Bell's Palsy: Difference between revisions
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==Treatment== | ==Treatment== | ||
Two meta-analyses reach conflicting conclusions.<ref name="doi10.1136/bmj.b3354">{{Cite journal | Two [[meta-analysis|meta-analyses]] reach conflicting conclusions.<ref name="doi10.1136/bmj.b3354">{{Cite journal | ||
| doi = 10.1136/bmj.b3354 | volume = 339 | issue = sep07_1 | pages = b3354 | last = Quant | first = Eudocia C | | doi = 10.1136/bmj.b3354 | volume = 339 | issue = sep07_1 | pages = b3354 | last = Quant | first = Eudocia C | ||
| coauthors = Shafali S Jeste, Rajeev H Muni, Alison V Cape, Manveen K Bhussar, Anton Y Peleg | | coauthors = Shafali S Jeste, Rajeev H Muni, Alison V Cape, Manveen K Bhussar, Anton Y Peleg | ||
| title = The benefits of steroids versus steroids plus antivirals for treatment of Bell's palsy: a meta-analysis | | title = The benefits of steroids versus steroids plus antivirals for treatment of Bell's palsy: a meta-analysis | ||
| journal = BMJ | accessdate = 2009-09-10 | date = 2009-09-07 | url = http://www.bmj.com/cgi/content/abstract/339/sep07_1/b3354 }}</ref><ref name="pmid19724046">{{cite journal| author=de Almeida JR, Al Khabori M, Guyatt GH, Witterick IJ, Lin VY, Nedzelski JM et al.| title=Combined corticosteroid and antiviral treatment for Bell palsy: a systematic review and meta-analysis. | journal=JAMA | year= 2009 | volume= 302 | issue= 9 | pages= 985-93 | pmid=19724046 | | journal = BMJ | accessdate = 2009-09-10 | date = 2009-09-07 | url = http://www.bmj.com/cgi/content/abstract/339/sep07_1/b3354 }}</ref><ref name="pmid19724046">{{cite journal| author=de Almeida JR, Al Khabori M, Guyatt GH, Witterick IJ, Lin VY, Nedzelski JM et al.| title=Combined corticosteroid and antiviral treatment for Bell palsy: a systematic review and meta-analysis. | journal=JAMA | year= 2009 | volume= 302 | issue= 9 | pages= 985-93 | pmid=19724046 | ||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19724046 | doi=10.1001/jama.2009.1243 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> While both agree that [[corticosteroid]]s improve recovery, one analysis supported [[antiviral]]s<ref name="pmid19724046"/> while the other did not<ref name="doi10.1136/bmj.b3354"/>. | | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19724046 | doi=10.1001/jama.2009.1243 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> While both agree that [[corticosteroid]]s improve recovery, one analysis supported [[antiviral]]s<ref name="pmid19724046"/> while the other did not<ref name="doi10.1136/bmj.b3354"/>. The negative meta-analysis by Quant noted that the two trials<ref name="pmid18849193">{{cite journal| author=Engström M, Berg T, Stjernquist-Desatnik A, Axelsson S, Pitkäranta A, Hultcrantz M et al.| title=Prednisolone and valaciclovir in Bell's palsy: a randomised, double-blind, placebo-controlled, multicentre trial. | journal=Lancet Neurol | year= 2008 | volume= 7 | issue= 11 | pages= 993-1000 | pmid=18849193 | ||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18849193 | doi=10.1016/S1474-4422(08)70221-7 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref><ref name="pmid17942873">{{cite journal |author=Sullivan FM, Swan IR, Donnan PT, ''et al'' |title=Early treatment with prednisolone or acyclovir in Bell's palsy |journal=N. Engl. J. Med. |volume=357 |issue=16 |pages=1598–607 |year=2007 |pmid=17942873 |doi=10.1056/NEJMoa072006 |issn=}}</ref> that Quant interpreted as having the highest quality were negative. | |||
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One of the highest quality [[randomized controlled trial]]s was by Sullivan who studied 496 patients within 3 days after the onset of symptoms using 25 mg of prednisolone twice a day for 10 days.<ref name="pmid17942873">{{cite journal |author=Sullivan FM, Swan IR, Donnan PT, ''et al'' |title=Early treatment with prednisolone or acyclovir in Bell's palsy |journal=N. Engl. J. Med. |volume=357 |issue=16 |pages=1598–607 |year=2007 |pmid=17942873 |doi=10.1056/NEJMoa072006 |issn=}}</ref> Sullivan found improved facial function at 3 months from 64% to 83.0%.<ref name="pmid17942873"/> This means that the drug benefits one out of every five patients treated ([[number needed to treat]] is 5). Acyclovir was also studied in this trial but showed no benefit. This trial contradicts a previous [[randomized controlled trial]] of 99 patients in which acyclovir was better than prednisone at improving electroneurography evidence of volitional muscle motion and in preventing partial nerve degeneration.<ref name="pmid8651631">{{cite journal |author=Adour KK, Ruboyianes JM, Von Doersten PG, ''et al'' |title=Bell's palsy treatment with acyclovir and prednisone compared with prednisone alone: a double-blind, randomized, controlled trial |journal=Ann. Otol. Rhinol. Laryngol. |volume=105 |issue=5 |pages=371–8 |year=1996 |pmid=8651631 |doi= |issn=}}</ref> | |||
This | |||
==References== | ==References== | ||
<references/> | <references/> | ||
Revision as of 05:15, 10 September 2009
In medicine, Bell's Palsy is "A syndrome characterized by the acute onset of unilateral facial paralysis which progresses over a 2-5 day period. Weakness of the orbicularis oculi muscle and resulting incomplete eye closure may be associated with corneal injury. Pain behind the ear often precedes the onset of paralysis. This condition may be associated with human herpesvirus 1 infection of the facial nerve."[1]
Etiology/cause
Most cases of Bell's Palsy are caused by Herpes simplex virus type 1[2] Some cases are caused by Herpes zoster virus.[3]
Treatment
Two meta-analyses reach conflicting conclusions.[4][5] While both agree that corticosteroids improve recovery, one analysis supported antivirals[5] while the other did not[4]. The negative meta-analysis by Quant noted that the two trials[6][7] that Quant interpreted as having the highest quality were negative.
| Sutdy | Design | Result |
|---|---|---|
| Quant[4] 2009 |
Meta-analysis of 6 trials† | OR: 0.67‡ (95% CI, 0.37-1.20) |
| Almeida[5] 2009 |
Meta-analysis of 8 trials | RR: 0.75 (95% CI, 0.56-1.00) |
| Notes: † Quant excluded the trial of Antunes[8] and the negative trial of Vazquez[9] ‡ The original publication reported the odds ratio for increase in good outcomes. This table uses the reciprocal in order to report the reduction in adverse outcomes. | ||
One of the highest quality randomized controlled trials was by Sullivan who studied 496 patients within 3 days after the onset of symptoms using 25 mg of prednisolone twice a day for 10 days.[7] Sullivan found improved facial function at 3 months from 64% to 83.0%.[7] This means that the drug benefits one out of every five patients treated (number needed to treat is 5). Acyclovir was also studied in this trial but showed no benefit. This trial contradicts a previous randomized controlled trial of 99 patients in which acyclovir was better than prednisone at improving electroneurography evidence of volitional muscle motion and in preventing partial nerve degeneration.[10]
References
- ↑ Anonymous (2024), Bell's Palsy (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Murakami S, Mizobuchi M, Nakashiro Y, Doi T, Hato N, Yanagihara N (1996). "Bell palsy and herpes simplex virus: identification of viral DNA in endoneurial fluid and muscle". Ann. Intern. Med. 124 (1 Pt 1): 27–30. PMID 7503474. [e]
- ↑ Peitersen E (2002). "Bell's palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies". Acta oto-laryngologica. Supplementum (549): 4–30. PMID 12482166. [e]
- ↑ 4.0 4.1 4.2 Quant, Eudocia C; Shafali S Jeste, Rajeev H Muni, Alison V Cape, Manveen K Bhussar, Anton Y Peleg (2009-09-07). "The benefits of steroids versus steroids plus antivirals for treatment of Bell's palsy: a meta-analysis". BMJ 339 (sep07_1): b3354. DOI:10.1136/bmj.b3354. Retrieved on 2009-09-10. Research Blogging.
- ↑ 5.0 5.1 5.2 de Almeida JR, Al Khabori M, Guyatt GH, Witterick IJ, Lin VY, Nedzelski JM et al. (2009). "Combined corticosteroid and antiviral treatment for Bell palsy: a systematic review and meta-analysis.". JAMA 302 (9): 985-93. DOI:10.1001/jama.2009.1243. PMID 19724046. Research Blogging.
- ↑ Engström M, Berg T, Stjernquist-Desatnik A, Axelsson S, Pitkäranta A, Hultcrantz M et al. (2008). "Prednisolone and valaciclovir in Bell's palsy: a randomised, double-blind, placebo-controlled, multicentre trial.". Lancet Neurol 7 (11): 993-1000. DOI:10.1016/S1474-4422(08)70221-7. PMID 18849193. Research Blogging.
- ↑ 7.0 7.1 7.2 Sullivan FM, Swan IR, Donnan PT, et al (2007). "Early treatment with prednisolone or acyclovir in Bell's palsy". N. Engl. J. Med. 357 (16): 1598–607. DOI:10.1056/NEJMoa072006. PMID 17942873. Research Blogging.
- ↑ Antunes ML, Fukuda Y, Testa JRG. Clinical treatment of Bell's palsy. Acta AWHO. 2000;19(2):68-75.
- ↑ Vazquez MC, Sanchez N, Calvo J. Eficacia de los antivirales en la parálisis de Bell. Rev Med Urug. 2008;24(3):1-8.
- ↑ Adour KK, Ruboyianes JM, Von Doersten PG, et al (1996). "Bell's palsy treatment with acyclovir and prednisone compared with prednisone alone: a double-blind, randomized, controlled trial". Ann. Otol. Rhinol. Laryngol. 105 (5): 371–8. PMID 8651631. [e]