched for studies published in all languages from 1984 to January 2009. Additional studies were identified from cited references.Selection criteria Randomised controlled trials that compared steroids with the combination of steroids and antivirals for the treatment of Bell’s palsy were included in this study. At least one month of follow-up and a primary end point of at least partial facial muscle recovery, as defined by a House-Brackmann grade of at least 2 (complete palsy is designated a grade of 6) or an equivalent score on an alternative recognised scoring system, were required.Review methods Two authors independently reviewed studies for methodological quality, treatment regimens, duration of symptoms before treatment, length of follow-up, and outcomes. Odds ratios with 95% confidence intervals were calculated and pooled using a random effects model.Results Six trials were included, a total of 1145 patients; 574 patients received steroids alone and 571 patients received steroids and antivirals. The pooled odds ratio for facial muscle recovery showed no benefit of steroids plus antivirals compared with steroids alone (odds ratio 1.50, 95% confidence interval 0.83 to 2.69; P=0.18). A one study removed analysis showed that the highest quality studies had the greatest effect on the lack of difference between study arms shown by the odds ratio. Subgroup analyses assessing causes of heterogeneity defined a priori (time from symptom onset to treatment, length of follow-up, and type of antiviral studied) showed no benefit of antivirals in addition to that provided by steroids.Conclusions Antivirals did not provide an added benefit in achieving at least partial facial muscle recovery compared with steroids alone in patients with Bell’s palsy. This study does not, therefore, support the routine use of antivirals in Bell’s palsy. Future studies should use improved herpes virus diagnostics and newer antivirals to assess whether combination therapy benefits patients with more severe facial paralysis at study entry.

The effect of n‐acetyl‐cysteine on recovery of the facial nerve after crush injury

“…While re‐establishment of direct neural integrity through re‐anastomosis is the first‐line therapy for transection injury, there is no universally accepted treatment for crush injury to the nerve. Several medical therapies have been tested in various conditions with facial nerve dysfunction and while early administration of steroids has shown improved functional outcomes in certain conditions of facial nerve dysfunction, such as Bell's Palsy, our understanding of the application of other neuro‐protective agents in this setting is limited 13, 14, 15…”

Paralysie faciale périphérique et soins dentaires : lien ou coïncidence, pour quelle prise en charge ?

“…Pour le traitement, les données sont contradictoires et il existe différentes approches [5,[7][8][9][10]. Pour certains auteurs, la prise de corticoïdes augmente significativement la probabilité de guérison complète, l'efficacité des antiviraux serait plus aléatoire ; pour d'autres, c'est l'inverse.…”

“…Pour certains auteurs, la prise de corticoïdes augmente significativement la probabilité de guérison complète, l'efficacité des antiviraux serait plus aléatoire ; pour d'autres, c'est l'inverse. Les corticoïdes augmenteraient la probabilité de récupération totale et assureraient un meilleur résultat à 6 mois [10,11]. Ils seraient éga-lement plus efficaces chez les personnes de plus 40 ans [8].…”

“…La posologie recommandée est de 60 mg/j de prednisolone pendant 5 j, puis elle est diminuée de 10 mg/j [5]. L'efficacité des antiviraux serait plus aléatoire [4,10,12]. Seuls, ils seraient moins efficaces que les corticoïdes, mais ils potentialiseraient l'effet de la prednisolone lorsqu'ils sont associés.…”

Bell Paralizisi: Bir Olgu Sunumu ve Gözden Geçirme

“…[26] According to the academy's 2012 guidelines, benefit from antivirals has not been established 27,28 . In an analysis by`Quant et al, the routine use of antiviral agents was not warranted and the study recommended that newer antiviral agents may prove more beneficial than older antiviral agents used in the studies analyzed to date 29 . The non-pharmacological measures that have been used are facial exercises, neuromuscular retraining and acupuncture.…”