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Abstract
A short cut review was carried out to establish whether acyclovir improves functional recovery in Bell's palsy. Altogether 49 papers were found using the reported search, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. A clinical bottom line is stated.
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Report by Man-Cheuk Yuen,Senior Medical Officer, Kwong Wah Hospital, Hong Kong Search checked by Ian Crawford, Clinical Research Fellow
Clinical scenario
A 45 year old man presents to the emergency department with a one day history of left side facial weakness. Physical examination confirms that the patient has an incomplete left sided Bell's palsy. As prednisone has a limited role in improving the recovery of incomplete Bell's palsy and medical literature postulates a viral aetiology in Bell's palsy, you wonder whether acyclovir would improve the outcome for this patient.
Three part question
In [an adult patient with Bell's palsy] does [acyclovir] improve [functional recovery]?
Search strategy
Medline 1966–04/02 using the OVID interface. Cochrane Library, Issue 1 2002. Medline: [exp Bell palsy or exp Facial paralysis OR exp Facial nerve OR bell palsy.af OR bells palsy.af OR (facial adj5 palsy).af OR (facial adj5 paralysis).af OR (facial adj5 weakness).af] AND [exp Acyclovir or acyclovir.af OR zovirax.af] LIMIT to Human AND English language. Cochrane: (Bell palsy)
Search outcome
Altogether 49 papers were found of which two were relevant and had been included in a systematic review by the Cochrane Neuromuscular Disease Group.1 A meta-analysis was not performed, as the two studies were not directly compatible. This review was last updated on the 19 November 2001. No further relevant papers were identified after this date. These papers are shown in table 6.
Comment(s)
The results from the Adour trial suggest that treatment with acyclovir and prednisolone is more effective than treatment with prednisolone alone. However, the results from the De Diego trial suggest that treatment with prednisolone alone is more effective than treatment with acyclovir alone. Both studies are small and a significant number of patients were lost to follow up in each. A large PRCT with a real placebo control group is needed to clarify the effectiveness of acyclovir in the treatment of Bell's palsy.
CLINICAL BOTTOM LINE
Current evidence does not support the use of acyclovir alone in Bell's palsy. The combination of acyclovir and prednisone may have a small benefit in the final functional recovery.
Report by Man-Cheuk Yuen,Senior Medical Officer, Kwong Wah Hospital, Hong Kong Search checked by Ian Crawford, Clinical Research Fellow