Combined Corticosteroid and Antiviral Treatment for Bell Palsy A Systematic Review and Meta-analysis

de Almeida JR, Al Khabori M, Guyatt GH, et al. — Wed, 02 Sep 2009 00:00:00 GMT

Context

New evidence has emerged regarding the use of corticosteroids and antiviral agents in Bell palsy.

Objective

To estimate the association of corticosteroids and antiviral agents with the risk of unsatisfactory facial recovery in patients with Bell palsy.

Data Sources

The search included MEDLINE, EMBASE, CENTRAL, PsychInfo, CINAHL, Web of Science, PAPERSFIRST, PROCEEDINGSFIRST, and PROQUEST to identify studies up to March 1, 2009.

Study Selection and Data Extraction

Eligible studies were randomized controlled trials comparing treatment with either corticosteroids or antiviral agents with a control and measuring at least 1 of the following outcomes: unsatisfactory facial recovery (≥4 months), unsatisfactory short-term recovery (6 weeks to <4 months), synkinesis and autonomic dysfunction, or adverse effects. Two reviewers extracted data on study characteristics, methods, and outcomes. Disagreement was resolved by consensus.

Results

Eighteen trials involving 2786 patients were eligible. Regression analysis identified a synergistic effect when corticosteroids and antiviral agents were administered in combination compared with alone (odds ratio for interaction term, 0.54 [95% confidence interval {CI}, 0.35-0.83]; P = .004). Meta-analysis using a random-effects model showed corticosteroids alone were associated with a reduced risk of unsatisfactory recovery (relative risk [RR], 0.69 [95% CI, 0.55-0.87]; P = .001) (number needed to treat to benefit 1 person, 11 [95% CI, 8-25]), a reduced risk of synkinesis and autonomic dysfunction (RR, 0.48 [95% CI, 0.36-0.65]; P < .001) (number needed to treat to benefit 1 person, 7 [95% CI, 6-10]), and no increase in adverse effects. Antiviral agents alone were not associated with a reduced risk of unsatisfactory recovery (RR, 1.14 [95% CI, 0.80-1.62]; P = .48). When combined with antiviral agents, corticosteroids were associated with greater benefit (RR, 0.48 [95% CI, 0.29-0.79]; P = .004) than antiviral agents alone. When combined with corticosteroids, antiviral agents were associated with greater risk reduction of borderline significance compared with corticosteroids alone (RR, 0.75 [95% CI, 0.56-1.00]; P = .05).

Conclusions

In Bell palsy, corticosteroids are associated with a reduced risk of unsatisfactory recovery. Antiviral agents, when administered with corticosteroids, may be associated with additional benefit.

Treatment of Bell Palsy Translating Uncertainty Into Practice

Steiner JF. — Wed, 02 Sep 2009 00:00:00 GMT

Bell palsy is an inflammatory condition of the facial nerve that is associated with herpes simplex or varicella virus infections and can result in temporary or permanent facial disfigurement and pain. With an annual incidence of 13 to 43 per 100 000 population, more than 60 000 cases are diagnosed each year in the United States. Approximately 15% of patients with Bell palsy will have persistent facial nerve dysfunction and related impairments in quality of life.

JAMA: Facial Nerve Topic Collection

Combined Corticosteroid and Antiviral Treatment for Bell Palsy A Systematic Review and Meta-analysis

Treatment of Bell Palsy Translating Uncertainty Into Practice