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Evidence summaries

Antivirals for Bell's Palsy (Idiopathic Facial Paralysis)

There is no additional benefit from the combination of antivirals with corticosteroids compared to corticosteroids alone for the treatment of Bell's palsy of various degrees of severity. Corticosteroids alone are more effective than antivirals alone and antivirals plus corticosteroids are more effective than placebo or no treatment. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 11 studies with a total of 2883 subjects with idiopathic facial paralysis. Trials evaluated antivirals (valaciclovir or aciclovir) with and without corticosteroids versus control therapies for the treatment of Bell's palsy. The follow-up ranged from 3 to 12 months.

  • Incomplete recovery: There was no significant benefit from adding antivirals to corticosteroids in comparison with corticosteroids alone for people with Bell's palsy (RR 0.69, 95% CI 0.47 to 1.02; 9 studies, n = 1715). For people with severe Bell's palsy (House-Brackmann scores of 5 and 6 or the equivalent in other scales), a reduction in the rate of incomplete recovery at month 6 was seen, when antivirals plus corticosteroids were used (RR 0.64, 95% CI 0.41 to 0.99; 4 studies, n = 478). The outcome for the participants receiving corticosteroids alone was significantly better than for those receiving antivirals alone (RR 2.09, 95% CI 1.36 to 3.20; 11 studies, n = 1169). The treatment effect of placebo was significantly lower than that of antivirals plus corticosteroids (RR 0.56, 95% CI 0.41 to 0.76, n = 658). Antivirals alone had a non-significant detrimental effect on the outcome compared with placebo (RR 1.10, 95% CI 0.87 to 1.40; 2 studies, n = 658).
  • Motor synkinesis or crocodile tears: When comparing antivirals and corticosteroids with corticosteroids and placebo assessing this outcome, there was a significant difference in long-term sequelae in favour of antivirals plus corticosteroids (RR 0.73, 95% CI 0.54 to 0.99; 3 studies, n = 869). Three trials comparing antivirals alone with corticosteroids alone investigating this outcome showed fewer sequelae with corticosteroids (RR 1.44, 95% CI 1.11 to 1.85; 3 studies, n = 873).
  • Adverse events: They were available in 3 studies (n=1528). None of the 4 comparisons (antivirals plus corticosteroids versus corticosteroids plus placebo or no treatment; antivirals versus corticosteroids; antivirals plus corticosteroids versus placebo; antivirals versus placebo) showed significant differences.

    References

    • Gagyor I, Madhok VB, Daly F et al. Antiviral treatment for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev 2015;7():CD001869. [PubMed].

Primary/Secondary Keywords