Practice parameter: steroids, acyclovir, and surgery for Bell’s palsy (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Grogan PM, Gronseth GS. Neurology 2001;56:830–836.

Abstract

Acute peripheral facial paresis of unknown cause, so-called Bell’s palsy, is common, with an annual incidence of 20 per 100,000. Most patients with Bell’s palsy recover without treatment; 71% achieve complete recovery, and 84% achieve near normal function. Commonly employed noncontroversial treatment modalities for Bell’s palsy include eye patching and lubrication to protect the cornea. Controversy remains regarding the effectiveness of commonly used pharmacologic therapies—steroids and acyclovir—as well as surgical facial nerve decompression. The authors identified articles by searching Medline and selected those that prospectively compared outcomes in patients treated with steroids, acyclovir, or surgery with patients not receiving these modalities. The quality of each study (class I to IV) was graded using a standard classification-of-evidence scheme. The proportion of patients recovering facial function in the treated group was compared with the proportion of patients recovering facial function in the control group. The authors identified no adequately powered class I studies for any treatment modality. The pooled results of two class I and two class II studies showed significantly better facial outcomes in steroid-treated patients compared with nonsteroid-treated patients (relative rate good outcome 1.16, 95% CI 1.05 to 1.29). One class II study demonstrated a significant benefit from acyclovir in combination with prednisone compared with prednisone alone (relative rate good outcome 1.22, 95% CI 1.02 to 1.45). All studies describing outcomes in patients treated with facial nerve decompression were graded as class IV. The authors conclude that for patients with Bell’s palsy, a benefit from steroids, acyclovir, or facial nerve decompression has not been definitively established. However, available evidence suggests that steroids are probably effective and acyclovir (combined with prednisone) is possibly effective in improving facial function outcomes. Insufficient evidence exists to make recommendations regarding surgical facial nerve decompression for Bell’s palsy. Well-designed studies of the effectiveness of treatments for Bell’s palsy are still needed.—Nancy J. Newman