valacyclovir and Bell-Palsy

Bell palsy should be suspected in patients with acute onset of unilateral facial weakness or paralysis involving the forehead in the absence of other neurologic abnormalities. The overall prognosis is good. More than two-thirds of patients with typical Bell palsy have a complete spontaneous recovery. For children and pregnant women, the rate of complete recovery is up to 90%. Bell palsy is idiopathic. Laboratory testing and imaging are not required for diagnosis. When other causes of facial weakness are being considered, laboratory testing may identify a treatable cause. An oral corticosteroid regimen (prednisone, 50 to 60 mg per day for five days followed by a five-day taper) is the first-line treatment for Bell palsy. Combination therapy with an oral corticosteroid and antiviral may reduce rates of synkinesis (misdirected regrowth of facial nerve fibers manifesting as involuntary co-contraction of certain facial muscles). Recommended antivirals include valacyclovir (1 g three times per day for seven days) or acyclovir (400 mg five times per day for 10 days). Treatment with antivirals alone is ineffective and not recommended. Physical therapy may be beneficial in patients with more severe paralysis.

Topics: Acyclovir; Antiviral Agents; Bell Palsy; Child; Female; Humans; Paralysis; Pregnancy; Valacyclovir

Antiviral treatments for Bell palsy have been widely used, but there is no definite conclusion of which is the most effective antiviral drug. We conducted a systematic review of randomized controlled trials (RCTs) including network meta-analysis to investigate the comparative effectiveness of antiviral treatments for Bell palsy.. RCTs comparing effectiveness between antiviral treatments and placebo were included. Risk of bias within and across studies was assessed with the Cochrane tool and the GRADE approach, respectively. Random-effects pairwise meta-analyses were conducted, followed by network meta-analysis.. Three electronic databases were searched from inception to May 18, 2020.. 11 trials and 3393 patients with four arms and eleven contrasts were included.. Significant differences were observed between placebo and famciclovir with respect to overall recovery and no statistically significant differences were found from other comparisons. Treatment ranking based on the evidence network indicated that famciclovir shared the best results, followed by valacyclovir, acyclovir, and finally placebo. Adverse events of famciclovir were too rare and slight to be analyzed. Our confidence in pairwise comparisons was moderate to low, due to study limitations, inconsistency, and imprecision; our confidence in ranking was moderate, due to study limitations. Inconsistency is not deemed to exist by a loop-specific approach and node-splitting procedure. Results of exploring publication bias are satisfying.. According to pairwise and network comparisons, famciclovir could be better than placebo and the effectiveness of other antiviral treatments are similar. For clinical efficacy, famciclovir obtains the best recovery rate of facial function for Bell palsy. Acyclovir has the lowest rate of synkinesis, though, it is not adequately recommended and more superior trails are needed in the future.

Topics: Acyclovir; Antiviral Agents; Bell Palsy; Humans; Network Meta-Analysis; Valacyclovir

Corticosteroids are widely used in the treatment of idiopathic facial paralysis (Bell's palsy), but the effectiveness of additional treatment with an antiviral agent is uncertain. Significant morbidity can be associated with severe cases of Bell's palsy.. To assess the effects of antiviral treatments alone or in combination with any other therapy for Bell's palsy.. On 7 October 2014 we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE, EMBASE, LILACS, DARE, NHS EED, and HTA. We also reviewed the bibliographies of the identified trials and contacted trial authors and known experts in the field and relevant drug companies to identify additional published or unpublished data. We searched clinical trials registries for ongoing studies.. We considered randomised controlled trials or quasi-randomised controlled trials of antivirals with and without corticosteroids versus control therapies for the treatment of Bell's palsy. We excluded trials that had a high risk of bias in several domains.. Pairs of authors independently assessed trials for relevance, eligibility, and risk of bias, using standard Cochrane procedures.. Eleven trials, including 2883 participants, met the inclusion criteria and are included in the final analysis. We added four studies to the previous review for this update. Some of the trials were small, and a number were at high or unclear risk of bias. Other trials did not meet current best standards in allocation concealment and blinding. Incomplete recoveryWe found no significant benefit from adding antivirals to corticosteroids in comparison with corticosteroids alone for people with Bell's palsy (risk ratio (RR) 0.69, 95% confidence interval (CI) 0.47 to 1.02, n = 1715). For people with severe Bell's palsy (House-Brackmann scores of 5 and 6 or the equivalent in other scales), we found a reduction in the rate of incomplete recovery at month six when antivirals plus corticosteroids were used (RR 0.64, 95% CI 0.41 to 0.99, n = 478). The outcome for the participants receiving corticosteroids alone was significantly better than for those receiving antivirals alone (RR 2.09, 95% CI 1.36 to 3.20, n = 1169). The treatment effect of placebo was significantly lower than that of antivirals plus corticosteroids (RR 0.56, 95% CI 0.41 to 0.76, n = 658). Antivirals alone had a non-significant detrimental effect on the outcome compared with placebo (RR 1.10, 95% CI 0.87 to 1.40, n = 658). Motor synkinesis or crocodile tearsIn three trials comparing antivirals and corticosteroids with corticosteroids and placebo that assessed this outcome, we found a significant difference in long-term sequelae in favour or antivirals plus corticosteroids (RR 0.73, 95% CI 0.54 to 0.99, n = 869). Three trials comparing antivirals alone with corticosteroids alone investigating this outcome showed fewer sequelae with corticosteroids (RR 1.44, 95% CI 1.11 to 1.85, n = 873). We found no data on long-term sequelae for other comparisons. Adverse events Adverse event data were available in three studies giving comparison data on 1528 participants. None of the four comparisons (antivirals plus corticosteroids versus corticosteroids plus placebo or no treatment; antivirals versus corticosteroids; antivirals plus corticosteroids versus placebo; antivirals versus placebo) showed significant differences in adverse events between treatment and control arms. We could find no correlation with specific treatment within these results.. Moderate-quality evidence from randomised controlled trials showed no additional benefit from the combination of antivirals with corticosteroids compared to corticosteroids alone or with placebo, and no benefit from antivirals alone compared to placebo, for the treatment of Bell's palsy. Moderate-quality evidence showed a small but just significant benefit of combination therapy compared with corticosteroids alone in severe Bell's palsy. We found no significant increase in adverse events from the use of antivirals compared with either placebo or corticosteroids.

Topics: Acyclovir; Anti-Inflammatory Agents; Antiviral Agents; Bell Palsy; Drug Therapy, Combination; Herpes Simplex; Humans; Prednisolone; Randomized Controlled Trials as Topic; Valacyclovir; Valine

Corticosteroids are widely used in the treatment of idiopathic facial paralysis (Bell's palsy), but the effectiveness of additional treatment with an antiviral agent is uncertain. Significant morbidity can be associated with severe cases of Bell's palsy.. To assess the effects of antiviral treatments alone or in combination with any other therapy for Bell's palsy.. On 7 October 2014 we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE, EMBASE, LILACS, DARE, NHS EED, and HTA. We also reviewed the bibliographies of the identified trials and contacted trial authors and known experts in the field and relevant drug companies to identify additional published or unpublished data. We searched clinical trials registries for ongoing studies.. We considered randomised controlled trials or quasi-randomised controlled trials of antivirals with and without corticosteroids versus control therapies for the treatment of Bell's palsy. We excluded trials that had a high risk of bias in several domains.. Pairs of authors independently assessed trials for relevance, eligibility, and risk of bias, using standard Cochrane procedures.. Eleven trials, including 2883 participants, met the inclusion criteria and are included in the final analysis. We added four studies to the previous review for this update. Some of the trials were small, and a number were at high or unclear risk of bias. Other trials did not meet current best standards in allocation concealment and blinding. Incomplete recoveryWe found no significant benefit from adding antivirals to corticosteroids in comparison with corticosteroids alone for people with Bell's palsy (risk ratio (RR) 0.69, 95% confidence interval (CI) 0.47 to 1.02, n = 1715). For people with severe Bell's palsy (House-Brackmann scores of 5 and 6 or the equivalent in other scales), we found a reduction in the rate of incomplete recovery at month six when antivirals plus corticosteroids were used (RR 0.64, 95% CI 0.41 to 0.99, n = 478). The outcome for the participants receiving corticosteroids alone was significantly better than for those receiving antivirals alone (RR 2.09, 95% CI 1.36 to 3.20, n = 1169). The treatment effect of placebo was significantly lower than that of antivirals plus corticosteroids (RR 0.56, 95% CI 0.41 to 0.76, n = 658). Antivirals alone had a non-significant detrimental effect on the outcome compared with placebo (RR 1.10, 95% CI 0.87 to 1.40, n = 658). Motor synkinesis or crocodile tearsIn three trials comparing antivirals and corticosteroids with corticosteroids and placebo that assessed this outcome, we found a significant difference in long-term sequelae in favour of antivirals plus corticosteroids (RR 0.73, 95% CI 0.54 to 0.99, n = 869). Three trials comparing antivirals alone with corticosteroids alone investigating this outcome showed fewer sequelae with corticosteroids (RR 1.44, 95% CI 1.11 to 1.85, n = 873). We found no data on long-term sequelae for other comparisons. Adverse events Adverse event data were available in three studies giving comparison data on 1528 participants. None of the four comparisons (antivirals plus corticosteroids versus corticosteroids plus placebo or no treatment; antivirals versus corticosteroids; antivirals plus corticosteroids versus placebo; antivirals versus placebo) showed significant differences in adverse events between treatment and control arms. We could find no correlation with specific treatment within these results.. Moderate-quality evidence from randomised controlled trials showed no additional benefit from the combination of antivirals with corticosteroids compared to corticosteroids alone for the treatment of Bell's palsy of various degrees of severity. Moderate-quality evidence showed a small but just significant benefit of combination therapy compared with corticosteroids alone in severe Bell's palsy. Corticosteroids alone were more effective than antivirals alone and antivirals plus corticosteroids were more effective than placebo or no treatment. There was no benefit from antivirals alone over placebo.Moderate-quality evidence indicated that the combination of antivirals and corticosteroids reduced sequelae of Bell's palsy compared with corticosteroids alone.We found no significant increase in adverse events from the use of antivirals compared with either placebo or corticosteroids, based on moderate-quality evidence.

Topics: 2-Aminopurine; Acyclovir; Anti-Inflammatory Agents; Antiviral Agents; Bell Palsy; Drug Therapy, Combination; Famciclovir; Herpes Simplex; Humans; Prednisolone; Randomized Controlled Trials as Topic; Treatment Outcome; Valacyclovir; Valine

Topics: 2-Aminopurine; Acyclovir; Anti-Inflammatory Agents; Antiviral Agents; Bell Palsy; Drug Therapy, Combination; Famciclovir; Herpes Simplex; Humans; Prednisolone; Randomized Controlled Trials as Topic; Treatment Outcome; Valacyclovir; Valine

Corticosteroids are widely used in the treatment of idiopathic facial paralysis (Bell's palsy), but the effectiveness of additional treatment with an antiviral agent is uncertain. Significant morbidity can be associated with severe cases of Bell's palsy. This review was first published in 2001 and revised several times, most recently in 2009. This version replaces an update of the review in Issue 7 of the Cochrane Library subsequently withdrawn because of an ongoing investigation into the reliability of data from an included study.. To assess the effects of antiviral treatments alone or in combination with any other therapy for Bell's palsy.. On 7 October 2014 we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE, EMBASE, LILACS, DARE, NHS EED, and HTA. We also reviewed the bibliographies of the identified trials and contacted trial authors and known experts in the field and relevant drug companies to identify additional published or unpublished data. We searched clinical trials registries for ongoing studies.. We considered randomised controlled trials or quasi-randomised controlled trials of antivirals with and without corticosteroids versus control therapies for the treatment of Bell's palsy. We excluded trials that had a high risk of bias in several domains.. Pairs of authors independently assessed trials for relevance, eligibility, and risk of bias, using standard Cochrane procedures.. Ten trials, including 2280 participants, met the inclusion criteria and are included in the final analysis. Some of the trials were small, and a number were at high or unclear risk of bias. Other trials did not meet current best standards in allocation concealment and blinding. Incomplete recoveryWe found a significant benefit from adding antivirals to corticosteroids in comparison with corticosteroids alone for people with Bell's palsy (risk ratio (RR) 0.61, 95% confidence interval (CI) 0.39 to 0.97, n = 1315). For people with severe Bell's palsy (House-Brackmann scores of 5 and 6 or the equivalent in other scales), we found a reduction in the rate of incomplete recovery at month six when antivirals plus corticosteroids were used, compared to corticosteroids alone (RR 0.64, 95% CI 0.41 to 0.99, n = 478). The outcome for the participants receiving corticosteroids alone was significantly better than for those receiving antivirals alone (RR 2.82, 95% CI 1.09 to 7.32, n = 768). The treatment effect of placebo was significantly lower than that of antivirals plus corticosteroids (RR 0.56, 95% CI 0.41 to 0.76, n = 658). Antivirals alone produced no benefit compared with placebo (RR 1.10, 95% CI 0.87 to 1.40, n = 658). Motor synkinesis or crocodile tearsIn two trials comparing antivirals and corticosteroids with corticosteroids and placebo that assessed this outcome, we found a significant difference in long-term sequelae in favour of antivirals plus corticosteroids (RR 0.56, 95% CI 0.36 to 0.87, n = 469). Two trials comparing antivirals alone with corticosteroids alone investigating this outcome showed fewer sequelae with corticosteroids (RR 1.52, 95% CI 1.08 to 2.12, n = 472). We found no data on long-term sequelae for other comparisons. Adverse events Adverse event data were available in three studies giving comparison data on 1528 participants. None of the four comparisons (antivirals plus corticosteroids versus corticosteroids plus placebo or no treatment; antivirals versus corticosteroids; antivirals plus corticosteroids versus placebo; antivirals versus placebo) showed significant differences in adverse events between treatment and control arms. We could find no correlation with specific treatment within these results.. Low-quality evidence from randomised controlled trials showed a benefit from the combination of antivirals with corticosteroids compared to corticosteroids alone for the treatment of Bell's palsy of various degrees of severity. Low-quality evidence showed a benefit of combination therapy compared with corticosteroids alone in severe Bell's palsy. Corticosteroids alone were more effective than antivirals alone and antivirals plus corticosteroids were more effective than placebo or no treatment. There was no benefit from antivirals alone over placebo.Moderate-quality evidence indicated that the combination of antivirals and corticosteroids reduced sequelae of Bell's palsy compared with corticosteroids alone.We found no significant increase in adverse events from the use of antivirals compared with either placebo or corticosteroids, based on low-quality evidence.

Topics: Acyclovir; Anti-Inflammatory Agents; Antiviral Agents; Bell Palsy; Drug Therapy, Combination; Herpes Simplex; Humans; Prednisolone; Randomized Controlled Trials as Topic; Valacyclovir; Valine

Topics: Acyclovir; Anti-Inflammatory Agents; Antiviral Agents; Bell Palsy; Humans; Prednisone; Systematic Reviews as Topic; Treatment Outcome; Valacyclovir; Valine

Antiviral agents against herpes simplex virus are widely used in the treatment of idiopathic facial paralysis (Bell's palsy), but their effectiveness is uncertain. Significant morbidity can be associated with severe cases.. This review addresses the effect of antiviral therapy on Bell's palsy.. We updated the search of the Cochrane Neuromuscular Disease Group Trials Register (December 2008), MEDLINE (from January 1966 to December 8 2008), EMBASE (from January 1980 to December 8 2008) and LILACS (from January 1982 to December 2008).. Randomized trials of antivirals with and without corticosteroids versus control therapies for the treatment of Bell's palsy.. Twenty-three papers were selected for consideration.. Seven trials including 1987 participants met the inclusion criteria, adding five studies to the two in the previous review.Incomplete recovery at one year. There was no significant benefit in the rate of incomplete recovery from antivirals compared with placebo (n = 1886, RR 0.88, 95% CI 0.65 to 1.18). In meta-analyses with some unexplained heterogeneity, the outcome with antivirals was significantly worse than with corticosteroids (n = 768, RR 2.82, 95% CI 1.09 to 7.32) and the outcome with antivirals plus corticosteroids was significantly better than with placebo (n = 658, RR 0.56, 95% CI 0.41 to 0.76).Motor synkinesis or crocodile tears at one year. In single trials, there was no significant difference in long term sequelae comparing antivirals and corticosteroids with corticosteroids alone (n = 99, RR 0.39, 95% CI 0.14 to 1.07) or antivirals with corticosteroids (n = 101, RR 1.03, 95% CI 0.51 to 2.07).Adverse events.There was no significant difference in rates of adverse events between antivirals and placebo (n = 1544, RR 1.06, 95% CI 0.81 to 1.38), between antivirals and corticosteroids (n = 667, RR 0.96, 95% CI 0.65 to 1.41) or between the antiviral-corticosteroid combination and placebo (n = 658, RR 1.15, 95% CI 0.79 to 1.66).. High quality evidence showed no significant benefit from anti-herpes simplex antivirals compared with placebo in producing complete recovery from Bell's palsy. Moderate quality evidence showed that antivirals were significantly less likely than corticosteroids to produce complete recovery.

Topics: Acyclovir; Anti-Inflammatory Agents; Antiviral Agents; Bell Palsy; Drug Therapy, Combination; Herpes Simplex; Humans; Prednisolone; Randomized Controlled Trials as Topic; Valacyclovir; Valine

The literature has been reviewed for evidence of the efficacy of antiviral agents in both the prophylaxis and treatment of recurrent oral herpes simplex virus (HSV) infections and discussed by a panel of experts. Emphasis was given to randomized controlled trials. Management of herpes-associated erythema multiforme and Bell palsy were also considered. The evidence suggests that 5% acyclovir (ACV) in the cream base may reduce the duration of lesions if applied early. Recurrent herpes labialis (RHL) and recurrent intraoral HSV infections can be effectively treated with systemic ACV 400 mg 3 times a day or systemic valacyclovir 500 to 1000 mg twice a day for 3 to 5 days (longer in the immunocompromised). RHL in the immunocompetent can be effectively prevented with (1) sunscreen alone (SPF 15 or above), (2) systemic ACV 400 mg 2 to 3 times a day, or (3) systemic valacyclovir 500 to 2000 mg twice a day. Valacyclovir 500 mg twice a day is also effective in suppressing erythema multiforme triggered by HSV. Further studies are needed to compare treatment efficacy between topical penciclovir, docosanol, and ACV cream for RHL.

Topics: Acyclovir; Antiviral Agents; Bell Palsy; Cidofovir; Cytosine; Erythema Multiforme; Herpes Labialis; Humans; Immunocompromised Host; Organophosphonates; Secondary Prevention; Sunscreening Agents; Time Factors; Valacyclovir; Valine

Bell's palsy is a peripheral palsy of the facial nerve that results in muscle weakness on one side of the face. Affected patients develop unilateral facial paralysis over one to three days with forehead involvement and no other neurologic abnormalities. Symptoms typically peak in the first week and then gradually resolve over three weeks to three months. Bell's palsy is more common in patients with diabetes, and although it can affect persons of any age, incidence peaks in the 40s. Bell's palsy has been traditionally defined as idiopathic; however, one possible etiology is infection with herpes simplex virus type 1. Laboratory evaluation, when indicated by history or risk factors, may include testing for diabetes mellitus and Lyme disease. A common short-term complication of Bell's palsy is incomplete eyelid closure with resultant dry eye. A less common long-term complication is permanent facial weakness with muscle contractures. Approximately 70 to 80 percent of patients will recover spontaneously; however, treatment with a seven-day course of acyclovir or valacyclovir and a tapering course of prednisone, initiated within three days of the onset of symptoms, is recommended to reduce the time to full recovery and increase the likelihood of complete recuperation.

Topics: Acyclovir; Anti-Inflammatory Agents; Antiviral Agents; Bell Palsy; Diagnosis, Differential; Humans; Prednisone; Valacyclovir; Valine

The most common disorder of the facial nerve is acute idiopathic facial paralysis or Bell's palsy and there may be significant morbidity or incomplete recovery associated with severe cases.. To assess the efficacy of aciclovir or similar agents for treating Bell's palsy.. We searched the Cochrane Neuromuscular Disease Group register (searched April 2003), MEDLINE (from January 1966 to April 2003), EMBASE (from January 1980 to April 2003) and LILACS (from January 1982 to April 2003). We also contacted authors of identified trials.. Randomised or quasi-randomised trials of aciclovir or valaciclovir therapy, alone or in combination with any other drug, in patients with Bell's palsy.. We identified six randomised trials.. Three studies met our inclusion criteria, including 246 patients. One study evaluated aciclovir with corticosteroid versus corticosteroid alone, another study evaluated aciclovir alone versus corticosteroid and a further study evaluated valaciclovir with corticosteroid versus corticosteroid alone or versus placebo alone. Incomplete recovery after one year: data were not available. An analysis was performed on data reported at the end of the study period in each trial. The results from one study four months after the start of treatment significantly favoured the treatment group, whilst the results of the study three months after the start of treatment significantly favoured the control group. The results from the second study at four months showed no statistically significant difference between the three groups. Adverse events: relevant data were not reported in any of the three trials. Complete facial paralysis six months after start of treatment: only one patient had complete paralysis upon entering one of the studies. This patient was assigned to the control group and the level of recovery attained was not reported. Motor synkinesis or crocodile tears one year after start of treatment: data were available up to a maximum of four months after onset of paralysis. One study reported a significant difference between the treatment groups in favour of the aciclovir plus corticosteroid group over corticosteroid alone, another demonstrated an inconclusive result with no difference between the aciclovir and corticosteroid. The third study did not comment upon these sequelae.. More data are needed from a large multicentre randomised controlled and blinded study with at least 12 months' follow up before a definitive recommendation can be made regarding the effect of aciclovir or valaciclovir on Bell's palsy.

Topics: Acyclovir; Antiviral Agents; Bell Palsy; Herpes Simplex; Humans; Randomized Controlled Trials as Topic; Valacyclovir; Valine

Small but interesting evidences suggest that facial rehabilitation for acute Bell Palsy (BP) could improve facial outcomes in patients who benefited from optimal medication, but whose symptoms are still severe two weeks after BP's onset.. This study aimed to provide preliminary evidence of the long-term effects of a new facial retraining based on motor imagery and mirror therapy, the Mirror Effect Plus Protocol (MEPP).. Twenty BP patients received the standard medication for acute BP and were then randomly allocated to the treatment (MEPP) or control group, if their palsy was still at least moderate-to-severe at 14 days post onset. Three blind independent assessors graded the patients' evolution until 6 months after onset.. Significant differences between the groups were not found for any measured variable; however, a trend toward better recovery was found in the treatment group for every measured variable. This trend grew bigger for patients with severe or total BP.. This study suggests a promising effect of the MEPP on acute severe to total BP but requires further investigation with a larger number of participants.. Facial rehabilitation should be considered as an adjunct to medication for acute and most severe degrees of BP.

Topics: Adult; Anti-Inflammatory Agents; Antiviral Agents; Bell Palsy; Combined Modality Therapy; Drug Therapy, Combination; Face; Female; Humans; Longitudinal Studies; Male; Middle Aged; Physical Therapy Modalities; Prednisone; Rehabilitation; Single-Blind Method; Valacyclovir

To determine whether early intervention with intratympanic steroid injection, known as concurrent intratympanic steroid therapy, is effective as a supplement to systemic steroid therapy for treating moderate-severe to severe Bell's palsy.. An open-label historical control trial.. Tertiary referral center.. A total of 35 Bell's palsy patients presenting with House-Brackmann grade IV or higher were treated with intratympanic steroid therapy concurrent with standard systemic treatment and compared with 108 patients treated with standard systemic therapy alone started within 7 days of onset.. In the concurrent intratympanic steroid therapy group, patients received both 410 mg of prednisolone (standard dose) and 1.65 mg of intratympanic dexamethasone for 10 consecutive days. Patients in the control group received the standard dose, or more, of systemic prednisolone. Both groups were additionally treated with valacyclovir.. The primary outcome measure was restoration of a House-Brackmann score of grade I.. The rate of recovery to House-Brackmann Grade I was higher for the concurrent intratympanic steroid therapy group than for the control group (94% vs 73%, p = 0.008). The adjusted odds ratio was 5.47 (95% confidence interval: 1.18-25.21, p = 0.029).. The recovery rate was higher for concurrent intratympanic steroid therapy treatment than for standard-of-care control treatment, regardless of whether steroid with lower or equivalent glucocorticoid action was administered. This result suggests that concurrent treatment with intratympanic steroid therapy is a potentially beneficial supplement to systemic steroid administration.

Topics: Adult; Antiviral Agents; Bell Palsy; Combined Modality Therapy; Dexamethasone; Drug Therapy, Combination; Facial Paralysis; Female; Glucocorticoids; Humans; Injection, Intratympanic; Male; Middle Aged; Odds Ratio; Prospective Studies; Valacyclovir; Young Adult

To study the development of synkinesis in Bell's palsy. Frequency, severity, gender aspects and predictors were analysed.. Data from the randomised controlled Scandinavian Bell's palsy trial including 829 patients.. Frequency and severity of synkinesis at 12 months were the main outcome measures. Mean Sunnybrook synkinesis scores, voluntary movement scores and composite scores between 6 and 12 months were compared.. In 743 patients with a 12-month follow-up, synkinesis frequency was 21.3%. There was no gender difference. Synkinesis was moderate to severe in 6.6% of patients. Those with synkinesis at 6 months had a synkinesis score of 4.1 (±2.8 sd), which increased to 4.7 (±3.2) (P = 0.047) at 12 months (n = 93). Sunnybrook composite score at 1 month was the best predictor for synkinesis development with receiver operating characteristics and area under the curve (AUC) 0.87. Risk for synkinesis increased with a lower Sunnybrook composite score. Furthermore, at 1 month, symmetry of voluntary movement had higher predictive value for synkinesis than resting symmetry with AUC 0.87 and 0.77, respectively. Gentle eye closure and open-mouth smile were the only independent significant predictive items (AUC 0.86).. Moderate-to-severe synkinesis was present in 6.6% of patients. The mean synkinesis score increased between 6 and 12 months, and outcome should therefore be evaluated after at least 12 months. Sunnybrook composite score and symmetry of voluntary movement at 1 month were good predictors for synkinesis.

Topics: Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Bell Palsy; Dose-Response Relationship, Drug; Double-Blind Method; Drug Therapy, Combination; Female; Follow-Up Studies; Glucocorticoids; Humans; Male; Middle Aged; Prednisolone; Synkinesis; Time Factors; Treatment Outcome; Valacyclovir; Valine; Young Adult

To study whether prednisolone reduces sequelae in Bell's palsy.. Prospective, randomized, double-blind, placebo-controlled, multicenter trial with 12 months of follow-up.. Seventeen referral centers.. In all, 829 patients aged 18 to 75 years.. Randomization within 72 hours in a factorial fashion to placebo plus placebo (n = 206); prednisolone, 60 mg/d for 5 days, with the dosage then tapered for 5 days, plus placebo (n = 210); valacyclovir hydrochloride, 1000 mg 3 times daily for 7 days, plus placebo (n = 207); or prednisolone plus valacyclovir (n = 206).. Facial function at 12 months assessed with the Sunnybrook and House-Brackmann grading systems.. In 184 of the 829 patients, the Sunnybrook score was less than 90 at 12 months; 71 had been treated with prednisolone and 113 had not (P < .001). In 98 patients, the Sunnybrook score was less than 70; 33 had received prednisolone and 65 had not (P < .001). The difference between patients who received prednisolone and who did not in House-Brackmann gradings higher than I and higher than II was also significant (P < .001 and P = .01, respectively). No significant difference was found between patients who received prednisolone and those who did not in Sunnybrook scores less than 50 (P = .10) or House-Brackmann grades higher than III (P = .80). Synkinesis was assessed with the Sunnybrook score in 743 patients. Ninety-six patients had a synkinesis score more than 2, of whom 33 had received prednisolone and 63 had not (P = .001). Sixty patients had a synkinesis score more than 4, of whom 22 had received prednisolone and 38 had not (P = .005).. Prednisolone significantly reduces mild and moderate sequelae in Bell's palsy.. clinicaltrials.gov Identifier: NCT00510263.

Topics: Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Bell Palsy; Double-Blind Method; Female; Finland; Glucocorticoids; Humans; Male; Middle Aged; Placebos; Prednisolone; Prospective Studies; Sweden; Treatment Outcome; Valacyclovir; Valine

To evaluate the treatment effect of prednisolone and/or valaciclovir in Bell's palsy patients with different baseline severity of palsy.. Patient data were collected from the Scandinavian Bell's Palsy Study, a prospective, randomised, double-blind, placebo-controlled, multi-centre trial.. Sixteen otorhinolaryngological centres in Sweden and one in Finland.. Altogether, 829 patients aged 18-75 years were treated within 72 h of palsy onset. Patients were randomly assigned to treatment with prednisolone plus placebo (n = 210), valaciclovir plus placebo (n = 207), prednisolone plus valaciclovir (n = 206), placebo plus placebo (n = 206). Follow-up was 12 months.. Facial function was assessed using the Sunnybrook grading scale at baseline and at 12 months. Complete recovery was defined as Sunnybrook score = 100.. All patients, regardless of baseline severity, showed significantly higher complete recovery rates if treated with prednisolone compared with no prednisolone. In patients with severe palsy, recovery at 12 months was 51% with prednisolone treatment versus 31% without prednisolone (P = 0.02). Corresponding results were 68%versus 51% (P = 0.004) for moderate, and 83%versus 73% (P = 0.02) for mild palsy. In patient groups with moderate and mild palsy at baseline, significantly fewer prednisolone-treated patients had synkinesis at 12 months (P = 0.04 and P < 0.0001, respectively). For patients with severe palsy at baseline, prednisolone versus no prednisolone made no significant difference regarding synkinesis at 12 months. Valaciclovir did not add any significant effect to prednisolone regarding recovery rate or synkinesis at 12 months.. Prednisolone treatment resulted in higher complete recovery rates, regardless of severity at baseline. Prednisolone treatment should be considered in all patients irrespective of degree of palsy.

Topics: Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Bell Palsy; Double-Blind Method; Female; Finland; Glucocorticoids; Humans; Male; Middle Aged; Placebos; Prednisolone; Prospective Studies; Recovery of Function; Severity of Illness Index; Sweden; Treatment Outcome; Valacyclovir; Valine

To evaluate if treatment start and age are related to the outcome in Bell's palsy patients treated with prednisolone.. Prospective, randomized, double-blind, placebo-controlled, multicenter trial.. Sixteen otorhinolaryngologic centers in Sweden and 1 in Finland.. Data were collected from the Scandinavian Bell's palsy study. A total of 829 patients were treated within 72 hours of onset of palsy. Follow-up was 12 months.. Patients were randomly assigned to treatment with placebo plus placebo (n = 206), prednisolone plus placebo (n = 210), valacyclovir plus placebo (n = 207), or prednisolone plus valacyclovir (n = 206).. Facial function was assessed with the Sunnybrook grading system, and complete recovery was defined as Sunnybrook = 100. Time from onset of palsy to treatment start was registered.. Patients treated with prednisolone within 24 hours and 25 to 48 hours had significantly higher complete recovery rates, 66% (103/156) and 76% (128/168), than patients given no prednisolone, 51% (77/152) and 58% (102/177) (p = 0.008 and p = 0.0003, respectively). For patients treated within 49 to 72 hours of palsy onset, there were no significant differences. Patients aged 40 years or older had significantly higher complete recovery rates if treated with prednisolone, whereas patients aged younger than 40 years did not differ with respect to prednisolone treatment. However, synkinesis was significantly less in patients younger than 40 years given prednisolone (p = 0.002).. Treatment with prednisolone within 48 hours of onset of palsy resulted in significantly higher complete recovery rates and less synkinesis compared with no prednisolone.

Topics: Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Bell Palsy; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Female; Finland; Glucocorticoids; Humans; Intention to Treat Analysis; Male; Middle Aged; Prednisolone; Prospective Studies; Recovery of Function; Sweden; Time Factors; Treatment Outcome; Valacyclovir; Valine

To evaluate the effect of prednisolone and valacyclovir on ipsilateral pain around the ear and in the face or neck in Bell's palsy. The incidence and intensity of pain during the first 2 months of palsy and its prognostic value were also assessed.. Prospective, randomized, double-blind, placebo-controlled, multicenter trial.. Sixteen tertiary referral centers in Sweden and 1 in Finland.. Data are part of the Scandinavian Bell's palsy study; 829 patients aged 18 to 75 years with onset of palsy within 72 hours were included. Follow-up time was 12 months.. Patients were assigned to 1 of 4 treatment arms in a factorial fashion: placebo plus placebo; prednisolone 60 mg daily for 5 days, then tapering for 5 days, plus placebo; valacyclovir 1,000 mg 3 times daily for 7 days plus placebo; or prednisolone plus valacyclovir.. Pain was registered on a visual analog scale within 72 hours, at Days 11 to 17, 1 month, and 2 months. Facial function was assessed with the Sunnybrook and House-Brackmann systems.. Prednisolone and/or valacyclovir did not significantly affect the incidence or intensity of pain during the first 2 months. Pain was registered in 542 (65%) of 829 patients. At 2 months, 53 (8%) of 637 patients still reported pain. Subjects with pain at Days 11 to 17 had lower facial recovery rates at 12 months than those with no pain (p < 0.0001).. Prednisolone and/or valacyclovir did not affect the incidence or intensity of ipsilateral pain in Bell's palsy. The incidence of pain was similar during the first 2 weeks and then decreased. Presence of pain at Days 11 to 17 indicated a worse prognosis for facial recovery.

Topics: Acyclovir; Adult; Anti-Inflammatory Agents; Antiviral Agents; Bell Palsy; Double-Blind Method; Earache; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Neck Pain; Pain; Pain Measurement; Prednisolone; Prognosis; Prospective Studies; Treatment Outcome; Valacyclovir; Valine

We investigated how study design affects the rate of recovery in Bell's palsy.. Prospective, randomized, double-blind, placebo-controlled, multicenter trial.. Data were extracted from the Scandinavian Bell's palsy study, which included 829 patients. The study design was factorial; 416 patients given prednisolone, 413 not given prednisolone, 413 patients given valacyclovir, 416 not given valacyclovir. Data were analyzed with intention-to-treat principle and complete-case analysis methods and recovery was defined as Sunnybrook score 100, House-Brackmann grade I or < or =grade II at 12 months.. With the intention-to-treat principle and last-observation-carried-forward method (n = 829) and recovery defined as Sunnybrook 100, 300 of the 416 patients (72%) receiving prednisolone had recovered compared with 237 of the 413 (57%) who did not receive prednisolone (P < .0001). With recovery defined as House-Brackmann grade I, the corresponding recovery rates were 324 of 416 (78%) and 266 of 413 (64%) (P < .0001). With complete-case analysis and recovery defined House-Brackmann grade I (n = 782), 335 of 389 patients (86%) given prednisolone recovered compared with 277 of 393 (70%) in the group not given prednisolone (P < .0001). With recovery defined as House-Brackmann < or =grade II (n = 797), the corresponding recovery rates were 380 of 396 (96%) and 353 of 401 (88%) (P < .0001). The analysis method affected the recovery rates in the valacyclovir and no-valacyclovir groups in a similar way as in the prednisolone and no-prednisolone groups.. Recovery rates in a Bell's palsy study are substantially affected by the choice of analysis method and definition of recovery.

Topics: Acyclovir; Adolescent; Adult; Aged; Anti-Inflammatory Agents; Antiviral Agents; Bell Palsy; Data Interpretation, Statistical; Double-Blind Method; Female; Humans; Male; Middle Aged; Prednisolone; Prospective Studies; Recovery of Function; Research Design; Treatment Outcome; Valacyclovir; Valine

Previous trials of corticosteroid or antiviral treatments for Bell's palsy have been underpowered or have had insufficient follow-up. The aim of this study was to compare the short-term and long-term effects of prednisolone and valaciclovir in the recovery of the affected facial nerve in a large number of patients.. In this randomised, double-blind, placebo-controlled, multicentre trial, patients aged 18 to 75 years who sought care directly or were referred from emergency departments or general practitioners within 72 h of onset of acute, unilateral, peripheral facial palsy, between May, 2001, and September, 2006, were assessed. Patients were randomly assigned in permuted blocks of eight to receive placebo plus placebo; 60 mg prednisolone per day for 5 days then reduced by 10 mg per day (for a total treatment time of 10 days) plus placebo; 1000 mg valaciclovir three times per day for 7 days plus placebo; or prednisolone (10 days) plus valaciclovir (7 days). Follow-up was for 12 months. The primary outcome event was time to complete recovery of facial function, as assessed with a regional Sunnybrook scale score of 100 points. Analysis was by modified intention to treat. This study is registered with ClinicalTrials.gov, number NCT00510263.. Of 839 patients who were randomly assigned, 829 were included in the modified intention-to-treat analysis: 206 received placebo plus placebo, 210 prednisolone plus placebo, 207 valaciclovir plus placebo, and 206 prednisolone plus valaciclovir. Time to recovery was significantly shorter in the 416 patients who received prednisolone compared with the 413 patients who did not (hazard ratio 1.40, 95% CI 1.18 to 1.64; p<0.0001). There was no difference in time to recovery between the 413 patients treated with valaciclovir and the 416 patients who did not receive valaciclovir (1.01, 0.85 to 1.19; p=0.90). The number of patients with adverse events was similar in all treatment arms.. Prednisolone shortened the time to complete recovery in patients with Bell's palsy, whereas valaciclovir did not affect facial recovery.

Topics: Acyclovir; Adolescent; Adult; Aged; Anti-Inflammatory Agents; Antiviral Agents; Bell Palsy; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Female; Herpes Simplex; Humans; Male; Middle Aged; Placebos; Prednisolone; Recovery of Function; Time Factors; Treatment Outcome; Valacyclovir; Valine; Young Adult

To determine whether reactivation of herpes simplex virus (HSV) type 1 or varicella-zoster virus (VZV) is the main cause of Bell's palsy and whether antiviral drugs bring about recovery from Bell's palsy.. Randomized, multicenter, controlled study.. One hundred fifty patients with Bell's palsy were enrolled in this study. The patients were randomly assigned to a prednisolone group or a prednisolone-valacyclovir group, in whom virologic examinations for HSV-1 and VZV were performed by simple randomization scheme in sealed envelopes. The recovery rates among various groups were analyzed using the Kaplan-Meier method and the Cox proportional hazards model.. Reactivation of HSV-1, VZV, and both viruses was detected in 15.3%, 14.7%, and 4.0% of patients, respectively. There was no significant difference in recovery rates between the prednisolone group and the prednisolone-valacyclovir group, although recovery in the patients with HSV-1 reactivation tended to be higher in the prednisolone-valacyclovir group than in the prednisolone group. There was a significant difference in recovery among age groups and between individuals with complete and incomplete paralysis.. Reactivation of HSV-1 or VZV was observed in 34% of the patients with Bell's palsy. The effect of combination therapy with prednisolone and valacyclovir on recovery was not significantly higher than that with prednisolone alone.

Topics: Acyclovir; Adult; Aged; Anti-Inflammatory Agents; Antibodies; Antiviral Agents; Bell Palsy; Drug Therapy, Combination; Female; Herpesvirus 1, Human; Herpesvirus 3, Human; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; Prednisolone; Proportional Hazards Models; Treatment Outcome; Valacyclovir; Valine; Virus Activation

To investigate the effects of valacyclovir and prednisolone in comparison with those of placebo and prednisolone for the treatment of Bell's palsy, excluding zoster sine herpete.. Prospective, multicenter, randomized placebo-controlled study.. Six academic tertiary referral centers.. Ultimately, 221 patients with Bell's palsy who were treated within 7 days of the onset. Serological and polymerase chain reaction examinations were performed to distinguish Bell's palsy from zoster sine herpete.. The patients were treated with either valacyclovir (dosage, 1,000 mg/d for 5 days) plus prednisolone (VP [n = 114]) or placebo plus prednisolone (PP [n = 107]) administered orally.. Recovery from the palsy was defined as a score higher than 36 using Yanagihara 40-point scoring system without facial contracture or synkinesis. The patients were followed up until complete recovery occurred or for more than 6 months in cases with a poor prognosis.. The overall rate of patient recovery among those treated with VP (96.5%) was significantly better (p < 0.05) than the rate among those treated with PP (89.7%). The rate of patient recovery was also analyzed by classifying the initial severity of facial palsy. In cases of complete or severe palsy, the rates of patients treated with VP and PP who recovered were 95.7% (n = 92) and 86.6% (n = 82), respectively; the recovery rate for treatment with VP was significantly better than that with PP (p < 0.05).. The valacyclovir and prednisolone therapy was more effective in treating Bell's palsy, excluding zoster sine herpete, than the conventional prednisolone therapy. To our knowledge, this is the first controlled study of an antiviral agent in the treatment of a sufficient number of Bell's palsy cases based on an etiologic background.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Bell Palsy; Diagnosis, Differential; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Prednisolone; Severity of Illness Index; Valacyclovir; Valine

A man in his 70s presented with a 4-day history of bilateral frontal headache and heaviness of the face. He was unable to close either of his eyes, to wrinkle his forehead bilaterally and to raise either corner of his mouth. The patient was admitted with a diagnosis of bilateral facial palsy. From history, epidemiology, physical and laboratory findings, Bell's palsy was considered more probable than viral infection, Guillain-Barré syndrome and sarcoidosis. Oral administration of prednisolone, valacyclovir and mecobalamin were initiated promptly, which improved his symptoms. In areas in which Lyme disease is not endemic, we believe that Bell's palsy is the most probable cause of isolated bilateral facial palsy. Patients with bilateral facial paralysis under the suspicion of Bell's palsy should be immediately started on steroid therapy.

Topics: Bell Palsy; Facial Paralysis; Guillain-Barre Syndrome; Humans; Male; Prednisolone; Valacyclovir

COVID-19 is caused by the novel SARS-CoV-2 and is a potentially fatal disease that is of great global public health concern. In addition to respiratory symptoms, neurological manifestations have been associated with COVID-19. This is attributed to the neurotropic nature of coronaviruses. The authors present a case of Bell's palsy associated with COVID-19 in a term primigravida.

Topics: Adult; Anti-Inflammatory Agents; Antiviral Agents; Bell Palsy; COVID-19; Diagnosis, Differential; Facial Paralysis; Female; Guillain-Barre Syndrome; Humans; Neurologic Examination; Physical Therapy Modalities; Prednisolone; Pregnancy; Pregnancy Complications, Infectious; Stroke; Treatment Outcome; Valacyclovir

Topics: Anti-Inflammatory Agents; Antiviral Agents; Bell Palsy; Bioethics; Clinical Decision-Making; COVID-19; COVID-19 Drug Treatment; Decision Making, Shared; Female; Humans; Middle Aged; Prednisone; SARS-CoV-2; Valacyclovir

Frayser MR. You're the flight surgeon: Bell's palsy. Aerop Med Hum Perform. 2017; 88(6):601-604.

Topics: Acyclovir; Adult; Age Factors; Animals; Antiviral Agents; Bell Palsy; Glucocorticoids; Humans; Male; Pilots; Prednisone; Recovery of Function; Return to Work; Valacyclovir; Valine

Bell's palsy is an idiopathic, acute peripheral palsy of the facial nerve that supplies the muscles of facial expression. Despite an expected 70% full recovery rate, up to 30% of patients are left with potentially disfiguring facial weakness, involuntary movements, or persistent lacrimation. The most frequently used treatment options are corticosteroids and antiviral drugs. However, accompanying clinical conditions, such as uncontrolled diabetes, hypertension, gastrointestinal disturbances, polypharmacy of geriatric patients, and significant sequelae ratios, indicate the need for safe and effective complementary therapies that would enhance the success of the conventional interventions.. A 26-year-old female presented with numbness and earache on the left side of the face; these symptoms had been ongoing for 8-10h. Physical examination revealed peripheral facial paralysis of House-Brackmann grade III and corticosteroid-valacyclovir treatment was initiated. On the same day, Kinesio Taping was applied to the affected nerve and muscle area with the aim of primarily neurofacilitation and edema-pain relief. On the fifth day, acupuncture treatment was started and was continued for 3 consecutive days. A physical therapy program was administered for the subsequent 10days. At the 3-week follow-up examination, Bell's palsy was determined as grade I, and the treatment was stopped.. Acupuncture and Kinesio Taping, in conjunction with physical therapy modalities, are safe and promising complementary therapies for the acute management of Bell's palsy. However, further large scale and randomized controlled studies are necessary to assess whether these complementary interventions have significant additive or synergistic effect for complete recovery of patients with Bell's palsy.

Topics: Acupuncture Therapy; Acyclovir; Adrenal Cortex Hormones; Adult; Antiviral Agents; Athletic Tape; Bell Palsy; Facial Nerve; Female; Humans; Physical Therapy Modalities; Valacyclovir; Valine

Topics: Acyclovir; Adolescent; Antiviral Agents; Bell Palsy; Central Nervous System Neoplasms; Facial Nerve; Humans; Magnetic Resonance Imaging; Male; Optic Nerve Diseases; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prednisone; Recovery of Function; Recurrence; Spinal Puncture; Treatment Outcome; Valacyclovir; Valine

Topics: Acyclovir; Aged; Antiviral Agents; Bell Palsy; Diagnosis, Differential; Drug Therapy, Combination; Female; Glucocorticoids; Herpes Zoster Oticus; Humans; Prednisone; Valacyclovir; Valine

Bell's palsy is characterised by an acute onset of unilateral, lower motor neuron weakness of the facial nerve in the absence of an identifiable cause. Establishing the correct diagnosis is imperative and choosing the correct treatment options can optimise the likelihood of recovery.. This article summarises our understanding of Bell's palsy and the evidence-based management options available for adult patients.. The basic assessment should include a thorough history and physical examination as the diagnosis of Bell's palsy is based on exclusion. For confirmed cases of Bell's palsy, corticosteroids are the mainstay of treatment and should be initiated within 72 hours of symptom onset. Antiviral therapy in combination with corticosteroid therapy may confer a small benefit and may be offered on the basis of shared decision making. Currently, no recommendations can be made for acupuncture, physical therapy, electrotherapy or surgical decompression because well-designed studies are lacking and available data are of low quality.

Topics: Acyclovir; Adrenal Cortex Hormones; Adult; Aged; Antiviral Agents; Bell Palsy; Disease Management; Drug Therapy, Combination; Female; General Practice; Humans; Male; Prednisone; Valacyclovir; Valine

To evaluate the validity of early (within 3 wk) and late-term (after 3 wk) electroneurography (ENoG) findings in Bell's palsy (BP) to predict the prognosis.. Retrospective case review.. Tertiary referral center.. Patients with peripheral facial paralysis with no identified cause. All patients were given the same treatment.. House Brackmann (HB) grading and ENoG.. The records of 38 patients with BP were retrospectively analyzed. This study included only those patients who had been followed up for at least 4 months on a regular basis or until complete recovery. ENoG was performed for orbicularis oculi and orbicularis oris muscles and degeneration ratio was calculated separately. Correlation between HB grading and ENoG findings, relationship between duration for maximum recovery and ENoG findings, and also initial HB grading and recovery rate were investigated.. Complete recovery rate was significantly higher in patients with HB grades I to III at initial examination. A significant correlation was found between HB grading and degree of ENoG degeneration at the 7th and 14th days of FP. Patients with degeneration less than 80% for orbicularis oculi and less than 65% for orbicularis oris had significantly better and faster recovery than those with higher level of degeneration (p < 0.05).. ENoG and HB grading during first to fourth weeks of BP are useful prognostic indicators. Serial ENoG examinations are recommended to predict the status of neural degeneration and the prognosis of the palsy. However, ENoG in late term may not be compatible with clinical facial function.

Topics: Acyclovir; Adult; Aged; Anti-Inflammatory Agents; Antiviral Agents; Bell Palsy; Electric Stimulation; Electrodiagnosis; Facial Muscles; Female; Follow-Up Studies; Humans; Male; Middle Aged; Predictive Value of Tests; Prednisolone; Prognosis; Recovery of Function; Reproducibility of Results; Retrospective Studies; ROC Curve; Valacyclovir; Valine; Young Adult

To study the correlation between Sunnybrook and House-Brackmann facial grading systems at different time points during the course of peripheral facial palsy.. Prospective multicenter trial.. Seventeen otorhinolaryngological centers.. Data are part of the Scandinavian Bell's palsy study. The facial function of 1920 patients with peripheral facial palsy was assessed 5397 times with both Sunnybrook and House-Brackmann (H-B) facial grading systems. Grading was done at initial visit, at days 11 to 17 of palsy onset, and at 1 month, 2 months, 3 months, 6 months, and 12 months. Statistical evaluation was by Spearman correlation coefficient and box plot analysis.. Spearman correlation coefficient varied from -0.81 to -0.96, with the weakest correlation found at initial visit. Box plot analysis for all assessments revealed that Sunnybrook scores were widely spread over different H-B grades. With 50% of the results closest to the median, Sunnybrook composite scores varied in H-B grades as follows: H-B I, 100; H-B II, 71 to 90; H-B III, 43 to 62; H-B IV, 26 to 43; H-B V, 13 to 25; and H-B VI, 5 to 14.. Gradings correlated better in follow-up assessments than at initial visit. As shown by the wide overlap of the grading results, subjective grading systems are only approximate. However, a conversion table for Sunnybrook and H-B gradings was obtained and is included in the article. It can be used for further development of facial grading systems.

Topics: Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Bell Palsy; Facial Asymmetry; Facial Muscles; Facial Paralysis; Glucocorticoids; Humans; Middle Aged; Prednisolone; Randomized Controlled Trials as Topic; Valacyclovir; Valine; Young Adult

To search for prognostic predictors and reexamine the usefulness of electroneurography (ENoG) in predicting the prognosis of peripheral facial palsy using statistical methods.. Prospective study.. Tertiary referral center.. Consecutive 142 patients with Bell's palsy and 26 with Ramsay Hunt syndrome treated with steroid plus antiviral agents.. Multivariate analysis was used to identify which factors, including Yanagihara grading score and ENoG, predict better recovery. Receiver operating characteristic (ROC) curves were constructed for ENoG and grading score. The cumulative recovery rate by ENoG was calculated using Kaplan-Meier analysis. Recovery was defined as the improvement of grading score to 36 points or more (full score, 40) without synkinesis.. Multivariate analysis revealed that Ramsay Hunt syndrome, the worst grading score and ENoG were the significant prognostic predictors. The area under the ROC curve for ENoG was broader than those for grading score, indicating that ENoG was superior to grading score in terms of accuracy for prognosis prediction. The ROC curve revealed that more than 85% degeneration on ENoG had the best specificity (77.8%) and sensitivity (71.4%) to predict nonrecovery. When ENoG was subjected to the analysis of cumulative recovery rate using Kaplan-Meier plots, patients with more than 85% degeneration on ENoG had significantly poorer prognosis.. ENoG was the most effective factor for prediction of the prognosis of peripheral facial palsy, and more than 85% degeneration had the best specificity and sensitivity to predict nonrecovery.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Bell Palsy; Drug Therapy, Combination; Female; Glucocorticoids; Herpes Zoster Oticus; Humans; Hydrocortisone; Kaplan-Meier Estimate; Male; Middle Aged; Prognosis; ROC Curve; Treatment Outcome; Valacyclovir; Valine

Two randomised double-blind trials in about 1400 patients showed that for every 7 to 8 patients treated with prednisolone, one additional patient will recover normal motor function after 9 to 12 months.

Topics: Acyclovir; Adrenal Cortex Hormones; Antiviral Agents; Bell Palsy; Double-Blind Method; Drug Therapy, Combination; Humans; Prednisolone; Randomized Controlled Trials as Topic; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; Bell Palsy; Facial Paralysis; Glucocorticoids; Humans; Prednisolone; Randomized Controlled Trials as Topic; Treatment Outcome; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; Bell Palsy; Drug Therapy, Combination; Humans; Prednisolone; Randomized Controlled Trials as Topic; Valacyclovir; Valine

Topics: Acyclovir; Anti-Inflammatory Agents; Antiviral Agents; Bell Palsy; Drug Therapy, Combination; Humans; Hyperbaric Oxygenation; Prednisolone; Valacyclovir; Valine; Vitamin B 12; Vitamin B Complex

Topics: Acyclovir; Anti-Inflammatory Agents; Antiviral Agents; Bell Palsy; Drug Therapy, Combination; Evidence-Based Medicine; Humans; Hyperbaric Oxygenation; Prednisolone; Valacyclovir; Valine; Vitamin B 12; Vitamin B Complex

Despite recent evidence suggesting that Bell's palsy is associated with reactivation of alfa-herpes viruses, the disease has been treated empirically, and the use of valacyclovir has not been definitively established. In 2007, two prospective, randomised, placebo-controlled trials evaluating valacyclovir were reported in patients with Bell's palsy. One demonstrated that valacyclovir/prednisolone therapy was statistically more effective than placebo/prednisolone therapy in improving the recovery of patients with Bell's palsy, excluding zoster sine herpete. However, considering the cost-benefit ratio of this treatment and the limitations of virological diagnoses, we recommend that valacyclovir should be used in cases of severe palsy within 3 days after the onset of Bell's palsy.

Topics: Acyclovir; Antiviral Agents; Bell Palsy; Cost-Benefit Analysis; Drug Therapy, Combination; Herpes Zoster; Humans; Prednisolone; Randomized Controlled Trials as Topic; Valacyclovir; Valine

Topics: Acyclovir; Adrenal Cortex Hormones; Ambulatory Care; Antiviral Agents; Bell Palsy; Electromyography; Electrophysiology; Follow-Up Studies; Hospitalization; Humans; Male; Middle Aged; Prognosis; Time Factors; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; Bell Palsy; Humans; Prednisolone; Randomized Controlled Trials as Topic; Valacyclovir; Valine

Bell's palsy accounts for two-thirds ofall acute facial palsies. Presumed reactivation of the herpes simplex virus and concurrent swelling of the facial nerve prompted the use of antivirals in combination with corticosteroids, although evidence supporting the effectiveness of this approach was weak. A recently published randomized placebo-controlled clinical trial assessed the effectiveness of adding valacyclovir to prednisolone; another larger primary-care-based study compared treatment with prednisolone, acyclovir or both with placebo. In patients with severe or complete facial palsy, the addition of valacyclovir improved the chance of complete recovery, but as this study was single-blinded, results should be interpreted with caution. Early treatment with prednisolone (25 mg twice daily for to days) significantly improved the chance of complete recovery at 3 and 9 months. Acyclovir, given alone or in addition to prednisolone, did not show any benefit.

Topics: Acyclovir; Anti-Inflammatory Agents; Antiviral Agents; Bell Palsy; Drug Therapy, Combination; Herpesvirus 1, Human; Humans; Prednisolone; Treatment Outcome; Valacyclovir; Valine

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Age Factors; Anti-Inflammatory Agents; Bell Palsy; Child; Female; Follow-Up Studies; Glucocorticoids; Humans; Incidence; Male; Prednisone; Prodrugs; Sex Factors; Time Factors; Treatment Outcome; Valacyclovir; Valine

Idiopathic peripheral facial palsy is the most common and frequent unilateral cranial neurological disorder characterized by an isolated facial nerve paralysis.. We report a case of an idiopathic facial paralysis (Bell's palsy) in the immediate puerperium in a patient with mild preeclampsia and diagnosed fetal IUGR. Additionally, the presence of Bell's palsy in the puerperium of the mother of our patient suggests a familiar tendency.. Every gynaecologist and obstetrician should be aware of this quite uncommon complication during pregnancy and the puerperium. This case report illustrates that Bell's palsy can occur in the immediate post-partum after mild preeclamptic symptoms. For these women, a maternal surveillance can be recommended. A fast and accurate diagnosis with a subsequent immediate treatment might be very important in avoiding worsening of the symptoms and therefore improve the recovery prognosis.

Topics: Acyclovir; Adult; Bell Palsy; Cesarean Section; Cheek; Female; Glucocorticoids; Humans; Methylprednisolone; Pirenzepine; Postpartum Period; Pre-Eclampsia; Pregnancy; Time Factors; Treatment Outcome; Valacyclovir; Valine

Some clinicians claim a spontaneous complete recovery of facial nerve function after Bell's palsy in more than 80% of patients. However, for elderly patients and patients with a severe paresis/paralysis this is not the case. The main cause of Bell's palsy is probably reactivation of latent herpes viruses. Recent literature supports treatment with corticosteroids and antiviral medication, inhibiting viral replication and reducing oedema in the bony canal of the facial nerve. Using this medication in the first days of the disease provides a further 15% of patients with a good outcome in addition to the ones that improve spontaneously. Therefore, prednisone and valacyclovir are recommended for all patients with Bell's palsy and severe dysfunction, i.e. House-Brackmann facial grading scale IV, V and VI.

Topics: Acyclovir; Anti-Inflammatory Agents; Antiviral Agents; Bell Palsy; Herpesviridae Infections; Humans; Prednisone; Treatment Outcome; Valacyclovir; Valine; Virus Activation

Idiopathic facial paralysis, or Bell's palsy, shows a nonepidemic pattern that might indicate reactivation of a latent microorganism such as herpes simplex type I as a causative agent. Thirty percent of patients with Bell's palsy given no treatment will not recover completely, and 5% will have severe sequelae. The aim of this study was to find out whether treatment with an antiviral drug in combination with corticosteroids is more effective than no medical treatment at all in patients with Bell's palsy. Fifty-six consecutive adult patients attending the otorhinolaryngology department of the University Hospital of Lund from 1997 to 1999 were treated with 1 g of valacyclovir hydrochloride 3 times per day for 7 days and 50 mg of prednisone daily for 5 days, with the dose being reduced by 10 mg daily for the next 5 days. Fifty-six adult patients with Bell's palsy attending the same department between 1995 and 1996 who were given no medical treatment were studied retrospectively and used as the control group. Forty-nine patients (87.5%) in the treatment group recovered completely, as compared with 38 patients (68%) in the control group (p < .05). One patient (1.8%) in the treatment group displayed severe sequelae, defined as a House-Brackmann score of IV or worse, as compared with 10 of 56 patients (18%) in the control group (p < .01). Among patients over 60 years old, 10 of 10 in the treatment group had complete recovery, as compared with 5 of 12 patients in the control group (p < .01). The present study showed a significantly better outcome in patients with Bell's palsy treated with valacyclovir and prednisone as compared with patients given no medical treatment. This difference in outcome was especially pronounced among elderly patients.

Topics: Acyclovir; Adult; Anti-Inflammatory Agents; Antiviral Agents; Bell Palsy; Case-Control Studies; Drug Administration Schedule; Drug Therapy, Combination; Female; Herpesvirus 1, Human; Humans; Male; Middle Aged; Prednisone; Treatment Outcome; Valacyclovir; Valine; Virus Activation

Topics: Acyclovir; Antiviral Agents; Bell Palsy; Drug Therapy, Combination; Herpes Simplex; Humans; Prednisone; Valacyclovir; Valine