I would firstly like to thank Madhok et al, for their paper
“Prescribe prednisolone alone for Bell’s palsy diagnosed within 72 hours
of symptom onset” with patients’ diagnosed with Bell’s palsy.
The authors suggested that future research should involve comparing
the use of valaciclovir with prednisolone, instead of the regularly used
aciclovir.
In October 2008, such a study was completed. Engström et al, carried
out a randomised, placebo-controlled, double-blind study over a 6-year
period within 16 centres in Sweden and one in Finland.1 Their study used 4
groups like Sullivan et al,2 whereby patients were randomly selected into
each group to prevent selection bias:
1) Prednisolone and placebo
2) Valaciclovir and placebo
3) Prednisolone and valaciclovir
4) Placebo and placebo1
Using a large sample size of 829 patients, Engström et al’s “aim was
to compare the short-term and long-term effects of prednisolone and
valaciclovir in the recovery of the affected facial nerve”.1 The results
showed that patients who had taken prednisolone had a shorter recovery
period than those who did not.1 Furthermore there was no significant
difference in recovery time for patients on valaciclovir than those who
were not.1
Nevertheless, it is not possible for every patient to be treated
within 72 hours with steroids alone, due to a number of variables:
1) A patient presenting for treatment after 72 hours from the onset
of their symptoms.
2) Incorrect initial diagnosis by either the primary care or emergency
departments.
3) Patients’ could have an allergy/contraindication to steroids or have co
-morbidities that do not allow them to take steroids.
Therefore it would be of great value to investigate other optional
treatments in case of such scenarios. Moreover, it is imperative to
recognise treatment modalities for patients presenting after 72 hours from
the onset of their symptoms, avoiding the risk of future complications.
References
1. Engström M, Berg T, Stjernquist-Desatnik A, Axelsson S, Pitkäranta A, Hultcrantz M, Kanerva M, Hanner P, Jonsson L. ‘Prednisolone and valaciclovir in Bell's palsy: a randomised, double-blind, placebo-controlled, multicentre trial’. Lancet neurology. 2008 November; 7(11): 993-1000.
2. Sullivan FM, Swan IR, Donnan PT, Morrison JM, Smith BH, McKinstry B, Davenport RJ, Vale LD, Clarkson JE, Hammersley V, Hayavi S, McAteer A, Stewart K, Daly F. ‘Early treatment with prednisolone or acyclovir in Bell's palsy’. The New England journal of medicine. 2007 October; 357(16):1598-607.
Rapid Response:
Valaciclovir in Bell's Palsy
I would firstly like to thank Madhok et al, for their paper
“Prescribe prednisolone alone for Bell’s palsy diagnosed within 72 hours
of symptom onset” with patients’ diagnosed with Bell’s palsy.
The authors suggested that future research should involve comparing
the use of valaciclovir with prednisolone, instead of the regularly used
aciclovir.
In October 2008, such a study was completed. Engström et al, carried
out a randomised, placebo-controlled, double-blind study over a 6-year
period within 16 centres in Sweden and one in Finland.1 Their study used 4
groups like Sullivan et al,2 whereby patients were randomly selected into
each group to prevent selection bias:
1) Prednisolone and placebo
2) Valaciclovir and placebo
3) Prednisolone and valaciclovir
4) Placebo and placebo1
Using a large sample size of 829 patients, Engström et al’s “aim was
to compare the short-term and long-term effects of prednisolone and
valaciclovir in the recovery of the affected facial nerve”.1 The results
showed that patients who had taken prednisolone had a shorter recovery
period than those who did not.1 Furthermore there was no significant
difference in recovery time for patients on valaciclovir than those who
were not.1
Nevertheless, it is not possible for every patient to be treated
within 72 hours with steroids alone, due to a number of variables:
1) A patient presenting for treatment after 72 hours from the onset
of their symptoms.
2) Incorrect initial diagnosis by either the primary care or emergency
departments.
3) Patients’ could have an allergy/contraindication to steroids or have co
-morbidities that do not allow them to take steroids.
Therefore it would be of great value to investigate other optional
treatments in case of such scenarios. Moreover, it is imperative to
recognise treatment modalities for patients presenting after 72 hours from
the onset of their symptoms, avoiding the risk of future complications.
References
1. Engström M, Berg T, Stjernquist-Desatnik A, Axelsson S, Pitkäranta A, Hultcrantz M, Kanerva M, Hanner P, Jonsson L. ‘Prednisolone and valaciclovir in Bell's palsy: a randomised, double-blind, placebo-controlled, multicentre trial’. Lancet neurology. 2008 November; 7(11): 993-1000.
2. Sullivan FM, Swan IR, Donnan PT, Morrison JM, Smith BH, McKinstry B, Davenport RJ, Vale LD, Clarkson JE, Hammersley V, Hayavi S, McAteer A, Stewart K, Daly F. ‘Early treatment with prednisolone or acyclovir in Bell's palsy’. The New England journal of medicine. 2007 October; 357(16):1598-607.
Competing interests:
None declared
Competing interests: No competing interests