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WITHDRAWN: Aciclovir or valaciclovir for Bell's palsy (idiopathic facial paralysis).

Abstract

BACKGROUND

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.

OBJECTIVES

To assess the efficacy of aciclovir or similar agents for treating Bell's palsy.

SEARCH STRATEGY

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.

SELECTION CRITERIA

Randomised or quasi-randomised trials of aciclovir or valaciclovir therapy, alone or in combination with any other drug, in patients with Bell's palsy.

DATA COLLECTION AND ANALYSIS

We identified six randomised trials.

MAIN RESULTS

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.

AUTHORS' CONCLUSIONS

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. Two trials, one with 551 participants comparing prednisolone with acyclovir with both and with neither, another with 221 participants comparing prednisolone and valacyclovir with prednisolone and placebo have just been published and will be included in an update of this review.

Authors+Show Affiliations

Department of Clinical Neurophysiology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK, WC1N 3BG.No affiliation info available

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

19370569

Citation

Allen, David, and Louisa Dunn. "WITHDRAWN: Aciclovir or Valaciclovir for Bell's Palsy (idiopathic Facial Paralysis)." The Cochrane Database of Systematic Reviews, 2009, p. CD001869.
Allen D, Dunn L. WITHDRAWN: Aciclovir or valaciclovir for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev. 2009.
Allen, D., & Dunn, L. (2009). WITHDRAWN: Aciclovir or valaciclovir for Bell's palsy (idiopathic facial paralysis). The Cochrane Database of Systematic Reviews, (2), CD001869. https://doi.org/10.1002/14651858.CD001869.pub3
Allen D, Dunn L. WITHDRAWN: Aciclovir or Valaciclovir for Bell's Palsy (idiopathic Facial Paralysis). Cochrane Database Syst Rev. 2009 Apr 15;(2)CD001869. PubMed PMID: 19370569.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - WITHDRAWN: Aciclovir or valaciclovir for Bell's palsy (idiopathic facial paralysis). AU - Allen,David, AU - Dunn,Louisa, Y1 - 2009/04/15/ PY - 2009/4/17/entrez PY - 2009/4/17/pubmed PY - 2009/6/24/medline SP - CD001869 EP - CD001869 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 2 N2 - BACKGROUND: 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. OBJECTIVES: To assess the efficacy of aciclovir or similar agents for treating Bell's palsy. SEARCH STRATEGY: 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. SELECTION CRITERIA: Randomised or quasi-randomised trials of aciclovir or valaciclovir therapy, alone or in combination with any other drug, in patients with Bell's palsy. DATA COLLECTION AND ANALYSIS: We identified six randomised trials. MAIN RESULTS: 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. AUTHORS' CONCLUSIONS: 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. Two trials, one with 551 participants comparing prednisolone with acyclovir with both and with neither, another with 221 participants comparing prednisolone and valacyclovir with prednisolone and placebo have just been published and will be included in an update of this review. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/19370569/WITHDRAWN:_Aciclovir_or_valaciclovir_for_Bell's_palsy__idiopathic_facial_paralysis__ L2 - https://doi.org/10.1002/14651858.CD001869.pub3 DB - PRIME DP - Unbound Medicine ER -