Bell's Palsy: Difference between revisions
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In [[medicine]], '''Bell's Palsy''' is "A syndrome characterized by the acute onset of unilateral facial paralysis which progresses over a 2-5 day period. Weakness of the orbicularis oculi muscle and resulting incomplete eye closure may be associated with corneal injury. Pain behind the ear often precedes the onset of paralysis. This condition may be associated with human herpesvirus 1 infection of the facial nerve."<ref>{{MeSH}}</ref> | |||
==Etiology/cause== | ==Etiology/cause== | ||
Most cases of Bell's Palsy are caused by [[Herpes simplex virus]] type 1<ref name="pmid7503474">{{cite journal |author=Murakami S, Mizobuchi M, Nakashiro Y, Doi T, Hato N, Yanagihara N |title=Bell palsy and herpes simplex virus: identification of viral DNA in endoneurial fluid and muscle |journal=Ann. Intern. Med. |volume=124 |issue=1 Pt 1 |pages=27–30 |year=1996 |pmid=7503474 |doi= |issn=}}</ref> Some cases are caused by [[Herpes zoster]] virus.<ref name="pmid12482166">{{cite journal |author=Peitersen E |title=Bell's palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies |journal=Acta oto-laryngologica. Supplementum |volume= |issue=549 |pages=4–30 |year=2002 |pmid=12482166 |doi= |issn=}}</ref> | Most cases of Bell's Palsy are caused by [[Herpes simplex virus]] type 1<ref name="pmid7503474">{{cite journal |author=Murakami S, Mizobuchi M, Nakashiro Y, Doi T, Hato N, Yanagihara N |title=Bell palsy and herpes simplex virus: identification of viral DNA in endoneurial fluid and muscle |journal=Ann. Intern. Med. |volume=124 |issue=1 Pt 1 |pages=27–30 |year=1996 |pmid=7503474 |doi= |issn=}}</ref> Some cases are caused by [[Herpes zoster]] virus.<ref name="pmid12482166">{{cite journal |author=Peitersen E |title=Bell's palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies |journal=Acta oto-laryngologica. Supplementum |volume= |issue=549 |pages=4–30 |year=2002 |pmid=12482166 |doi= |issn=}}</ref> | ||
==Treatment== | ==Treatment== | ||
A [[randomized controlled trial]] 496 | Two meta-analyses reach conflicting conclusions.<ref name="doi10.1136/bmj.b3354">{{Cite journal | ||
| doi = 10.1136/bmj.b3354 | volume = 339 | issue = sep07_1 | pages = b3354 | last = Quant | first = Eudocia C | |||
| coauthors = Shafali S Jeste, Rajeev H Muni, Alison V Cape, Manveen K Bhussar, Anton Y Peleg | |||
| title = The benefits of steroids versus steroids plus antivirals for treatment of Bell's palsy: a meta-analysis | |||
| journal = BMJ | accessdate = 2009-09-10 | date = 2009-09-07 | url = http://www.bmj.com/cgi/content/abstract/339/sep07_1/b3354 }}</ref><ref name="pmid19724046">{{cite journal| author=de Almeida JR, Al Khabori M, Guyatt GH, Witterick IJ, Lin VY, Nedzelski JM et al.| title=Combined corticosteroid and antiviral treatment for Bell palsy: a systematic review and meta-analysis. | journal=JAMA | year= 2009 | volume= 302 | issue= 9 | pages= 985-93 | pmid=19724046 | |||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19724046 | doi=10.1001/jama.2009.1243 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> While both agree that [[corticosteroid]]s improve recovery, one analysis supported [[antiviral]]s<ref name="pmid19724046"/> while the other did not<ref name="doi10.1136/bmj.b3354"/>. | |||
{| class="wikitable" | |||
|+ Do [[antiviral]]s add to [[corticosteroid]]s in improving Bell's Palsy? | |||
! Sutdy!! Design!!Result | |||
|- | |||
| Quant<ref name="doi10.1136/bmj.b3354"/><br/>2009|| [[Meta-analysis]] of 6 trials†||[[Odds ratio|OR]]: 0.67‡ (95% CI, 0.37-1.20) | |||
|- | |||
| Almeida<ref name="pmid19724046"/><br/>2009|| [[Meta-analysis]] of 8 trials||[[Relative risk|RR]]: 0.75 (95% CI, 0.56-1.00) | |||
|- | |||
|colspan="3"|Notes:<br/>† Quant excluded the trial of Antunes<ref>Antunes ML, Fukuda Y, Testa JRG. Clinical treatment of Bell's palsy. Acta AWHO. 2000;19(2):68-75.</ref> and the negative trial of Vazquez<ref>Vazquez MC, Sanchez N, Calvo J. [http://www.rmu.org.uy/revista/24/3/2/es/3/resumen/ Eficacia de los antivirales en la parálisis de Bell]. Rev Med Urug. 2008;24(3):1-8.</ref><br/>‡ The original publication reported the odds ratio for increase in good outcomes. This table uses the reciprocal in order to report the reduction in adverse outcomes. | |||
|} | |||
A [[randomized controlled trial]] 496 patients within 3 days after the onset of symptoms using 25 mg of prednisolone twice a day for 10 days improved facial function at 3 months from 64% to 83.0%.<ref name="pmid17942873">{{cite journal |author=Sullivan FM, Swan IR, Donnan PT, ''et al'' |title=Early treatment with prednisolone or acyclovir in Bell's palsy |journal=N. Engl. J. Med. |volume=357 |issue=16 |pages=1598–607 |year=2007 |pmid=17942873 |doi=10.1056/NEJMoa072006 |issn=}}</ref> This means that the drug benefits one out of every five patients treated ([[number needed to treat]] is 5). Acyclovir was also studied in this trial but showed no benefit. | |||
This results contradicts a previous [[randomized controlled trial]] of 99 patients in which acyclovir was better than prednisone at improving electroneurography evidence of volitional muscle motion and in preventing partial nerve degeneration.<ref name="pmid8651631">{{cite journal |author=Adour KK, Ruboyianes JM, Von Doersten PG, ''et al'' |title=Bell's palsy treatment with acyclovir and prednisone compared with prednisone alone: a double-blind, randomized, controlled trial |journal=Ann. Otol. Rhinol. Laryngol. |volume=105 |issue=5 |pages=371–8 |year=1996 |pmid=8651631 |doi= |issn=}}</ref> | This results contradicts a previous [[randomized controlled trial]] of 99 patients in which acyclovir was better than prednisone at improving electroneurography evidence of volitional muscle motion and in preventing partial nerve degeneration.<ref name="pmid8651631">{{cite journal |author=Adour KK, Ruboyianes JM, Von Doersten PG, ''et al'' |title=Bell's palsy treatment with acyclovir and prednisone compared with prednisone alone: a double-blind, randomized, controlled trial |journal=Ann. Otol. Rhinol. Laryngol. |volume=105 |issue=5 |pages=371–8 |year=1996 |pmid=8651631 |doi= |issn=}}</ref> | ||
Revision as of 05:10, 10 September 2009
In medicine, Bell's Palsy is "A syndrome characterized by the acute onset of unilateral facial paralysis which progresses over a 2-5 day period. Weakness of the orbicularis oculi muscle and resulting incomplete eye closure may be associated with corneal injury. Pain behind the ear often precedes the onset of paralysis. This condition may be associated with human herpesvirus 1 infection of the facial nerve."[1]
Etiology/cause
Most cases of Bell's Palsy are caused by Herpes simplex virus type 1[2] Some cases are caused by Herpes zoster virus.[3]
Treatment
Two meta-analyses reach conflicting conclusions.[4][5] While both agree that corticosteroids improve recovery, one analysis supported antivirals[5] while the other did not[4].
| Sutdy | Design | Result |
|---|---|---|
| Quant[4] 2009 |
Meta-analysis of 6 trials† | OR: 0.67‡ (95% CI, 0.37-1.20) |
| Almeida[5] 2009 |
Meta-analysis of 8 trials | RR: 0.75 (95% CI, 0.56-1.00) |
| Notes: † Quant excluded the trial of Antunes[6] and the negative trial of Vazquez[7] ‡ The original publication reported the odds ratio for increase in good outcomes. This table uses the reciprocal in order to report the reduction in adverse outcomes. | ||
A randomized controlled trial 496 patients within 3 days after the onset of symptoms using 25 mg of prednisolone twice a day for 10 days improved facial function at 3 months from 64% to 83.0%.[8] This means that the drug benefits one out of every five patients treated (number needed to treat is 5). Acyclovir was also studied in this trial but showed no benefit.
This results contradicts a previous randomized controlled trial of 99 patients in which acyclovir was better than prednisone at improving electroneurography evidence of volitional muscle motion and in preventing partial nerve degeneration.[9]
References
- ↑ Anonymous (2024), Bell's Palsy (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Murakami S, Mizobuchi M, Nakashiro Y, Doi T, Hato N, Yanagihara N (1996). "Bell palsy and herpes simplex virus: identification of viral DNA in endoneurial fluid and muscle". Ann. Intern. Med. 124 (1 Pt 1): 27–30. PMID 7503474. [e]
- ↑ Peitersen E (2002). "Bell's palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies". Acta oto-laryngologica. Supplementum (549): 4–30. PMID 12482166. [e]
- ↑ 4.0 4.1 4.2 Quant, Eudocia C; Shafali S Jeste, Rajeev H Muni, Alison V Cape, Manveen K Bhussar, Anton Y Peleg (2009-09-07). "The benefits of steroids versus steroids plus antivirals for treatment of Bell's palsy: a meta-analysis". BMJ 339 (sep07_1): b3354. DOI:10.1136/bmj.b3354. Retrieved on 2009-09-10. Research Blogging.
- ↑ 5.0 5.1 5.2 de Almeida JR, Al Khabori M, Guyatt GH, Witterick IJ, Lin VY, Nedzelski JM et al. (2009). "Combined corticosteroid and antiviral treatment for Bell palsy: a systematic review and meta-analysis.". JAMA 302 (9): 985-93. DOI:10.1001/jama.2009.1243. PMID 19724046. Research Blogging.
- ↑ Antunes ML, Fukuda Y, Testa JRG. Clinical treatment of Bell's palsy. Acta AWHO. 2000;19(2):68-75.
- ↑ Vazquez MC, Sanchez N, Calvo J. Eficacia de los antivirales en la parálisis de Bell. Rev Med Urug. 2008;24(3):1-8.
- ↑ Sullivan FM, Swan IR, Donnan PT, et al (2007). "Early treatment with prednisolone or acyclovir in Bell's palsy". N. Engl. J. Med. 357 (16): 1598–607. DOI:10.1056/NEJMoa072006. PMID 17942873. Research Blogging.
- ↑ Adour KK, Ruboyianes JM, Von Doersten PG, et al (1996). "Bell's palsy treatment with acyclovir and prednisone compared with prednisone alone: a double-blind, randomized, controlled trial". Ann. Otol. Rhinol. Laryngol. 105 (5): 371–8. PMID 8651631. [e]