Bell Palsy

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Is that a stroke or is that Bell palsy? Jessie gives us some board review!

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Bruce M. -

You mention anti-virals being used for Bells. I thought the NEJM article, conclusion below, was the final say on this as not being useful.
In patients with Bell's palsy, early treatment with prednisolone significantly improves the chances of complete recovery at 3 and 9 months. There is no evidence of a benefit of acyclovir given alone or an additional benefit of acyclovir in combination with prednisolone. (Current Controlled Trials number, ISRCTN71548196. opens in new tab.)

Michele L. -

Etiology not only viral. In our area we have had many cases of Lyme related Bell’s palsy. In endemic areas a thourough history for tick bites, rash and fever are indicated.

Mel H. -

Great comments - the antiviral thing is really confusing and the jury I think it still out. Initial studies where very positive, then not so much. 2019 Cochrane review is a little on the fence, see below. So lot of practice variation. With NO evidence I would say, antivirals are now cheap with good side effect profiles and especially in people with significant deficits I still would probably give them until we get more evidence...but that might be totally wrong :)

Cochrane 2019:
The combination of antivirals and corticosteroids may have little or no effect on rates of incomplete recovery in comparison to corticosteroids alone in Bell's palsy of various degrees of severity, or in people with severe Bell's palsy, but the results were very imprecise. Corticosteroids alone were probably more effective than antivirals alone and antivirals plus corticosteroids were more effective than placebo or no treatment. There was no clear benefit from antivirals alone over placebo.

The combination of antivirals and corticosteroids probably reduced the late sequelae of Bell's palsy compared with corticosteroids alone. Studies also showed fewer episodes of long‐term sequelae in corticosteroid‐treated participants than antiviral‐treated participants.

We found no clear difference in adverse events from the use of antivirals compared with either placebo or corticosteroids, but the evidence is too uncertain for us to draw conclusions.

An adequately powered RCT in people with Bell’s palsy that compares different antiviral agents may be indicated.

Dr. Metal -

This is what makes Daily Dose/EMRAP great. I am watching the new Daily Dose at noon on my lunch break and I also had the same question regarding antivirals in Bells Palsy. I notice there are comments and the one and only Mel H. answers questions almost real time on day of release! Great job EMRAP team.

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