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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)

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4 Responses to “Steroids alone best choice for Bell’s palsy”

  1. James said

    I currently have bell’s palsy, I’ve had it now for over 4 years. I took the steroid concoction after receiving the first onset of full muscle function loss to the left side of my face. The treatment that was prescribed did nothing for me and recovery to this point was extremely slow.

    As of now I have confused muscle control. By confused control I mean tightening of the lips and smiling will cause my left eye to squint, the same goes for yawning and smirking. Smile is not all that great either.

    Almost every morning brings on some new onset. These are just a few to name:

    •Headaches on the left side only (forehead, center and back of head)
    •Tearing, fogging, pressure and dryness of the eye
    •Muscle twitching and painful muscle locking in the jaw, cheek and neck
    •Constant Numbing feeling in face.

    So far I have sought my own forms of treatments that include massage therapy, acupuncture, as well the drugs given at the first onset and nothing seems to work in restoring. Doctors say there is nothing more they can do. One thing that concerns me is that when I work out, perform strenuous task or even under stress period it will bring on some of the symptoms listed above.

    Something else that’s extremely crazy is that many web sites state that Bell’s is not contagious but 3 others at my workplace caught it about the time I did. One individual even works in the same area as me.

    I’m looking for any type of help, studies, home remedies or possible treatments. If anyone could help it would be greatly appreciated.

  2. James Lerner, L.Ac., R.N. said

    The following caught my eye, after I’d seen your article. The CME website for physicians is taking essentially the opposite view, focusing on the possibility you mentioned that future research may find some further use for anti-virals in treating Bell’s Palsy!

    Week in Review MedscapeCME Pulse
    Monday, September 28, 2009 1:52 PM
    Adding an Antiviral to Corticosteroid May Heighten Benefit in Bell’s Palsy

  3. phyllis marcus said

    My husband received the steroid treatment immediately in the emergency room for his Bell’s Palsy. It completely took care of it. A friend of ours who hadn’t known about the steroid treatment still has facial disfigurment. Luckily, another friend of ours told us about reading of this treatment so when it occured we knew to immediately go to the emergency room and request it.

  4. marcia kelly said

    You continue to do a great job, and service, with your excellent research and sharing online, as you did with the print newsletter. Thanks!

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