Credits Earned (2024) Crédits obtenus

Redeem Prepaid Membership

Tools for Practice Outils pour la pratique


#4 Bell’s Palsy: What to Do and What Not to Do?


CLINICAL QUESTION
QUESTION CLINIQUE
Do corticosteroids or antivirals provide any benefit to patients with Bell’s palsy?


BOTTOM LINE
RÉSULTAT FINAL
The best evidence indicates that corticosteroids (in doses of prednisolone 25 mg BID or 60 mg x5 days, then tapered by 10 mg/day) improve the odds of complete recovery from Bell’s palsy. Trials of antivirals (used either alone or in addition to prednisolone) are inconsistent, but they seem to offer little to no advantage.



CFPCLearn Logo

Reading Tools for Practice Article can earn you MainPro+ Credits

La lecture d'articles d'outils de pratique peut vous permettre de gagner des crédits MainPro+

Join Now S’inscrire maintenant

Already a CFPCLearn Member? Log in

Déjà abonné à CMFCApprendre? Ouvrir une session



EVIDENCE
DONNÉES PROBANTES
Corticosteroids: 
  • Cochrane review1 of seven Randomized Controlled Trials (RCTs) including 895 patients comparing corticosteroids to placebo or no treatment. 
    • Satisfactory recovery at >6 months: Corticosteroids 83% versus no corticosteroid 72%Number Needed to Treat (NNT)=10.
Antivirals: 
  • Meta-analysis2 of 10 RCTs including 2,419 patients comparing addition of antivirals (+/- corticosteroids) to placebo or no antiviral. 
    • No statistically significant difference in complete recovery: Antivirals 70.6%, no antiviral 68.7%. 
      • No benefit in severe Bell’s palsy and in patients also receiving corticosteroids. 
    • Satisfactory recovery: Antivirals 79.5% versus no antiviral 74.6%, NNT=21 
      • Results not statistically significant when excluding trials at high risk of bias. 
  • Cochrane review3 of 10 RCTs of 2,280 patients found that adding antivirals to corticosteroids increased likelihood of complete recovery, but: 
    • Inappropriately included “satisfactory but incomplete recovery” (House-Brackmann grade 2) as complete recovery.  
  • Limitations: Only one RCT at low risk of bias, efficacy exaggerated in smaller, lower-quality studies; selective outcome reporting.
Context:  
  • Other meta-analyses found similar conclusions for corticosteroid efficacy4 and antiviral inefficacy.5 
    • Consistent with results of two highest-quality trials.6,7 
  • Canadian Bell’s palsy guidelines8 recommend: 
    • Corticosteroids for all patients with Bell’s palsy. 
    • Against using antivirals alone, or adding to corticosteroids for mild-moderate Bell’s palsy. 
    • Considering adding antivirals to corticosteroids for severe Bell’s palsy (based on older meta-analysis4). 
  • Corticosteroid doses in two high-quality trials: 
    • Prednisolone 25 mg BID x10 days.6 
    • Prednisolone 60 mg/day x5 days, then tapered by 10 mg/day.7 
    • Dose of prednisone = prednisolone.  
  updated aug 2016 ricky


Marie Lynn Lacasse December 14, 2021

This evidence confirms my practice. I do not prescribe antivirals for Bell’s palsy.


Latest Tools for Practice
Derniers outils pour la pratique

#367 Oral Calcitonin Gene-related Peptide Antagonists: A painfully long name for the acute treatment of migraines

What are the risks and benefits of ubrogepant for the acute treatment of episodic migraines?
Read Lire 0.25 credits available Crédits disponibles

#366 Looking for Closure: Managing simple excisions or wounds efficiently

What are some options for efficiency in wound closure?
Read Lire 0.25 credits available Crédits disponibles

#365 Shrooms for Glooms: Evidence for psilocybin for depression

What are the benefits and harms of psilocybin for treatment-resistant/recurrent depression?
Read Lire 0.25 credits available Crédits disponibles

This content is certified for MainPro+ Credits, log in to access

Ce contenu est certifié pour les crédits MainPro+, Ouvrir une session


Author(s)
Auteur(s)
  • G. Michael Allan MD CCFP
  • Michael R Kolber MD CCFP MSc

1. Madhok VB, Gagyor I, Daly F, et al. Cochrane Database Syst Rev. 2016; 7:CD001942.

2. Turgeon RD, Wilby KJ, Ensom MHH. Am J Med. 2015; 128:617-28.

3. Gagyor I, Madhok VB, Daly F, et al. Cochrane Database Syst Rev. 2015; 11:CD001869.

4. de Almeida JR, Al Khabori M, Guyatt GH, et al. JAMA. 2009; 302:985-93.

5. Quant EC, Jeste SS, Muni RH, et al. BMJ. 2009; 339:b3354.

6. Sullivan FM, Swan IR, Donnan PT, et al. N Engl J Med. 2007; 357:1598-607.

7. Engstrom M, Berg T, Stjernquist-Desatnik A, et al. Lancet Neurol. 2008; 7:993-1000.

8. de Almeida JR, Guyatt GH, Sud S, et al. CMAJ. 2014; 186:917-22.

Authors do not have any conflicts of interest to declare.

Les auteurs n’ont aucun conflit d’intérêts à déclarer.

Most recent review: 19/08/2016

By: Ricky D. Turgeon BSc(Pharm) ACPR PharmD

Comments:

Evidence Updated: New evidence; Bottom Line: Minor change.

Learning at a glance
Yearly credits
Acquired ()
Your content by topic
Cardiology Dermatology Emergency
My Bookmarks