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Seventy-two hours max

A large double-blind randomized placebo-controlled primary care study in Scotland looked at the efficacy of prednisolone or acyclovir in treating early Bell palsy. Adults 16 years of age or older with unilateral idiopathic facial-nerve weakness who presented to emergency rooms or to primary care physicians were recruited into the study, as long as they could be assessed by a collaborating otorhinolaryngologist within 72 hours of symptom onset. More than 550 patients were randomized into 4 treatment groups (placebo, prednisolone, acyclovir, or prednisolone and acyclovir) for 10 days of treatment. Final outcomes were available for 496 patients.

Baseline assessment was done shortly after randomization. Recovery was assessed at 3 months and again at 9 months if recovery was incomplete. Facial photographs were assessed independently by 3 experts using a standardized measure to determine the primary outcome of facial-nerve function. Secondary outcomes included health-related quality of life, facial appearance, and pain. Adverse events were also recorded. Pill containers (and unused pills) were collected.

Almost 65% of those treated with placebo were fully recovered at 3 months and 85% at 9 months. Treatment with prednisolone within 72 hours of symptom onset increased these rates to 83% at 3 months and almost 95% at 9 months. Acyclovir treatment alone was no better than placebo and there was no additional benefit when added to prednisolone. The number needed to treat to achieve 1 additional complete recovery was 6 at 3 months and 8 at 9 months. There were no clinically significant differences between the treatment groups in secondary outcomes and no serious adverse events in any group.

	Bottom line

TOP Bottom line

 

• In Bell palsy, early treatment with prednisolone substantially improves the chances of complete recovery at 3 (NNT = 6) and 9 (NNT = 8) months.
  
• There is no additional benefit to adding acyclovir to prednisolone.
  

Source:
Sullivan FM, Swan IRC, Donnan PT, Morrison JM, Smith BH, McKinstry B, et al. Early treatment with prednisolone or acyclovir in Bell’s palsy. N Engl J Med 2007;357(16):1598-607.[Abstract/Free Full Text]

This Article Full Text (PDF) Rapid Responses: Submit a response Alert me when this article is cited Alert me when Rapid Responses are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Search for Related Content