Practice Change Page

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

BMJ 2009; 338 doi: http://dx.doi.org/10.1136/bmj.b255 (Published 06 February 2009) Cite this as: BMJ 2009;338:b255
  1. Vishnu Madhok, clinical research fellow1,
  2. Gavin Falk, clinical research fellow2,
  3. Tom Fahey, professor of primary care medicine2,
  4. Frank M Sullivan, director of Scottish School of Primary Care1
  1. 1Tayside Centre for General Practice, Division of Community Health Sciences, University of Dundee, Dundee DD2 4BF
  2. 2Department of General Practice, Royal College of Surgeons in Ireland, 120 St Stephen’s Green, Dublin 2, Ireland
  1. Correspondence to: F M Sullivan f.m.sullivan{at}chs.dundee.ac.uk
  • Accepted 13 August 2008

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

The clinical problem

Bell’s palsy affects 11 to 40 people per 100 000 population each year,1 and although most patients recover, as many as 30% are left with facial disfigurement and pain. Uncertainty surrounds the most commonly used treatments, corticosteroids and antiviral agents: two Cochrane reviews examining their effectiveness concluded that there were unsatisfactory data to determine definitive treatment.2 3 However, on the basis of a more recent randomised controlled trial of prednisolone and aciclovir for early Bell’s palsy,4 we now propose that prednisolone should be prescribed immediately on diagnosis and that aciclovir either alone or in combination does not confer any benefit.

The evidence for change

The treatment of Bell’s palsy has been an area of clinical uncertainty in terms of whether to treat with corticosteroid or antiviral therapy. Two separate Cochrane reviews in 2004 examined the effectiveness of corticosteroids and antiviral agents in patients with Bell’s palsy.2 3 The first Cochrane …

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