What's new this month in BMJ Journals

Treating Bell's palsy: there's no consensus

Neurologists differ greatly in the advice they offer on inquiries about treating Bell's palsy. Asked about their likely response to a general practitioner's enquiry and their prescribing policy, 5% of consultants and specialist registrars in Scotland said they would always offer a consultation, rising to 29% if there were atypical features. They advised steroids at different doses to be started at different stages of the disease, while aciclovir was recommended by 20% (40% if Ramsay Hunt syndrome was part of the clinical picture). The authors point out that two Cochrane reviews had found no proof of benefit from these drugs, but available studies were underpowered to detect a treatment effect. A randomised study will start soon in Scotland with the hope of resolving this uncertainty.

J Neurol Neurosurg Psychiatry 2005;76: 293-4

Stroke guidelines may be too conservative

Audit of the first 1460 patients …