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. 2019 Sep 5;9(9):CD001869.
doi: 10.1002/14651858.CD001869.pub9.

Antiviral treatment for Bell's palsy (idiopathic facial paralysis)

Ildiko Gagyor  1 , Vishnu B Madhok, Fergus Daly, Frank Sullivan
Affiliations

Antiviral treatment for Bell's palsy (idiopathic facial paralysis)

Ildiko Gagyor et al. Cochrane Database Syst Rev. .

Abstract

Background: 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. This review was first published in 2001 and most recently updated in 2015. Since a significant benefit of corticosteroids for the early management of Bell's palsy has been demonstrated, the main focus of this update, as in the previous version, was to determine the effect of adding antivirals to corticosteroid treatment. We undertook this update to integrate additional evidence and to better assess the robustness of findings, taking risk of bias fully into account.

Objectives: To assess the effects of antiviral treatments alone or in combination with any other therapy for Bell's palsy.

Search methods: We searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS in July 2019. We reviewed the bibliographies of the identified trials and contacted trial authors to identify additional published or unpublished data. We searched clinical trials registries for ongoing studies.

Selection criteria: We considered randomised controlled trials (RCTs) or quasi-RCTs of antivirals with and without corticosteroids versus control therapies for the treatment of Bell's palsy. We excluded trials that followed-up participants for less than three months.

Data collection and analysis: We independently assessed trials for relevance, eligibility, and risk of bias, using standard Cochrane procedures. We performed sensitivity analyses excluding trials at high or unclear risk of bias in at least five domains, and reported these data as the primary analyses.

Main results: Fourteen trials, including 2488 participants, met the inclusion criteria. Most were small, and most were at high or unclear risk of bias in multiple domains. We included four new studies at this update.Incomplete recoveryA combination of antivirals and corticosteroids may have little or no effect on rates of incomplete recovery in people with Bell's palsy compared to corticosteroids alone (risk ratio (RR) 0.81, 95% confidence interval (CI) 0.38 to 1.74; 3 trials, N = 766; random-effects; low-certainty evidence). We excluded 10 trials that were at high or unclear risk of bias in several domains from this analysis and limited all analyses to studies at lower risk of bias. Recovery rates were better in participants receiving corticosteroids alone than antivirals alone (RR 2.69, 95% CI 0.73 to 10.01; 2 trials, N = 667; random-effects), but the result was imprecise and allowed for the possibility of no effect. The rate of incomplete recovery was lower with antivirals plus corticosteroids than with placebo or no treatment (RR 0.56, 95% CI 0.42 to 0.76; 2 trials, N = 658; random-effects). Antivirals alone had no clear effect on incomplete recovery rates compared with placebo, but the result was imprecise (RR 1.10, 95% CI 0.87 to 1.40; 2 trials, N = 658; fixed-effect). For people with severe Bell's palsy (House-Brackmann score of 5 and 6, or equivalent on other scales), we found that the combination of antivirals and corticosteroids had no clear effect on incomplete recovery at month six compared to corticosteroids alone, although the result was again imprecise (RR 0.82, 95% CI 0.57 to 1.17; 2 trials, N = 98; random-effects).Motor synkinesis or crocodile tearsAntivirals plus corticosteroids reduced the proportion of participants who experienced these long-term sequelae from Bell's palsy compared to placebo plus corticosteroids (RR 0.56, 95% CI 0.36 to 0.87; 2 trials, N = 469; fixed-effect; moderate-certainty evidence). Antivirals plus corticosteroids reduced long-term sequelae compared to placebo but there was no clear difference in this outcome with antivirals alone compared to placebo.Adverse events Adverse event data were available in four studies providing data on 1592 participants. None of the four comparisons showed clear differences in adverse events between treatment and comparison arms (very low-certainty evidence); for the comparison of antivirals plus corticosteroids and corticosteroids alone in studies at lower risk of bias, the RR was 1.17 (95% CI 0.81 to 1.69; 2 trials, N = 656; fixed-effect; very low-certainty evidence).

Authors' conclusions: The combination of antivirals and corticosteroids may have little or no effect on rates of incomplete recovery in comparison to corticosteroids alone in Bell's palsy of various degrees of severity, or in people with severe Bell's palsy, but the results were very imprecise. Corticosteroids alone were probably more effective than antivirals alone and antivirals plus corticosteroids were more effective than placebo or no treatment. There was no clear benefit from antivirals alone over placebo.The combination of antivirals and corticosteroids probably reduced the late sequelae of Bell's palsy compared with corticosteroids alone. Studies also showed fewer episodes of long-term sequelae in corticosteroid-treated participants than antiviral-treated participants.We found no clear difference in adverse events from the use of antivirals compared with either placebo or corticosteroids, but the evidence is too uncertain for us to draw conclusions.An adequately powered RCT in people with Bell's palsy that compares different antiviral agents may be indicated.

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Conflict of interest statement

Ildiko Gagyor: None known

Vishnu B Madhok: I have received payment for reviewing a review prepared by BMJ Evidence and have also received a consultancy fee as a committee member for the Medical Defense Society and a Psoriatic Arthritis Research study.

Fergus Daly: The fact that I am a named author on one of the included articles (Sullivan 2007), did not influence in any way my thinking, presentation or contribution to this review.

Frank Sullivan: Received an Exploration Fund grant from North York General Hospital of $7800 for a review of the accuracy and completeness of coding of Bell's Palsy in Canadian family physician electronic medical records. The grant was used to pay for a summer student. I am the author of one of the included studies (Sullivan 2007). I have no other known conflicts of interest.

Figures

1
1
Study flow diagram.
2
2
A summary of review authors' 'Risk of bias' assessments for included studies. Red = high risk of bias; yellow = unclear risk of bias; green = low risk of bias.
3
3
Forest plot of comparison: 1 Antivirals plus corticosteroids versus corticosteroids plus placebo or no treatment (AS versus OS): sensitivity analysis based on risk of bias (excluding studies at high or unclear risk of bias in fewer than five domains), outcome: 1.1 Incomplete recovery at end of study.
4
4
Forest plot of comparison: 1 Antivirals plus corticosteroids versus corticosteroids plus placebo or no treatment (AS versus OS): trials at lower risk of bias, outcome: 1.2 Incomplete recovery at end of study (full data set).
5
5
Forest plot of comparison: 3 Antivirals plus corticosteroids versus placebo, outcome: 3.1 Incomplete recovery at end of study.
6
6
Funnel plot of comparison: 1 Antivirals plus corticosteroids versus corticosteroids plus placebo or no treatment (AS versus OS): trials at lower risk of bias, outcome: 1.2 Incomplete recovery at end of study (full data set).
1.1
1.1. Analysis
Comparison 1 Antivirals plus corticosteroids versus corticosteroids plus placebo or no treatment (AS versus OS): trials at lower risk of bias, Outcome 1 Incomplete recovery at end of study (trials at lower risk of bias).
1.2
1.2. Analysis
Comparison 1 Antivirals plus corticosteroids versus corticosteroids plus placebo or no treatment (AS versus OS): trials at lower risk of bias, Outcome 2 Incomplete recovery at end of study (full data set).
1.3
1.3. Analysis
Comparison 1 Antivirals plus corticosteroids versus corticosteroids plus placebo or no treatment (AS versus OS): trials at lower risk of bias, Outcome 3 Incomplete recovery at end of study in severe cases: data set limited to trials at lower risk of bias.
1.4
1.4. Analysis
Comparison 1 Antivirals plus corticosteroids versus corticosteroids plus placebo or no treatment (AS versus OS): trials at lower risk of bias, Outcome 4 Incomplete recovery at end of study in severe cases: full data set.
1.5
1.5. Analysis
Comparison 1 Antivirals plus corticosteroids versus corticosteroids plus placebo or no treatment (AS versus OS): trials at lower risk of bias, Outcome 5 Motor synkinesis or crocodile tears.
1.6
1.6. Analysis
Comparison 1 Antivirals plus corticosteroids versus corticosteroids plus placebo or no treatment (AS versus OS): trials at lower risk of bias, Outcome 6 Adverse events (trials at lower risk of bias).
1.7
1.7. Analysis
Comparison 1 Antivirals plus corticosteroids versus corticosteroids plus placebo or no treatment (AS versus OS): trials at lower risk of bias, Outcome 7 Adverse events (full data set).
2.1
2.1. Analysis
Comparison 2 Antivirals versus corticosteroids (AO versus OS): trials at lower risk of bias, Outcome 1 Incomplete recovery at end of study: trials at lower risk of bias.
2.2
2.2. Analysis
Comparison 2 Antivirals versus corticosteroids (AO versus OS): trials at lower risk of bias, Outcome 2 Incomplete recovery at end of study: full data set.
2.3
2.3. Analysis
Comparison 2 Antivirals versus corticosteroids (AO versus OS): trials at lower risk of bias, Outcome 3 Motor synkinesis and crocodile tears: trials at lower risk of bias.
2.4
2.4. Analysis
Comparison 2 Antivirals versus corticosteroids (AO versus OS): trials at lower risk of bias, Outcome 4 Motor synkinesis and crocodile tears: full data set.
2.5
2.5. Analysis
Comparison 2 Antivirals versus corticosteroids (AO versus OS): trials at lower risk of bias, Outcome 5 Adverse events.
3.1
3.1. Analysis
Comparison 3 Antivirals plus corticosteroids versus placebo (AS versus OO), Outcome 1 Incomplete recovery at end of study.
3.2
3.2. Analysis
Comparison 3 Antivirals plus corticosteroids versus placebo (AS versus OO), Outcome 2 Motor synkinesis or crocodile tears.
3.3
3.3. Analysis
Comparison 3 Antivirals plus corticosteroids versus placebo (AS versus OO), Outcome 3 Adverse events.
4.1
4.1. Analysis
Comparison 4 Antivirals versus placebo (AO versus OO), Outcome 1 Incomplete recovery at end of study.
4.2
4.2. Analysis
Comparison 4 Antivirals versus placebo (AO versus OO), Outcome 2 Motor synkinesis or crocodile tears.
4.3
4.3. Analysis
Comparison 4 Antivirals versus placebo (AO versus OO), Outcome 3 Adverse events.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Adour 1996 {published data only}
    1. Adour KK, Ruboyianes JM, Doersten PG, Byl FM, Trent CS, Quesenberry CP Jr, et al. Bell's palsy treatment with acyclovir and prednisone compared with prednisone alone: a double‐blind, randomized, controlled trial. Annals of Otology, Rhinology and Laryngology 1996;105(5):371‐8. [PUBMED: 8651631] - PubMed
De Diego 1998 {published data only}
    1. Diego JI, Prim MP, Sarria MJ, Madero R, Gavilan J. Idiopathic facial paralysis: a randomized, prospective, and controlled study using single‐dose prednisone versus acyclovir three times daily. Laryngoscope 1998;108(4 Pt 1):573‐5. [PUBMED: 9546272] - PubMed
Engström 2008 {published data only}
    1. Engström M, Berg T, Stjernquist‐Desatnik A, Axelsson S, Pitkäranta A, Hultkrantz M, et al. Prednisolone and valaciclovir in Bell's palsy: a randomised, double blind, placebo controlled, multicentre trial. Lancet Neurology 2008;7(11):993‐1000. [DOI: 10.1016/51474-4422(08)70221-7; PUBMED: 18849193] - DOI - PubMed
Hato 2007 {published data only}
    1. Hato N, Yamada H, Kohno H, Matsumoto S, Honda N, Gyo K, et al. Valacyclovir and prednisolone treatment for Bell's palsy: a multicenter, randomized, placebo‐controlled study. Otology and Neurotology 2007;28(3):408‐13. [PUBMED: 17414047] - PubMed
Kawaguchi 2007 {published data only}
    1. Kawaguchi K, Inamura H, Abe Y, Koshu H, Takashita E, Muraki Y, et al. Reactivation of herpes simplex virus type 1 and varicella‐zoster virus and therapeutic effects of combination therapy with prednisolone and valacyclovir in patients with Bell's palsy. Laryngoscope 2007;117(1):147‐56. [PUBMED: 17202945] - PubMed
Khajeh 2015 {published data only}
    1. Khajeh A, Fayyazi A, Soleimani G, Miri‐Aliabad G, Shaykh Veisi S, Khajeh B. Comparison of the efficacy of combination therapy of prednisolone ‐ acyclovir with prednisolone alone in Bell’s palsy. Iranian Journal of Child Neurology 2015;9(2):17‐20. [PUBMED: 26221158] - PMC - PubMed
Khedr 2016 {published data only}
    1. Khedr EM, Badry R, Ali AM, Abo El‐Fetoh N, El‐Hammady DH, Ghandour AM, et al. Steroid/antiviral treatment of Bell's palsy: double blind randomized clinical trial. Restorative Neurology and Neuroscience 2016;34(6):897‐905. [PUBMED: 27689547] - PubMed
Lee 2013 {published data only}
    1. Lee HY, Byun JY, Park MS, Yeo SG. Steroid‐antiviral treatment improves the recovery rate in patients with severe Bell's palsy. American Journal of Medicine 2013;126(4):336‐41. [PUBMED: 23394867] - PubMed
Li 1997 {published data only}
    1. Li Y, Gao P, Mao X, Cao P. Randomized clinical trial of acyclovir plus prednisone versus prednisone alone in Bell's palsy. Ceylon Journal of Medical Science 1997;40(2):37‐41.
Minnerop 2008 {published and unpublished data}
    1. Minnerop M, Herbst M, Fimmers R, Kaabar P, Matz B, Klockgether T, et al. Bell's palsy: combined treatment of famciclovir and prednisone is superior to prednisone alone. Journal of Neurology 2008;255(11):1726‐30. [PUBMED: 18769863] - PubMed
Shahidullah 2011 {published data only}
    1. Shahidullah M, Haque A, Islam MR, Rizvi AN, Sultana N, Mia BA, et al. Comparative study between combination of famciclovir and prednisolone with prednisolone alone in acute Bell's palsy. Mymensingh Medical Journal: MMJ 2011;20(4):605‐13. [CRS: 8300125000010514; EMBASE: 22081178; CN‐00857180; PUBMED: 22081178] - PubMed
Sullivan 2007 {published and unpublished data}
    1. Sullivan FM, Swan IR, Donnan PT, Morrison JM, Smith BH, McKinstry B, et al. Early treatment with prednisolone or acyclovir in Bell's palsy. New England Journal of Medicine 2007;357(16):1598‐607. [PUBMED: 17942873] - PubMed
Vázquez 2008 {published data only}
    1. Vázquez MC, Sánchez N, Calvo J, Perna A. Efficacy of antiviral in Bell's palsy [Eficacia de los antivirales en la parálisis de Bell]. Revista Medica del Uruguay 2008;24(3):167‐74. [LILACS 501670]
Yeo 2008 {published data only}
    1. Yeo SG, Lee YC, Park DC, Cha CI. Acyclovir plus steroid versus steroid alone in the treatment of Bell's palsy. American Journal of Otolaryngologyy 2008;29(3):163‐6. [PUBMED: 18439948] - PubMed

References to studies excluded from this review

Abdelghany 2013 {published data only}
    1. Abdelghany AM, Kamel SB. Retracted: the effect of prednisolone and/or acyclovir in relation to severity of Bell's palsy at presentation. Egyptian Journal of Ear, Nose, Throat and Allied Sciences 2013;14(3):155‐9. [DOI: ]
    1. Abdelghany AM, Kamel SB. Retraction notice to ‘‘The effect of prednisolone and/or acyclovir in relation to severity of Bell’s palsy at presentation” [Egypt. J. Ear NoseThroat Allied Sci 14(3) (2013) 155–9]. Egyptian Journal of Ear, Nose and Throat 2017;18(3):329. [DOI: ]
Ahangar 2006 {published data only}
    1. Ahangar AA, Hosseini S, Saghebi R. Comparison of the efficacy of prednisolone versus prednisolone and acyclovir in the treatment of Bell's palsy. Neurosciences (Riyadh, Saudi Arabia) 2006;11(4):256‐9. [PUBMED: 22266433] - PubMed
Antunes 2000 {published data only (unpublished sought but not used)}
    1. Antunes ML, Fukuda Y, Testa JRG. Clinical treatment of Bell's palsy: comparative study among valaciclovir plus deflazacort, deflazacort and placebo [Tratamento clinico da paralisia de Bell: estudo comparativo com o uso de valaciclovir mais deflazacort versus deflazacort versus placebo]. Acta Associação William House de Otologia 2000;19(2):68‐75.
Axelsson 2003 {published data only}
    1. Axelsson S, Lindberg S, Stjernquist‐Desatnik A. Outcome of treatment with valacyclovir and prednisone in patients with Bell's palsy. Annals of Otology, Rhinology and Laryngology 2003;112(3):197‐201. - PubMed
Chen 2005 {published data only}
    1. Chen WL, Yang ZH, Huang ZQ. Outcome of treatment of 46 patients with Bell's palsy with aciclovir and prednisone. Shanghai Kou Qiang Yi Xue [Shanghai Journal of Stomatology] 2005;14(6):590‐2. - PubMed
de Aquino 2001 {published data only (unpublished sought but not used)}
    1. Aquino JE, Cruz Filho NA. Comparative study of three types of treatment of idiopathic facial palsy (Bell) [Estudo comparativo com tres tipos de tratamento clinico na paralisa facial idiopatica (Bell)]. Acta Associação William House de Otologia 2001;20(4):195‐200. [lil‐299927]
Ferreira 2016 {published data only}
    1. Ferreira M, Firmino MJ, Marques EA, Santos PC, Duarte JA. Are corticosteroids useful in all degrees of severity and rapid recovery of Bell’s palsy?. Acta Oto‐Laryngologica 2016;136(7):736‐41. [PUBMED: 27003272] - PubMed
Hato 2003 {published data only}
    1. Hato N, Matsumoto S, Kisaki H, Takahashi H, Wakisaka H, Honda N, et al. Efficacy of early treatment of Bell's palsy with oral acyclovir and prednisolone. Otology & Neurotology 2003;24(6):948‐51. [PUBMED: 14600480 ] - PubMed
Hultcrantz 2005 {published data only}
    1. Hultcrantz M. Treatment of facial paresis ‐ evidence‐based recommendations [Behandling avfacialispares ‐ evidensbaserade rekommendationer]. Lakartidningen 2005;102(10):744‐75. [PUBMED: 15839165] - PubMed
Ibarrondo 1999 {published data only}
    1. Ibarrondo J, Navarrete ML, Encarnación LF, Quesada P, Crespo F, García M, et al. Treatment of idiopathic facial paralysis: corticoids versus acyclovir versus empirical treatment [Tratamiento de la paralisis facial idiopatica: corticoides versus aciclovir versus empirico]. Acta Otorrinolaringologica Espanola 1999;50(2):118‐20. [PUBMED: 10217684] - PubMed
Inanli 2001 {published data only}
    1. Inanli S, Tutkun A, Ozturk O, Batman C, Uneri C, Sehitoglu MA. Idiopathic facial nerve paralysis treatment with acyclovir and prednisolone compared with prednisolone alone [Idiopatik fasiyal sinir paralizisinde prednizolon ve asiklovir Kkmbine tedavisinin prednizolon tedavisi ile karsilastirlmasi]. Turkish Archives of Otolaryngology 2001;39(1):19‐24.
Kang 2015 {published data only}
    1. Kang HM, Jung SY, Byun JY, Park MS, Yeo SG. Steroid plus antiviral treatment for Bell's palsy. Journal of Internal Medicine 2015;277(5):532‐9. [PUBMED: 25041467] - PubMed
Ramos Macias 1992 {published data only}
    1. Ramos Macías A, Miguel Martínez I, Martín Sánchez AM, Gómez González JL, Martín Galán A. Incorporation of acyclovir in the treatment of peripheral paralysis. A study of 45 cases [Incorporación del aciclovir en el tratamiento de la parálisis periférica. Un estudio en 45 casos]. Acta Otorrinolaringológica Espanola 1992;43(2):117‐20. [PUBMED: 1605959] - PubMed
Roy 2005 {published data only}
    1. Roy A, Jose J, Kamath V, Matthew T. Efficacy of aciclovir and methylprednisolone versus methylprednisolone alone in the treatment of Bell's palsy. Journal of the Neurological Sciences 2005;238(Suppl 1):S207‐8.
Zhou 1999 {published data only}
    1. Zhou P. Aciclovir in treating Bell's palsy. Chinese Journal of New Drugs and Clinical Remedies 1999;18(1):13‐4.

References to studies awaiting assessment

References to ongoing studies

ACTRN12615000563561 {published data only}
    1. ACTRN12615000563561. Bell's Palsy in Children (BellPIC): protocol for a multicentre, placebo‐controlled randomized trial. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368505 (first received 7 May 2015). - PMC - PubMed
NCT03781700 {published data only}
    1. NCT03781700. Evaluation of cortisone treatment in children with acute facial nerve palsy (FACE). clinicaltrials.gov/ct2/show/NCT03781700 (date received 20 December 2018).

Additional references

Abiko 2002
    1. Abiko Y, Ikeda M, Hondo R. Secretion and dynamics of herpes simplex virus in tears and saliva of patients with Bell's Palsy. Otology & Neurotology 2002;23(5):779‐83. [PUBMED: 12218634] - PubMed
Adour 1971
    1. Adour KK, Swanson PJ Jr. Facial paralysis in 403 consecutive patients: emphasis on treatment response in patients with Bell's palsy. Transactions ‐ American Academy of Ophthalmology and Otolaryngology 1971;75(6):1284‐301. - PubMed
Adour 1974
    1. Adour KK, Wingerd J. Idiopathic facial paralysis (Bell's palsy): factors affecting severity and outcome in 446 patients. Neurology 1974;24(12):1112‐6. - PubMed
Adour 1982
    1. Adour KK. Current concepts in neurology: diagnosis and management of facial paralysis. New England Journal of Medicine 1982;307(6):348‐51. [PUBMED: 7088100] - PubMed
Axelsson 2012
    1. Axelsson S, Berg T, Jonsson L, Engström M, Kanerva M, Stjernquist‐Desatnik A. Bell's palsy ‐ the effect of prednisolone and/or valaciclovir versus placebo in relation to baseline severity in a randomised controlled trial. Clinical Otolaryngology 2012;37(4):283‐90. [PUBMED: 22776019] - PubMed
Bateman 1992
    1. Bateman DE. Facial palsy. British Journal of Hospital Medicine 1992;47(6):430‐1. [PUBMED: 1568084] - PubMed
Berg 2012
    1. Berg T, Bylund N, Marsk E, Jonsson L, Kanerva M, Hultcrantz M, et al. The effect of prednisolone on sequelae in Bell's palsy. Archives of Otolaryngology ‐ Head & Neck Surgery 2012;138(5):445‐9. [PUBMED: 22652942] - PubMed
Brandenberg 1993
    1. Brandenberg NA, Annegers JF. Incidence and risk factors for Bell's Palsy in Laredo, Texas: 1974‐1982. Neuroepidemiology 1993;12(6):313‐25. [PUBMED: 8309506] - PubMed
Burgess 1984
    1. Burgess LP, Yim DW, Lepore ML. Bell's palsy: the steroid controversy revisited. Laryngoscope 1984;94(11 Pt 1):1472‐6. [PUBMED: 6387352 ] - PubMed
de Almeida 2009
    1. Almeida JR, Al Khabori M, Guyatt GH, Witterick IJ, Lin VY, Nedzelski JM, et al. Combined corticosteroid and antiviral treatment for Bell palsy: a systematic review and meta‐analysis. JAMA 2009;302(9):985‐93. [PUBMED: 19724046] - PubMed
Dong 2015
    1. Dong Y, Zhu Y, Ma C, Zhao H. Steroid‐antivirals treatment versus steroids alone for the treatment of Bell's palsy: a meta‐analysis. International Journal of Clinical and Experimental Medicine 2015;8(1):413‐21. [PUBMED: 25785012] - PMC - PubMed
Egger 1997
    1. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta‐analysis detected by a simple, graphical test. BMJ 1997;315(7109):629‐34. [PUBMED: 9310563] - PMC - PubMed
Egger 2007
    1. Egger M, Davey Smith G, Altman DG. Systematic Reviews in Health Care: Meta‐Analysis in Context. 6th Edition. London: BMJ Books, 2007. [ISBN: 978‐0‐7279‐1488‐0]
Fu 2018
    1. Fu X, Tang L, Wang C, Li M, Wu H, Li J, et al. A network meta‐analysis to compare the efficacy of steroid and antiviral medications for facial paralysis from Bell's palsy. Pain Physician 2018;21(6):559‐69. [PUBMED: 30508985] - PubMed
Goudakos 2009
    1. Goudakos JK, Markou KD. Corticosteroids versus corticosteroids plus antiviral agents in the treatment of Bell Palsy: a systematic review and meta‐analysis. Archives of Otolaryngology ‐ Head & Neck Surgery 2009;135(6):558‐64. [PUBMED: 19528403] - PubMed
GRADEpro GDT 2015 [Computer program]
    1. McMaster University (developed by Evidence Prime). GRADEpro GDT. Version (accessed prior to 30 July 2018). Hamilton (ON): McMaster University (developed by Evidence Prime), 2015.
Harris 2001
    1. Harris DL, Carr AT. The Derriford Appearance Scale (DAS59): a new psychometric scale for the evaluation of patients with disfigurements and aesthetic problems of appearance. British Journal of Plastic Surgery 2001;54(3):216‐22. [PUBMED: 11254413] - PubMed
Hernández 2008
    1. Hernández RA, Sullivan F, Donnan P, Swan I, Vale L, BELLS Trial Group. Economic evaluation of early administration of prednisolone and/or aciclovir for the treatment of Bell's palsy. Family Practice 2009;26(2):137‐44. [PUBMED: 19244470] - PubMed
Higgins 2011
    1. Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Higgins 2019
    1. Higgins JP, Savović J, Page MJ, Sterne JA, on behalf of the ROB2 Development Group. Revised Cochrane risk of bias tool for randomized trials (RoB 2). Available from sites.google.com/site/riskofbiastool/welcome/rob‐2‐0‐tool/current‐versio... 9 July 2019.
House 1983
    1. House JW. Facial nerve grading systems. Laryngoscope 1983;93:1056‐69. - PubMed
House 1985
    1. House JW, Brackmann DE. Facial nerve grading system. Otolarnygology ‐ Head & Neck Surgery 1985;93(2):146‐7. [PUBMED: 3921901] - PubMed
Katusic 1986
    1. Katusic SK, Beard CM, Wiederholt WC, Bergstralh EJ, Kurland LT. Incidence, clinical features and prognosis in Bell's Palsy, Rochester, Minnesota, 1968‐1982. Annals of Neurology 1986;20(5):622‐7. [PUBMED: 3789675] - PubMed
Lackner 2010
    1. Lackner A, Kessler HH, Walch C, Quasthoff S, Raggam RB. Early and reliable detection of herpes simplex virus type 1 and varicella zoster virus DNAs in oral fluid of patients with idiopathic peripheral facial nerve palsy: Decision support regarding antiviral treatment?. Journal of Medical Virology 2010;82(9):1582‐5. [PUBMED: 20648613] - PubMed
Lorber 1996
    1. Lorber B. Are all diseases infectious?. Annals of Internal Medicine 1996;125(10):844‐51. [PUBMED: 8928993] - PubMed
Madhok 2016
    1. Madhok VB, Gagyor I, Daly F, Somasundara D, Sullivan M, Gammie F, et al. Corticosteroids for Bell's palsy (idiopathic facial paralysis). Cochrane Database of Systematic Reviews 2016, Issue 7. [DOI: 10.1002/14651858.CD001942.pub5] - DOI - PMC - PubMed
Martyn 1997
    1. Martyn CN, Hughes RA. Epidemiology of peripheral neuropathy. Journal of Neurology, Neurosurgery & Psychiatry 1997;62(4):310‐8. [PUBMED: 9120441] - PMC - PubMed
May 1976
    1. May M, Wette R, Hardin WB Jr, Sullivan J. The use of steroids in Bell's palsy: a prospective controlled study. Laryngoscope 1976;86(8):1111‐22. [PUBMED: 781439] - PubMed
Morales 2013
    1. Morales DR, Donnan PT, Daly F, Staa TV, Sullivan FM. Impact of clinical trial findings on Bell's palsy management in general practice in the UK 2001‐2012: interrupted time series regression analysis. BMJ Open 2013;3(7):e003121. [PUBMED: 23864211] - PMC - PubMed
Murakami 1996
    1. Murakami S, Mizobuchi M, Nakashiro Y, Doi T, Hato N, Yanagihara N. Bell palsy and herpes simplex virus: identification of viral DNA in endoneurial fluid and muscle. Annals of Internal Medicine 1996;124(1 Pt 1):27‐30. [PUBMED: 7503474] - PubMed
NHS Surrey Downs 2018
    1. National Health Service. The Surrey Downs Clinical Commisioning Group. www.surreydownsccg.nhs.uk 2018.
Niparko 1993
    1. Niparko JK, Mattox DE. Bell's palsy and herpes zoster oticus. In: Johnson RT, Griffin JW editor(s). Current Therapy in Neurologic Disease. 4th Edition. St Louis, Missouri: BC Decker, 1993:355‐61. [ISBN: 0801677300]
Numthavaj 2011
    1. Numthavaj P, Thakkinstian A, Dejthevaporn C, Attia J. Corticosteroid and antiviral therapy for Bell's palsy: a network meta‐analysis. BMC Neurology 2011;11(1):1‐10. [DOI: 10.1186/1471-2377-11-1; PUBMED: 21208452] - DOI - PMC - PubMed
Peitersen 1982
    1. Peitersen E. The natural history of Bell's Palsy. American Journal of Otology 1982;4(2):107‐11. [PUBMED: 7148998 ] - PubMed
Peitersen 2002
    1. Peitersen E. Bell's palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Oto‐Laryngologica 2002;122(Suppl 549):4‐30. [PUBMED: 12482166 ] - PubMed
Prescott 1988
    1. Prescott CA. Idiopathic facial nerve palsy (the effect of treatment with steroids). Journal of Laryngology and Otology 1988;102(5):403‐7. [PUBMED: 3397632 ] - PubMed
Quant 2009
    1. Quant EC, Jeste SS, Muni RH, Cape AV, Bhussar MK, Peleg AY. The benefits of steroids versus steroids plus antivirals for treatment of Bell's palsy: a meta‐analysis. BMJ 2009;339:b3354. [PUBMED: 19736282] - PMC - PubMed
RevMan 2014 [Computer program]
    1. Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager 5 (RevMan 5). Version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Ross 1996
    1. Ross BG, Fradet G, Nedzelski JM. Development of a sensitive clinical facial grading system. Otolargynology ‐ Head and Neck Surgery 1996;114(3):380‐6. [PUBMED: 8649870] - PubMed
Victor 1994
    1. Victor M, Martin J. Disorders of the cranial nerves. In: Isselbacher KJ editor(s). Harrison's Principles of Internal Medicine. 13th Edition. New York: McGraw‐Hill, 1994:2347‐52. [ISBN: 0070323704]
Wolf 1978
    1. Wolf SM, Wagner JH, Davidson S, Forsythe A. Treatment of Bell's palsy with prednisone: a prospective randomized study. Neurology 1978;28(2):158‐61. [PUBMED: 340980] - PubMed
Yanagihara 1977
    1. Yanagihara N. Grading of facial palsy. Third international symposium on facial nerve surgery; 1976 Aug 9‐12; Zurich. Birmingham (AL): Aesculapius, 1977:533‐5.
Yanagihara 1988
    1. Yanagihara N, Yumoto E, Shibahara T. Familial Bell's palsy: analysis of 25 families. Annals of Otology, Rhinology and Laryngology Supplement 1988;137:8‐10. [PUBMED: 3144233] - PubMed
Yanagihara 2003
    1. Yanagihara N, Hato N. Assessment of facial nerve function following acoustic neuroma surgery: facial nerve grading system. In: Kanzaki J, Tos M, Sanna M, Moffat DA, Kunihiro T, Inoue Y editor(s). Acoustic Neuroma. Consensus on Systems for Reporting Results. 1st Edition. Vol. 10, Tokyo: Springer Japan, 2003:91‐8. [DOI: 10.1007/978-4-431-53942-116] - DOI

References to other published versions of this review

Allen 2004
    1. Allen D, Dunn L. Aciclovir or valaciclovir for Bell's palsy (idiopathic facial paralysis). Cochrane Database of Systematic Reviews 2004, Issue 3. [DOI: 10.1002/14651858.CD001869.pub2; PUBMED: 15266457 ] - DOI - PubMed
Gagyor 2015a
    1. Gagyor I, Madhok VB, Daly F, Somasundara D, Sullivan M, Gammie F, et al. Antiviral treatment for Bell's palsy (idiopathic facial paralysis). Cochrane Database of Systematic Reviews 2015, Issue 5. [DOI: 10.1002/14651858.CD001869.pub5; PUBMED: 25938618 ] - DOI - PubMed
Gagyor 2015b
    1. Gagyor I, Madhok VB, Daly F, Somasundara D, Sullivan M, Gammie F, et al. Antiviral treatment for Bell's palsy (idiopathic facial paralysis). Cochrane Database of Systematic Reviews 2015, Issue 7. [DOI: 10.1002/14651858.CD001869.pub6; PUBMED: 26130372] - DOI - PubMed
Gagyor 2015c
    1. Gagyor I, Madhok VB, Daly F, Somasundara D, Sullivan M, Gammie F, et al. Antiviral treatment for Bell's palsy (idiopathic facial paralysis). Cochrane Database of Systematic Reviews 2015, Issue 11. [DOI: 10.1002/14651858.CD001869.pub8; PUBMED: 26559436 ] - DOI - PubMed
Lockhart 2009
    1. Lockhart P, Daly F, Pitkethly M, Comerford N, Sullivan F. Antiviral treatment for Bell's palsy (idiopathic facial paralysis). Cochrane Database of Systematic Reviews 2009, Issue 4. [DOI: 10.1002/14651858.CD001869.pub4; PUBMED: 19821283] - DOI - PubMed
Sipe 2001a
    1. Sipe J, Dunn L. Aciclovir for Bell's palsy (idiopathic facial paralysis). Cochrane Database of Systematic Reviews 2001, Issue 2. [DOI: 10.1002/14651858.CD001869; PUBMED: 11406014] - DOI - PubMed
Sipe 2001b
    1. Sipe J, Dunn L. Aciclovir for Bell's palsy (idiopathic facial paralysis). Cochrane Database of Systematic Reviews 2001, Issue 4. [DOI: 10.1002/14651858.CD001869.pub2; PUBMED: 11687127] - DOI - PubMed

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