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Aciclovir or valaciclovir for Bell's palsy (idiopathic facial paralysis)
Editorial Group: Cochrane Neuromuscular Disease Group
Published Online: 19 JUL 2004
Assessed as up-to-date: 29 FEB 2004
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Allen D, Dunn L. Aciclovir or valaciclovir for Bell's palsy (idiopathic facial paralysis). Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD001869. DOI: 10.1002/14651858.CD001869.pub2.
- Publication Status: Edited
- Published Online: 19 JUL 2004
This is not the most recent version of the article. View current version (01 JUL 2015)
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.
To assess the efficacy of aciclovir or similar agents for treating Bell's palsy.
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.
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.
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.
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.
Plain language summary
More evidence is needed to show whether the antiviral drugs aciclovir or valaciclovir are effective in aiding recovery from Bell's palsy
Bell's palsy is a disease that causes one side of the face to be paralysed. This paralysis is usually temporary. Bell's palsy may be caused by an infection by the cold sore (herpes simplex) virus. The antiviral drugs aciclovir and valaciclovir are therefore considered a possibility in aiding recovery from Bell's palsy. It has also been suggested that a combination of aciclovir and corticosteroids may help. The review of trials found there was not enough evidence to show the effects of aciclovir or valaciclovir. More research is needed. 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.