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Bell's palsy - Evidence
Evidence on the use of steroids

  • There are two main benefits from prednisolone: faster recovery, and greater likelihood of complete recovery.
    • A direct comparison of prednisolone versus no prednisolone [Sullivan et al, 2007] showed that:
      • At 3 months, full recovery was seen in 83% versus 64% of people; NNT 6 (95% CI 4 to 9).
      • At 9 months, full recovery was seen in 95% versus 82% of people; NNT 8 (95% CI 6 to 14).
    • This randomized controlled trial (RCT) showed that prednisolone monotherapy has benefits over both placebo and a combination of aciclovir/prednisolone either alone or in combination.
    • The trial was a large (n = 551) multicentre RCT investigating the effects of prednisolone and aciclovir in people over 16 years of age.
    • The study had four arms; prednisolone 25 mg twice daily for 10 days, aciclovir 400 mg five times daily for 10 days, a combination of both, or placebo. All trial participants were referred within 72 hours of the onset of symptoms.
    • A successful outcome was complete recovery from facial paralysis as measured by the House-Brackmann scale, with follow-up at 3 months and 9 months.
    • There were no serious adverse events or clinically significant differences in secondary outcomes between the treatment groups.
  • A Cochrane systematic review [Salinas et al, 2004] of the use of corticosteroids for Bell's palsy concluded that the available evidence did not support the routine use of corticosteroids.
    • This review included four trials (n = 179). The steroids studied were cortisone acetate, prednisone, high-dose intravenous prednisone, and methylprednisolone. The primary outcome measure was the incomplete recovery of facial motor function 6 months or more after randomization.
    • A meta-analysis of data collected from three of the trials showed that 13/59 (22%) in the steroid group had incomplete recovery of facial motor function compared with 15/58 (26%) in the control group. This result was not statistically significant.
  • A systematic review of the use of corticosteroids in Bell's palsy in children [Salman and MacGregor, 2001] did not recommend the routine use of corticosteroids, although the available evidence was weak. The authors noted that Bell's palsy in children is usually more benign than in adults, with complete resolution occurring in 2–6 months in most cases.
  • A review of Bell's palsy in a recent BMJ Clinical Evidence review [Holland, 2008] concluded that corticosteroids may be no more effective than placebo at recovering facial motor function at 6–12 months, although this conclusion was principally based on one systematic review [Salinas et al, 2004].
  • A systematic review by the American Academy of Neurology [Grogan and Gronseth, 2001] was unable to draw any definitive conclusions regarding the use of corticosteroids in Bell's palsy, but described them as 'safe and probably effective'.

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