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.
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.
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.
Combined treatment with a steroid and an antiviral agent is more effective in treating severe to complete Bell's palsy than steroid treatment alone.
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Published online: February 07, 2013
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.
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
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- 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.
- 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.