Abstract
Background
The extent of facial nerve damage is expected to be more severe in higher grades of
facial palsy, and the outcome after applying different treatment methods may reveal
obvious differences between severe Bell's palsy and mild to moderate palsy. This study
aimed to systematically evaluate the effects of different treatment methods and related
prognostic factors in severe to complete Bell's palsy.
Methods
This randomized, prospective study was performed in patients with severe to complete
Bell's palsy. Patients were assigned randomly to treatment with a steroid or a combination
of a steroid and an antiviral agent. We collected data about recovery and other prognostic
factors.
Results
The steroid treatment group (S group) comprised 107 patients, and the combination
treatment group (S+A group) comprised 99 patients. There were no significant intergroup
differences in age, sex, accompanying disease, period from onset to treatment, or
results of an electrophysiology test (P >.05). There was a significant difference in complete recovery between the 2 groups.
The recovery (grades I and II) of the S group was 66.4% and that of the S+A group
was 82.8% (P=.010). The S+A group showed a 2.6-times higher possibility of complete recovery than
the S group, and patients with favorable electromyography showed a 2.2-times higher
possibility of complete recovery.
Conclusions
Combined treatment with a steroid and an antiviral agent is more effective in treating
severe to complete Bell's palsy than steroid treatment alone.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Bell's palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies.Acta Otolaryngol Suppl. 2002; 549: 4-30
- Incidence of Bell's palsy.Ann Otol Rhinol Laryngol Suppl. 1988; 137: 3-4
- Bell palsy and herpes simplex virus: identification of viral DNA in endoneural fluid and muscle.Ann Intern Med. 1996; 124: 27-30
- The management of peripheral facial nerve palsy: “paresis” versus “paralysis” and sources of ambiguity in study designs.Otol Neurotol. 2010; 31: 319-327
- Early treatment with prednisolone or acyclovir in Bell's palsy.N Engl J Med. 2007; 357: 1598-1607
- Antiviral treatment for Bell's palsy (idiopathic facial paralysis).Cochrane Database Syst Rev. 2009; 7 (CD001869)
- Valacyclovir and prednisolone treatment for Bell's palsy: a multicenter, randomized, placebo-controlled study.Otol Neurotol. 2007; 28: 408-413
- Bell's palsy: combined treatment of famciclovir and prednisone is superior to prednisone alone.J Neurol. 2008; 255: 1726-1730
- Facial nerve grading system.Otolarynogol Head Neck Surg. 1985; 93: 146-147
- Aciclovir.Drugs. 1994; 47: 153-205
- Idiopathic facial paralysis: a randomized, prospective, and controlled study using single-dose prednisone versus acyclovir three times daily.Laryngoscope. 1998; 108: 573-575
- Pharmacokinetics of acyclovir after intravenous and oral administration.J Antimicrob Chemother. 1983; 12: 29-37
- Reactivation of herpes simplex virus type 1 and varicella-zoster virus and therapeutic effects of combination therapy with prednisolone and valacyclovir in patients with Bell's palsy.Laryngoscope. 2007; 117: 147-156
- Outcome of treatment with valacyclovir and prednisone in patients with Bell's palsy.Ann Otol Rhinol Laryngol. 2003; 112: 197-201
- Bell's palsy—the effect of prednisolone and/or valaciclovir versus placebo in relation to baseline severity in a randomised controlled trial.Clin Otolaryngol. 2012; 37: 283-290
- Acyclovir plus steroid vs steroid alone in the treatment of Bell's palsy.Am J Otolaryngol. 2008; 29: 163-166
- Prednisolone and valaciclovir in Bell's palsy: a randomised, double-blind, placebo-controlled, multicentre trial.Lancet Neurol. 2008; 7: 993-1000
- A small effect of adding antiviral agents in treating patients with severe Bell palsy.Otolaryngol Head Neck Surg. 2012; 146: 353-357
- Antiviral therapy for Ramsay Hunt syndrome (herpes zoster oticus with facial palsy) in adults.Cochrane Database Syst Rev. 2008; 8 (CD006851)
- Combination therapy is preferable for patients with Ramsay Hunt syndrome.Otol Neurotol. 2011; 32: 852-855
- Prognostic factors of peripheral facial palsy: multivariate analysis followed by receiver operating characteristic and Kaplan-Meier analyses.Otol Neurotol. 2011; 32: 1031-1036
- Predicting the long-term outcome after idiopathic facial nerve paralysis.Otol Neurotol. 2011; 32: 848-851
- Prognostic value of electromyography in acute peripheral facial nerve palsy.Otol Neurotol. 2001; 22: 100-104
- Prognostic value of electroneurography and electromyography in facial palsy.Laryngoscope. 2008; 118: 394-397
- Prognosis of patients with recurrent facial palsy.Eur Arch Otorhinolaryngol. 2012; 269: 61-66
- A comparative study of age and degree of facial nerve recovery in patients with Bell's palsy.Eur Arch Otorhinolaryngol. 1999; 256: 520-522
- Analysis of prognostic factors in Bell's palsy and Ramsay Hunt syndrome.Auris Nasus Larynx. 2007; 34: 159-164
- Efficacy of early treatment of Bell's palsy with oral acyclovir and prednisolone.Otol Neurotol. 2003; 24: 948-951
Article info
Publication history
Published online: February 07, 2013
Footnotes
Funding: This research was supported by the Kyung Hee University Research Fund in 2011(KHU-2011-1098).
Conflict of Interest: None.
Authorship: All authors had full access to the data and played a role in writing this manuscript.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Uncertainties Around Antivirals in Severe Bell's Palsy TrialThe American Journal of MedicineVol. 126Issue 12
- PreviewWe read the article by Lee et al1 with interest. This trial follows a decade of randomized controlled trials assessing the value of pharmacotherapy in Bell's palsy.2 Overall, existing evidence supports the use of corticosteroids, although the role for antiviral medications is still debated.2 At first glance, the trial by Lee et al1 seems to identify a subgroup of patients with Bell's palsy who benefit from antiviral medications. However, we believe that some limitations cast doubt on the conclusions of this trial.
- Full-Text
- Preview
- Combination Therapy for Bell's PalsyThe American Journal of MedicineVol. 126Issue 12
- PreviewTreatment of Bell's palsy with antivirals constitutes an ongoing discussion. Lee et al1 were the first to perform a study in the relevant population domain (ie, patients with a severe palsy). Their manuscript confirms the results of a previous retrospective study.2 The authors are to be congratulated with the outcome: they offer clear proof of the effectiveness of combination therapy—corticosteroids and antivirals—enhancing recovery in patients with a severe palsy.
- Full-Text
- Preview
