Bell's palsy: Corticosteroids and/or antivirals?

Bell's palsy: Corticosteroids and/or antivirals?

For treatment of Bell's palsy, corticosteroids with or without antivirals have been the subject of much debate. A new meta-analysis suggests that combination therapy may lead to better outcomes. The review included 18 trials with 2786 patients. The outcomes were unsatisfactory facial recovery at 4 months, unsatisfactory short-term recovery, synkinesis and autonomic dysfunction, or adverse effects. Combination therapy with corticosteroids and antivirals resulted in slightly better outcome than steroids alone (P = 0.05). Antiviral agents alone did not show a benefit (JAMA 2009;302:985-993). At least one source (UpToDate) recommends a typical treatment regimen for Bell's palsy of prednisone 60-80 mg per day along with valacyclovir 1000 mg three times a day for 1 week.