Recent developments in Bell's palsy: Does a more recent single research paper trump a systematic review?

doi:10.1136/bmj.329.7474.1103-a

BMJ 2004;329:1103 (6 November), doi:10.1136/bmj.329.7474.1103-a

Letter

Recent developments in Bell's palsy

Does a more recent single research paper trump a systematic review?

EDITOR—I am a jobbing general practitioner, and the paperby Holland and Weiner on Bell's palsy left me confused.¹ Totreat somebody is a hard decision—not to treat somebody,even harder.

In 2002 the BMJ published an article about recent advances inneurology that proposed that there might be a case for prednisolonebut none so far for antiviral agents.² This was based on systematicreviews.

This article quotes from just two more recent papers (Axelssonet al and Murakami et al^3
4) and says that now the evidencebase is clearly in favour of using antivirals. Given that furtherrandomised controlled trials are in the pipeline, the authors'full support of antiviral use is more opinion than evidence,is it not?

Does a single more recent research paper trump a previous systematicreview?

I was also concerned by the statement in the blue box at thestart of the paper that claimed under recent developments thattreatment of partial Bell's palsy is controversial: a few patientsdon't recover if left untreated. Is it not also true that afew patients don't recover even if treated?

In addition, I thought the article muddled and unhelpful. Shouldpatients be admitted? What do the authors mean by psychologicalsupport?

Every year or so when I see a case of Bell's palsy I phone mylocal teaching hospital and ask the neurology registrar whatthe latest news is. The only thing I learnt from this articleis perhaps I also ought to ask the registrar in ear, nose, andthroat medicine too: perhaps we could have a live debate?

James A Cave, general practitioner

Newbury RG20 8UY ectopicmailbox-collector1{at}yahoo.co.uk

Competing interests: None declared.

References

Holland NJ, Weiner GM. Recent developments in Bell's palsy. BMJ 2004;329: 553-7. (4 September.)[Free Full Text]
Wiebe S, Nicolle MW. Recent developments in neurology. BMJ 2002;324: 656-60.[Free Full Text]
Axelsson S, Lindberg S, Stjernquist-Desatnik A. Outcome of treatment with valacyclovir and prednisone in patients with Bell's palsy. Ann Oto Rhinol Laryngol 2003;112: 197.[ISI][Medline]
Murakami S, Hato N, Horiuchi J, Honda N, Gyo K, Yanagihara N. Treatment of Ramsay Hunt syndrome with acyclovir-prednisone: significance of early diagnosis and treatment. Ann Neurol 1997;41: 353-7.[CrossRef][ISI][Medline]