Bell's palsy: new evidence provides a definitive drug therapy strategy

Abstract

Bell's palsy is acute, idiopathic, unilateral paralysis of the facial nerve1 and most GPs will see a new case about once every 5 years. Although most patients recover well, up to 30% have a poor outcome, with persistent facial weakness, psychological difficulties, and facial pain. The rapid, often painful onset of facial weakness is distressing for patients, leading them to present urgently to their GP. Primary care management has included various options, such as prednisolone and/or antiviral drugs, or neither, but evidence for these or other strategies has been weak or absent. This persisting uncertainty about ideal management can be disconcerting for GPs and their patients. In 2001, the American Academy of Neurology published guidelines on the management of Bell's palsy, concluding that, while the benefit of steroids and/or aciclovir had not been established, the available evidence indicated that steroids were ‘probably effective’, and that aciclovir combined with prednisolone was ‘possibly effective’.1 Subsequently, two articles published in the British Medical Journal triggered controversy when they recommended the early use of steroids and aciclovir,2,3 although no further reliable data had been published since the American guideline. After decades of little persuasive evidence, four randomised controlled trials, involving over 1800 patients, …