Antiviral treatment for Bell's palsy (idiopathic facial paralysis)

TY - JOUR

T1 - Antiviral treatment for Bell's palsy (idiopathic facial paralysis)

A1 - Lockhart,Pauline

A1 - Daly,Fergus

A1 - Pitkethly,Marie

A1 - Comerford,Natalia

A1 - Sullivan,Frank

AU - Lockhart,Pauline

AU - Daly,Fergus

AU - Pitkethly,Marie

AU - Comerford,Natalia

AU - Sullivan,Frank

PY - 2009

Y1 - 2009

N2 - <p>Background</p><p>Antiviral agents against herpes simplex virus are widely used in the treatment of idiopathic facial paralysis ( Bell's palsy), but their effectiveness is uncertain. Significant morbidity can be associated with severe cases.</p><p>Objectives</p><p>This review addresses the effect of antiviral therapy on Bell's palsy.</p><p>Search strategy</p><p>We updated the search of the Cochrane Neuromuscular Disease Group Trials Register ( December 2008), MEDLINE ( from January 1966 to December 8 2008), EMBASE ( from January 1980 to December 8 2008) and LILACS ( from January 1982 to December 2008).</p><p>Selection criteria</p><p>Randomized trials of antivirals with and without corticosteroids versus control therapies for the treatment of Bell's palsy.</p><p>Data collection and analysis</p><p>Twenty-three papers were selected for consideration.</p><p>Main results</p><p>Seven trials including 1987 participants met the inclusion criteria, adding five studies to the two in the previous review.</p><p>Incomplete recovery at one year. There was no significant benefit in the rate of incomplete recovery from antivirals compared with placebo (n = 1886, RR 0.88, 95% CI 0.65 to 1.18). Inmeta-analyses with some unexplained heterogeneity, the outcome with antivirals was significantly worse than with corticosteroids (n = 768, RR 2.82, 95% CI 1.09 to 7.32) and the outcome with antivirals plus corticosteroids was significantly better than with placebo (n = 658, RR 0.56, 95% CI 0.41 to 0.76).</p><p>Motor synkinesis or crocodile tears at one year. In single trials, there was no significant difference in long term sequelae comparing antivirals and corticosteroids with corticosteroids alone (n = 99, RR 0.39, 95% CI 0.14 to 1.07) or antivirals with corticosteroids (n = 101, RR 1.03, 95% CI 0.51 to 2.07).</p><p>Adverse events. There was no significant difference in rates of adverse events between antivirals and placebo (n = 1544, RR 1.06, 95% CI 0.81 to 1.38), between antivirals and corticosteroids (n = 667, RR 0.96, 95% CI 0.65 to 1.41) or between the antiviral-corticosteroid combination and placebo (n = 658, RR 1.15, 95% CI 0.79 to 1.66).</p><p>Authors' conclusions</p><p>High quality evidence showed no significant benefit from anti-herpes simplex antivirals compared with placebo in producing complete recovery from Bell's palsy. Moderate quality evidence showed that antivirals were significantly less likely than corticosteroids to produce complete recovery.</p>

AB - <p>Background</p><p>Antiviral agents against herpes simplex virus are widely used in the treatment of idiopathic facial paralysis ( Bell's palsy), but their effectiveness is uncertain. Significant morbidity can be associated with severe cases.</p><p>Objectives</p><p>This review addresses the effect of antiviral therapy on Bell's palsy.</p><p>Search strategy</p><p>We updated the search of the Cochrane Neuromuscular Disease Group Trials Register ( December 2008), MEDLINE ( from January 1966 to December 8 2008), EMBASE ( from January 1980 to December 8 2008) and LILACS ( from January 1982 to December 2008).</p><p>Selection criteria</p><p>Randomized trials of antivirals with and without corticosteroids versus control therapies for the treatment of Bell's palsy.</p><p>Data collection and analysis</p><p>Twenty-three papers were selected for consideration.</p><p>Main results</p><p>Seven trials including 1987 participants met the inclusion criteria, adding five studies to the two in the previous review.</p><p>Incomplete recovery at one year. There was no significant benefit in the rate of incomplete recovery from antivirals compared with placebo (n = 1886, RR 0.88, 95% CI 0.65 to 1.18). Inmeta-analyses with some unexplained heterogeneity, the outcome with antivirals was significantly worse than with corticosteroids (n = 768, RR 2.82, 95% CI 1.09 to 7.32) and the outcome with antivirals plus corticosteroids was significantly better than with placebo (n = 658, RR 0.56, 95% CI 0.41 to 0.76).</p><p>Motor synkinesis or crocodile tears at one year. In single trials, there was no significant difference in long term sequelae comparing antivirals and corticosteroids with corticosteroids alone (n = 99, RR 0.39, 95% CI 0.14 to 1.07) or antivirals with corticosteroids (n = 101, RR 1.03, 95% CI 0.51 to 2.07).</p><p>Adverse events. There was no significant difference in rates of adverse events between antivirals and placebo (n = 1544, RR 1.06, 95% CI 0.81 to 1.38), between antivirals and corticosteroids (n = 667, RR 0.96, 95% CI 0.65 to 1.41) or between the antiviral-corticosteroid combination and placebo (n = 658, RR 1.15, 95% CI 0.79 to 1.66).</p><p>Authors' conclusions</p><p>High quality evidence showed no significant benefit from anti-herpes simplex antivirals compared with placebo in producing complete recovery from Bell's palsy. Moderate quality evidence showed that antivirals were significantly less likely than corticosteroids to produce complete recovery.</p>

KW - Acyclovir [analogs & derivatives; therapeutic use]

KW - Antiviral Agents [therapeutic use]

KW - Bell Palsy [drug therapy; virology]

KW - Herpes Simplex [complications; drug therapy]

KW - Randomized Controlled Trials as Topic

KW - Valine [analogs & derivatives; therapeutic use]

KW - Humans

KW - HERPES-SIMPLEX-VIRUS

KW - POLYMERASE-CHAIN-REACTION

KW - VARICELLA-ZOSTER-VIRUS

KW - DOUBLE-BLIND

KW - ACYCLOVIR

KW - PREDNISOLONE

KW - EFFICACY

KW - VALACYCLOVIR

KW - REACTIVATION

KW - GENICULATE

U2 - 10.1002/14651858.CD001869.pub4

DO - 10.1002/14651858.CD001869.pub4

M1 - Scientific review

JO - Cochrane Database of Systematic Reviews

JF - Cochrane Database of Systematic Reviews

SN - 1469-493X

IS - 4

SP - -

ER -