Corticosteroids for Bell's palsy

Salinas RA, Alvarez G, Daly F, Ferreira J

Published Online:

March 17, 2010

Bell's palsy is a paralysis or weakness of muscles in the face, usually on one side, with no certain cause. Usually people recover, although some do not. Corticosteroid drugs are anti-inflammatory. Bell's palsy is caused by inflammation of the facial nerve. Reducing the inflammation should limit nerve damage. In this review of eight trials involving 1569 participants, corticosteroids significantly reduced the number of people left with weak faces after Bell's palsy and did not cause serious harm.

Abstract (click to read)

Background:

Inflammation and oedema of the facial nerve are implicated in causing Bell's palsy. Corticosteroids have a potent anti-inflammatory action which should minimise nerve damage.

Objectives:

The objective of this review was to assess the effect of corticosteroid therapy in Bell's palsy.

Search strategy:

We searched the Cochrane Neuromuscular Disease Group Trials Specialized Register (9 December 2008) for randomised trials, as well as MEDLINE (January 1966 to December 2008), EMBASE (January 1980 to December 2008) and LILACS (9 December 2008). We contacted known experts in the field to identify additional published or unpublished trials.

Selection criteria:

Randomised trials comparing different routes of administration and dosage schemes of corticosteroid or adrenocorticotrophic hormone therapy versus a control group where no therapy considered effective for this condition was administered, unless it was also given in a similar way to the experimental group.

Data collection and analysis:

Two authors independently assessed eligibility, trial quality, and extracted the data.

Main results:

Eight trials with a total of 1569 participants were included. Allocation concealment was appropriate in six trials, and the data reported allowed an intention-to-treat analysis in four, while unpublished data from the fifth and sixth trials were provided by the authors. The data included in the main outcome of this meta-analysis were collected from seven trials with a total of 1507 participants. Overall 175/754 (23%) of the participants allocated to corticosteroids had incomplete recovery of facial motor function six months or more after randomisation, significantly less than 245/753 (33%) in the control group (risk ratio (RR) 0.71, 95% confidence interval (CI) 0.61 to 0.83). There was, also, a significant reduction in motor synkinesis during follow-up in those receiving corticosteroids (RR 0.6, 95% CI 0.44 to 0.81). The reduction in the proportion of patients with cosmetically disabling sequelae six months after randomisation, however, was not significant (RR 0.97, 95% CI 0.44 to 2.15). The trial not included in the primary outcome of this meta-analysis showed a non-significant difference in outcomes between the arms.

Authors' conclusions:

The available evidence from randomised controlled trials shows significant benefit from treating Bell's palsy with corticosteroids.

This record should be cited as:

Salinas RA, Alvarez G, Daly F, Ferreira J. Corticosteroids for Bell's palsy (idiopathic facial paralysis). Cochrane Database of Systematic Reviews 2010, Issue 3. Art. No.: CD001942. DOI: 10.1002/14651858.CD001942.pub4

Assessed as up to date:

December 9, 2008

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Primary Review Group:

Neuromuscular Disease Group

Health topics:

Neurology > Peripheral neuropathy > Bell's palsy

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Corticosteroids for Bell's palsy

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