Steroids alone best choice for Bell’s palsy
Posted by medconsumers on September 23, 2009
Bell’s palsy is defined as the abrupt paralysis of the facial nerve, resulting in an inability to control facial muscles on the affected side. The good news is most people recover without treatment; the bad news is that up to 30% do not recover completely, often suffering facial pain, psychological trauma, and facial disfigurement. A meta-analysis of all trials that have compared the standard treatments for Bell’s palsy—steroids plus anti-viral drugs or steroids alone—was published recently in the online version of the British Medical Journal (BMJ). It concluded that steroids are the better choice and there is no benefit to adding anti-viral drugs.
It was not so long ago that steroids were shown to be better than no treatment at all. The first such trial was published in 2007 in the New England Journal of Medicine. Within 72 hours of the onset of Bell’s palsy symptoms, the participants were randomly assigned to treatment for 10 days with steroids, or an anti-viral drug (acyclovir), or both, or with placebo. Steroids alone proved to be the best in terms of decreasing permanent facial disfigurement (96% of those taking steroids recovered completely at 9 months, compared with 77% on the placebo).
Although this study should have put an end to the addition of anti-viral drugs like acyclovir (brand name: Zovirax), it didn’t. Perhaps this new study will change doctors’ prescribing practices. Eudocia C. Quant, Department of Neurology at Massachusetts General Hospital in Boston, and colleagues found six trials that had compared the two treatments in a combined total of 1,145 people with Bell’s palsy. Although the researchers identified steroids alone [e.g., prednisone or prednisolone] as the better choice, they left the door open for the possibility that future research might find the newer anti-viral drugs do have some benefit.
Maryann Napoli, Center for Medical Consumers(c)