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

Pauline Lockhart, Fergus Daly, Marie Pitkethly, Natalia Comerford, Frank Sullivan

    Research output: Contribution to journalReview articlepeer-review

    169 Citations (Scopus)
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    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.


    This review addresses the effect of antiviral therapy on Bell's palsy.

    Search strategy

    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).

    Selection criteria

    Randomized trials of antivirals with and without corticosteroids versus control therapies for the treatment of Bell's palsy.

    Data collection and analysis

    Twenty-three papers were selected for consideration.

    Main results

    Seven trials including 1987 participants met the inclusion criteria, adding five studies to the two in the previous review.

    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).

    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).

    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).

    Authors' conclusions

    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.
    This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2010, Issue 6. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.

    Original languageEnglish
    Article numberCD001869
    Pages (from-to)-
    Number of pages41
    JournalCochrane Database of Systematic Reviews
    Issue number4
    Publication statusPublished - 2010


    • Acyclovir [analogs & derivatives; therapeutic use]
    • Antiviral Agents [therapeutic use]
    • Bell Palsy [drug therapy; virology]
    • Herpes Simplex [complications; drug therapy]
    • Randomized Controlled Trials as Topic
    • Valine [analogs & derivatives; therapeutic use]
    • Humans


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