Prescribe prednisolone alone for Bell's palsy diagnosed within 72 hours of symptom onset

doi:10.1136/bmj.b255

Published 6 February 2009, doi:10.1136/bmj.b255
Cite this as: BMJ 2009;338:b255

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Prescribe prednisolone alone for Bell’s palsy diagnosed within 72 hours of symptom onset

Vishnu Madhok, clinical research fellow¹, Gavin Falk, clinical research fellow², Tom Fahey, professor of primary care medicine², Frank M Sullivan, director of Scottish School of Primary Care¹

¹ Tayside Centre for General Practice, Division of Community Health Sciences, University of Dundee, Dundee DD2 4BF, ² Department of General Practice, Royal College of Surgeons in Ireland, 120 St Stephen’s Green, Dublin 2, Ireland

Correspondence to: F M Sullivan f.m.sullivan@chs.dundee.ac.uk

The authors explain their reasons for the need for a new changein treatment for early Bell’s palsy

The first 150 words of the full text of this article appear below.

Bell’s palsy affects 11 to 40 people per 100 000 populationeach year,¹ and although most patients recover, as many as 30%are left with facial disfigurement and pain. Uncertainty surroundsthe most commonly used treatments, corticosteroids and antiviralagents: two Cochrane reviews examining their effectiveness concludedthat there were unsatisfactory data to determine definitivetreatment.² ³ However, on the basis of a more recent randomisedcontrolled trial of prednisolone and aciclovir for early Bell’spalsy,⁴ we now propose that prednisolone should be prescribedimmediately on diagnosis and that aciclovir either alone orin combination does not confer any benefit.

The treatment of Bell’s palsy has been an area of clinicaluncertainty in terms of whether to treat with corticosteroidor antiviral therapy. Two separate Cochrane reviews in 2004examined the effectiveness of corticosteroids and antiviralagents in patients with Bell’s palsy.² ³ The first Cochranereview included three randomised controlled trials . . . [Full text of this article]

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de Almeida, J. R., Al Khabori, M., Guyatt, G. H., Witterick, I. J., Lin, V. Y. W., Nedzelski, J. M., Chen, J. M. (2009). Combined Corticosteroid and Antiviral Treatment for Bell Palsy: A Systematic Review and Meta-analysis. JAMA 302: 985-993 [Abstract] [Full text]

Rapid Responses:

Read all Rapid Responses

A blanket corticosteroid policy is not fit for all specialties: Amit Patel
bmj.com, 10 Feb 2009 [Full text]
anti-inflammatories for the first 36 hours: Michael D Beary
bmj.com, 14 Feb 2009 [Full text]
Re: A blanket corticosteroid policy is not fit for all specialties: Vishnu Madhok
bmj.com, 16 Feb 2009 [Full text]
Re: Bell's Palsy as a diagnosis of exclusion: David P Crampsey
bmj.com, 16 Feb 2009 [Full text]
Lyme Serology: Timothy J Stannard
bmj.com, 17 Feb 2009 [Full text]
Valaciclovir in Bell's Palsy: Amir Saam Youshani, et al.
bmj.com, 17 Feb 2009 [Full text]
The use of antivirals in Bell's palsy is still appropriate in patients with severe or complete palsy: Donna M Wade
bmj.com, 20 Feb 2009 [Full text]
Exclusion of other pathologies: Sebastian Hendricks
bmj.com, 24 Feb 2009 [Full text]
Treatment for Bell's Palsy: George Y. Caldwell, et al.
bmj.com, 28 Feb 2009 [Full text]
Re: The use of antivirals in Bell's palsy is still appropriate in patients with severe or complete palsy: Vishnu Madhok, et al.
bmj.com, 1 Mar 2009 [Full text]