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Evidence summaries

Corticosteroid Treatment for Idiopathic Facial Paralysis (Bell's Palsy)

Early treatment with prednisolone improves the recovery of facial function in patients with Bell's palsy as compared to antiviral treatments or placebo, but seems not to make any significant longer-term difference in cosmetically disabling sequelae. Level of evidence: "A"

A Cochrane review 1 (review [Abstract]) included seven studies with a total of 895 subjects. Overall 79/452 (17%) of the participants allocated to corticosteroids had incomplete recovery of facial motor function six months or more after randomisation, significantly less than 125/447 (28%) in the control group (RR 0.63, 95% CI 0.50 to 0.80). The number of people who need to be treated with corticosteroids to avoid one incomplete recovery was 10 (95% CI 6 to 20). There was, also, a significant reduction in motor synkinesis during follow-up in those receiving corticosteroids (RR 0.64, 95% CI 0.45 to 0.91). The reduction in the proportion of patients with cosmetically disabling sequelae six months after randomisation, however, was not significant (RR 0.96, 95% CI 0.40 to 2.29).

    References

    • Madhok VB, Gagyor I, Daly F et al. Corticosteroids for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev 2016;7():CD001942. [PubMed].

Primary/Secondary Keywords