Evidence-Based Practice: Treatment of Bell’s Palsy



Evidence-Based Practice: Treatment of Bell’s PalsyMcKenzie R. PetersonUniversity of MaryEvidence-Based Practice: Treatment of Bell’s PalsyAccording to Salinas, Alvarez, Daly, and Ferreira (2010), “Bell’s palsy is an acute, generally unilateral, paralysis or weakness of facial musculature consistent with peripheral facial nerve dysfunction, of no detectable cause” (p. 2). Numthavaj, Thakkinstian, Dejthevaporn, and Attia (2011) provide some additional information regarding Bell’s palsy. Numthavaj et al., (2011) state that “although the actual cause of Bell’s palsy is unknown, the widely accepted mechanism is inflammation of the facial nerve … which leads to compression and demyelination of the axons, and disruption of blood supply to the nerve itself (p.1).” This condition has an incidence of about 23 to 24 cases per 100,000 population annually.Case PresentationA 45-year-old woman presents to the clinic with complaints of right sided-facial weakness. She has a negative neurological assessment and has no other acute signs of stroke. Her vital signs are normal and does not appear to be in any acute distress. Her computed tomographic (CT) and magnetic resonance imaging (MRI) scan showed no signs of intracranial hemorrhage, ischemia, or infarction. PICODo patients who present with Bell’s palsy treated with corticosteroids and antiviral medication versus corticosteroids alone lead to a higher recovery rate?Summary and appraisal of Key EvidenceNumthavaj, Thakkinstian, Dejthevaporn, and Attia (2011) performed a network meta-analysis that found six eligible studies that included a total of 1,805 participants. Meta-analyses are considered to be one of the highest levels of evidence. This article would be deemed excellent or good. A strength of this paper was that each of the eligible studies were independently assessed for quality based on a modified Jadad score. The number of participants also helped to increase the power of the meta-analysis. A weakness was the fact that the authors did not include papers that were not written in English. Beyond this, the meta-analysis was overall deemed robust by the authors. There is an opportunity for an individually-based retrieval of data, but is often much more difficult and time consuming. A particular threat to this meta-analysis is the statement made by the authors of the heterogeneity of their data. They believe that they were able to compensate for this by their mixed model with random intercept at the study level. Salinas, Alvarez, Daly, Ferreira (2011) performed a systematic review to assess the effect of corticosteroid therapy in Bell’s palsy that included eight trials and a total of 1,569 participants. Systematic reviews’ quality of evidence are deemed excellent. A significant strength of this review is the fact that the authors comprehensively searched MEDLINE, EMBASE, LILACS for randomized trials and various meta-analyses. The authors contacted known expert in the field for additional published or unpublished data. The quality of each trial was assessed by two different authors independently. A weakness of this review is the range of years allowed to be searched for potential inclusion. Data from 1966 through 2008 were considered. There is opportunity for an update of this review for newer and even more current treatment strategies. A threat to this review lies in the fact that at least one of the included studies was from 1976. Clinical Bottom LineThe clinical bottom line when considering these two articles is that treatment of Bell’s palsy with corticosteroids, prednisone in particular, remains the best evidence-based treatment (Numthavaj, Thakkinstian, Dejthevaporn, & Attia, 2011). Numthavaj et al. (2011) state it best in their conclusion by saying, “AVT (antiviral therapy) may lead to slight higher recovery rates at 3 and 6 months, compared to treating with corticosteroid alone … the sum of the data do not show that this is a significant difference” (p 9). Numthavaj et al. (2011) also state that “treating with AVT alone is significantly worse than treating with corticosteroid alone and is no better than placebo (p. 9).” Knowing these facts that are found in credible sources can help to guide prescribing practice and to better treat and prevent a potential life-long condition.References BIBLIOGRAPHY Numthavaj, P., Thakkinstian, A., Dejthevaporn, C., & Attia, J. (2011). Corticosteroid and Antiviral Therapy for Bell's Palsy: A Network Meta-analysis. BMC Neurology, 111. doi:10.1186/1471-2377-11-1Salinas, R. A., Alvarez, G., Daly, F., & Ferreira, J. (2010). Corticosteroids for Bell's Palsy (Idiopathic Facial Paralysis). Cochrane Database Of Systematic Reviews, (3), doi:10.1002/14651858.CD001942.pub4 ................
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