Bell’s Palsy is an idiopathic unilateral facial nerve paralysis.
Since the 2009 Cochrane review1 showing that antivirals added no benefit to corticosteroids in Bell’s Palsy, I stopped prescribing them. The NNT.com site has concluded the same. Looking at the literature a little more, the recommendations are a little murkier. Some groups are still advocating for antivirals for severe cases, because there may be a very small but questionably positive benefit.
- “Because of the possibility of a modest increase in recovery, patients might be offered antivirals (in addition to steroids) (Level C). Patients offered antivirals should be counseled that a benefit from antivirals has not been established, and, if there is a benefit, it is likely that it is modest at best”2
- UpToDate: “For the subgroup of patients with severe facial palsy at presentation, defined as House-Brackmann grade IV or higher, we suggest early combined therapy with prednisone (60 to 80 mg per day) plus valacyclovir (1000 mg three times daily) for one week rather than glucocorticoids alone (Grade 2B).”
- “The authors conclude that although a strong recommendation for adding antiviral agents to corticosteroids to further improve the recovery of patients with severe Bell palsy is precluded by the lack of robust evidence, it should be discussed with the patient.”3
- “Antiviral agents, when administered with corticosteroids, may be associated with additional benefit.”4
PV Card: Treatment of Bell’s Palsy
Adapted from 1,2,4
Go to the ALiEM Cards site for more resources.
Thanks to Dr. Kristin Berona (UCSF-SFGH EM resident) for the idea and notes!