CRITICAL SUMMARIES Combined antiviral-corticosteroid therapy for Bell palsy yields inconclusive benefit

Clinical question. Does the combination of antivirals with corticosteroids provide a better degree of recovery of facial muscle function than do corticosteroids alone in the treatment of patients with Bell palsy? Review methods. The authors conducted a search of four major databases for randomized controlled trials published between 1984 and January 2009. The review did not exclude any study on the basis of language. In addition, the authors searched the reference lists of systematic reviews for additional appropriate articles. The authors excluded from the review nonrandomized studies, animal studies, review articles, studies involving children or pregnant women, studies involving the comparison of corticosteroids only with antivirals, and trials lacking control groups and an assessment of facial muscle recovery. Two major requirements for inclusion were a follow-up period of at least one month and a primary end point of at least partial recovery of facial muscle function. The authors evaluated publication bias. Main results. The authors' review involved six studies comprising 1,145 patients: 574 who received corticosteroids alone and 571 who received both corticosteroids and antivirals. The antivirals used were acyclovir, valacyclovir or famciclovir. The authors assessed sources of possible heterogeneity (such as study quality, duration of symptoms before treatment initiation, length of follow-up and type of antiviral used) and found them to have no effect on the outcome. The results of the metaanalysis indicated that the degree of recovery of facial muscle function was not significantly better in patients who received corticosteroids and antivirals than in those who received corticosteroids alone (odds ratio, 1.50; 95 percent confidence interval, 0.83-2.69; P = .18). Conclusions. In the treatment of patients with Bell palsy, the addition of antivirals to corticosteroids provides no benefit beyond that of corticosteroids alone.