Steroid plus antiviral treatment for Bell's palsy.

Abstract

The effectiveness of antiviral agents for the treatment of Bell's palsy is uncertain. We evaluated whether a steroid with an antiviral agent (S+A group) provided better recovery outcomes than a steroid alone (S group) in patients with Bell's palsy. A total of 1342 patients diagnosed with Bell's palsy who visited the Kyung Hee Medical Center in Seoul, Korea, from 2002 to 2012 were included in this study. Patients in the S+A group were treated with prednisolone and antiviral agents (n=569) and those in the S group with prednisolone alone (n=773). Outcomes were measured using the House-Brackmann (HB) scale according to age, initial disease severity, electroneurography (ENoG) findings and underlying comorbidities. The rate of recovery (HB grades I and II) with initially severe Bell's palsy (HB grades V and VI) was higher in the S+A than in the S group (P=0.001). However, the rates of recovery were similar with initially moderate palsy (HB grades II-IV) (P=0.502). In patients classified according to age and ENoG-determined severity of palsy, the overall recovery rate was higher in the S+A than in the S group, but the differences were not statistically significant (P>0.05 for both). The recovery rate without diabetes mellitus (DM) and hypertension (HTN) was higher in the S+A group than in the S group (P=0.031). But in the patients with HTN and DM, the difference in recovery rates between the S+A and S groups was not statistically significant (P=0.805). Treatment with a steroid plus antiviral agent resulted in significantly higher recovery rates than steroid therapy alone in patients with initially severe Bell's palsy and without either HTN or DM, and a nonsignificant trend towards higher recovery rates in all patients with Bell's palsy in this study. Antiviral agents may therefore help in the treatment of Bell's palsy.