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Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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bell's palsy

Corticosteroids and Antiviral Agents for Bell Palsy

Patients with Bell palsy benefit significantly from corticosteroid therapy, and the addition of antiviral agents may confer even greater benefit, according to a JAMA meta-analysis.

Researchers examined 18 randomized controlled trials that compared antiviral or corticosteroid treatment with a control in nearly 2800 patients with Bell palsy. Among the findings:

Corticosteroids alone reduced the risk for unsatisfactory facial recovery (number needed to treat, 11).
Antiviral agents alone did not improve outcomes.
Corticosteroids plus antivirals were somewhat more effective than corticosteroids alone.

Neither treatment caused an increase in major adverse events.

An editorialist concludes that the analysis "helps resolve lingering doubt about the benefits of corticosteroids, but raises questions about the adjunctive role of antiviral medications."

Combined Corticosteroid and Antiviral Treatment for Bell Palsy
A Systematic Review and Meta-analysis

John R. de Almeida, MD; Murtadha Al Khabori, MD; Gordon H. Guyatt, MD, MSc, FRCPC; Ian J. Witterick, MD, MSc, FRCSC; Vincent Y. W. Lin, MD, FRCSC; Julian M. Nedzelski, MD, FRCSC; Joseph M. Chen, MD, FRCSC

JAMA. 2009;302(9):985-993.

Context New evidence has emerged regarding the use of corticosteroids and antiviral agents in Bell palsy.

Objective To estimate the association of corticosteroids and antiviral agents with the risk of unsatisfactory facial recovery in patients with Bell palsy.

Data Sources The search included MEDLINE, EMBASE, CENTRAL, PsychInfo, CINAHL, Web of Science, PAPERSFIRST, PROCEEDINGSFIRST, and PROQUEST to identify studies up to March 1, 2009.

Study Selection and Data Extraction Eligible studies were randomized controlled trials comparing treatment with either corticosteroids or antiviral agents with a control and measuring at least 1 of the following outcomes: unsatisfactory facial recovery (4 months), unsatisfactory short-term recovery (6 weeks to <4 months), synkinesis and autonomic dysfunction, or adverse effects. Two reviewers extracted data on study characteristics, methods, and outcomes. Disagreement was resolved by consensus.

Results Eighteen trials involving 2786 patients were eligible. Regression analysis identified a synergistic effect when corticosteroids and antiviral agents were administered in combination compared with alone (odds ratio for interaction term, 0.54 [95% confidence interval {CI}, 0.35-0.83]; P = .004). Meta-analysis using a random-effects model showed corticosteroids alone were associated with a reduced risk of unsatisfactory recovery (relative risk [RR], 0.69 [95% CI, 0.55-0.87]; P = .001) (number needed to treat to benefit 1 person, 11 [95% CI, 8-25]), a reduced risk of synkinesis and autonomic dysfunction (RR, 0.48 [95% CI, 0.36-0.65]; P < .001) (number needed to treat to benefit 1 person, 7 [95% CI, 6-10]), and no increase in adverse effects. Antiviral agents alone were not associated with a reduced risk of unsatisfactory recovery (RR, 1.14 [95% CI, 0.80-1.62]; P = .48). When combined with antiviral agents, corticosteroids were associated with greater benefit (RR, 0.48 [95% CI, 0.29-0.79]; P = .004) than antiviral agents alone. When combined with corticosteroids, antiviral agents were associated with greater risk reduction of borderline significance compared with corticosteroids alone (RR, 0.75 [95% CI, 0.56-1.00]; P = .05).

Conclusions In Bell palsy, corticosteroids are associated with a reduced risk of unsatisfactory recovery. Antiviral agents, when administered with corticosteroids, may be associated with additional benefit.

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Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.