Bell Palsy: Prednisolone Improves Outcomes, Acyclovir Ineffective

Early treatment with prednisolone improves outcomes in patients with Bell palsy, whereas acyclovir appears to offer no benefit, researchers report in the New England Journal of Medicine.
Some 550 patients with Bell palsy (most with moderate-to-severe paralysis) were randomized to receive, within 72 hours of symptom onset, 10 days of prednisolone, acyclovir, both drugs, or placebo. Prednisolone recipients were significantly more likely than nonrecipients to achieve complete recovery both at 3 months (83% vs. 64%) and 9 months (94% vs. 82%). Acyclovir did not have an effect on recovery.
Although editorialists agree that acyclovir appears to be ineffective in Bell palsy, they note that another antiviral, valacyclovir, in combination with steroids, improved outcomes in patients with severe disease in a recent randomized trial.