Clinical research study
Steroid-antiviral Treatment Improves the Recovery Rate in Patients with Severe Bell's Palsy

https://doi.org/10.1016/j.amjmed.2012.08.020Get rights and content

Abstract

Background

The extent of facial nerve damage is expected to be more severe in higher grades of facial palsy, and the outcome after applying different treatment methods may reveal obvious differences between severe Bell's palsy and mild to moderate palsy. This study aimed to systematically evaluate the effects of different treatment methods and related prognostic factors in severe to complete Bell's palsy.

Methods

This randomized, prospective study was performed in patients with severe to complete Bell's palsy. Patients were assigned randomly to treatment with a steroid or a combination of a steroid and an antiviral agent. We collected data about recovery and other prognostic factors.

Results

The steroid treatment group (S group) comprised 107 patients, and the combination treatment group (S+A group) comprised 99 patients. There were no significant intergroup differences in age, sex, accompanying disease, period from onset to treatment, or results of an electrophysiology test (P >.05). There was a significant difference in complete recovery between the 2 groups. The recovery (grades I and II) of the S group was 66.4% and that of the S+A group was 82.8% (P = .010). The S+A group showed a 2.6-times higher possibility of complete recovery than the S group, and patients with favorable electromyography showed a 2.2-times higher possibility of complete recovery.

Conclusions

Combined treatment with a steroid and an antiviral agent is more effective in treating severe to complete Bell's palsy than steroid treatment alone.

Section snippets

Methods

Between September 2008 and August 2011, we conducted a prospective, randomized study of patients who visited our tertiary medical center due to acute unilateral peripheral facial paralysis without skin lesions or intraoral lesions occurring within 7 days of presentation. The House-Brackmann grading system was used to evaluate the severity of facial palsy, and only patients with severe to complete Bell's palsy (House-Brackmann grade ≥5) were enrolled.9

All patients were hospitalized for 1 week.

Results

A total of 269 patients were enrolled in this study. After excluding 32 patients who did not match the inclusion criteria and 31 patients who did not complete this study due to adverse effects of treatment and did not present for follow-up, 206 patients completed the study (Figure 1).

The steroid treatment group (S group) comprised 107 patients, and the combination treatment group (S+A group) comprised 99 patients. There was no significant difference in the distribution of facial grades between

Discussion

Additional antiviral treatment in Bell's palsy is based on the hypothesis that herpes simplex virus infection may cause inflammation of the facial nerve. Theoretically, the infectious agents are eradicated by antiviral treatment, and swelling of the facial nerve is reduced by corticosteroids.6 However, antiviral agents cannot actually destroy virus that has already replicated, because these drugs prevent viral replication by interfering with viral DNA polymerase. In this respect, Hato et al

References (28)

  • M. Minnerop et al.

    Bell's palsy: combined treatment of famciclovir and prednisone is superior to prednisone alone

    J Neurol

    (2008)
  • J.W. House et al.

    Facial nerve grading system

    Otolarynogol Head Neck Surg

    (1985)
  • A.J. Wagstaff et al.

    AciclovirA reappraisal of its antiviral activity, pharmacokinetic properties and therapeutic efficacy

    Drugs

    (1994)
  • J.I. De Diego et al.

    Idiopathic facial paralysis: a randomized, prospective, and controlled study using single-dose prednisone versus acyclovir three times daily

    Laryngoscope

    (1998)
  • Cited by (65)

    View all citing articles on Scopus

    Funding: This research was supported by the Kyung Hee University Research Fund in 2011(KHU-2011-1098).

    Conflict of Interest: None.

    Authorship: All authors had full access to the data and played a role in writing this manuscript.

    View full text