Antiviral treatment for Bell's palsy

Cochrane: We reviewed the evidence about the effect of antiviral therapy alone or in combination with any other therapy, on Bell's palsy. Bell's palsy is a disease of the facial nerve that causes one side of the face to be paralysed. Some studies have suggested that it is caused by the same viral infections that cause cold sores (herpes simplex) or shingles (varicella zoster). If this is correct, antiviral drugs would be likely to help recovery. The paralysis is usually temporary even when left untreated, although without treatment about one person in five is left with permanent facial disfigurement or pain. A Cochrane review has already confirmed the effectiveness of corticosteroids in Bell’s palsy.



We identified 11 trials, which included 2883 participants with mild, moderate, or severe one-sided Bell’s palsy of unknown cause. Participants were aged from 14 to 84 years. The trials compared antivirals in combination with corticosteroids to corticosteroid treatment alone or in combination with placebo; antiviral treatment alone or in combination with placebo to placebo or no treatment only; antiviral treatment alone or in combination with placebo to corticosteroid treatment alone or in combination with placebo; and antiviral treatment in combination with corticosteroids to placebo or no treatment only. The duration of the included studies ranged from three months to 12 months.


This updated review provides moderate-quality evidence for no benefit for people with Bell's palsy from the combination of antivirals with corticosteroids compared to corticosteroids alone or with placebo, based on data from 1715 trial participants.
The combination of corticosteroids with antivirals is probably more effective than corticosteroids alone in the treatment of people with severe Bell’s palsy.
Antivirals alone (or combined with placebo) were not as effective as corticosteroids alone or corticosteroids in combination with antivirals.
Moderate-quality evidence showed a significant benefit with antivirals plus corticosteroids compared with corticosteroids alone in people with severe Bell’s palsy.
In three trials considerably more long-term after-effects of Bell's palsy were seen in people treated with corticosteroids alone than in people treated with antivirals and corticosteroids combined (moderate-quality evidence). There were also fewer long-term after-effects with corticosteroids alone than with antivirals alone (three trials).
Based on the evidence from three trials, none of the different treatments showed significant differences in adverse events, taking into account the moderate quality of data for this outcome.
The evidence in this review is current to October 2014.

Authors' conclusions: 

Moderate-quality evidence from randomised controlled trials showed no additional benefit from the combination of antivirals with corticosteroids compared to corticosteroids alone or with placebo, and no benefit from antivirals alone compared to placebo, for the treatment of Bell's palsy. Moderate-quality evidence showed a small but just significant benefit of combination therapy compared with corticosteroids alone in severe Bell’s palsy. We found no significant increase in adverse events from the use of antivirals compared with either placebo or corticosteroids.