Antivirals with steroids for all or just for severe Bell's palsy?

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"Antivirals with steroids for all or just for severe Bell’s palsy?"

Steroid therapy alone has become the standard treatment for Bell’s palsy.
A Cochrane systematic review by Gagyor 1 on antiviral treatment for Bell’s palsy found that across all cases of Bell’s palsy, adding anti-virals was marginally non significant p=0.06). However, in the subgroup of those with severe Bell’s Palsy (those who have complete or almost-complete facial paralysis) there was a statistically significant (p= 0.047) benefit from adding anti-viral agents to steroids.

The Evidence based medicine editorial2 on the Cochrane reviews suggests that given the marginal non-significance in all cases and the absence of reported adverse effects, treating physicians must balance the devastating consequences of an incomplete recovery with the preferences of the patient, limited side effects and low cost of adding antiviral therapy.

References:

  1. Gagyor I, Madhok VB, et al., Antiviral treatment for Bell’s palsy (idiopathic facial paralysis). Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD001869. DOI:
    10.1002/14651858.CD001869.pub6.
    http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001869.pub6/abstract

  2. John R Almeida Evidence based medicine on line 10.1136/ebmed-2015-110271

Gems are chosen by the Goodfellow director Dr. Bruce Arroll to be either practice changing or practice maintaining. The information is educational and not clinical advice.


As published in NZ Doctor 16/09/2015