Updated Bell’s Palsy Guideline

Workshop of Nicolaus Gerhaert van Leyden, “Head of a man with a facial paralysis”, c. 1470, Musée de l’Oeuvre de Notre Dame, Strasbourg. Cancre / Wikimedia Commons.

The last AAN guideline on Bell’s palsy is 11 years old and has just been updated. The reviewers found 3 newer studies of steroid treatment, which enrolled ~ 1000 subjects total. Prednisone (60 mg daily x 5 days then tapered for 5 days or 25 mg bid x 10 days) increased the probability of complete recovery by 13-15%; NNT 6-8. (That’s about the same effect size as tPA for acute stroke. I wonder how many docs would withhold prednisone in the “ideal” Bell’s palsy case?)

Two subgroups that may not benefit so much were complete palsies and zoster sine herpete. (But be careful when relying on subgroup analyses. Here’s a great treatment of that subject).

Anyway, we basically knew that. The antiviral data are more interesting. Three new studies of ~ 1500 subjects failed to show benefit. The studies lacked power to exclude a small benefit (risk difference < 7%) but for any difference higher than that, they found it “highly unlikely” that antivirals are effective.

About Justin A. Sattin

I'm a vascular neurologist and residency program director. I created this blog in order to share some thoughts with my resident and other colleagues, and to foster my own learning as well.
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