7/25/2019 kedokteran penelitian

1/1www.Consultant360.com February 2013 n CONSULTANT 99

Primary Care UpdateBrief Summaries for Clinical Practice

Bell Palsy:Updated Guideline for Treatment

Most patients with Bell palsy regainnormal facial function within 3weekseven those who do not re-

ceive treatment.1The severity of the palsyat 2 weeks after symptoms occur indi-cates the likelihood of long-term sequel-

ae. An improvement in symptoms 1 to 2weeks after their onset is a good predic-tor of a full recovery.1However, about15% of patients do not recover com-pletely and are left with residual facialweakness.2

Many treatmentsincluding corti-costeroids, antivirals, and surgical de-compressionhave been used in patientswith Bell palsy. Studies that have evalu-ated the effectiveness of these treatmentsmust be interpreted with caution because

the majority of patients recover withouttherapy (Figure).

In 2001, the Quality Standards Sub-committee of the American Academy ofNeurology (AAN) conducted a systematicreview and analysis of the literature to as-sess the effectiveness of treatments in im-proving facial function outcomes in pa-tients with Bell palsy.3Recently, the AANupdated its 2001 guideline; highlights arepresented here.4

RECOMMENDED TREATMENT

Oral corticosteroids are the main-stay of treatment because they can im-prove the likelihood of full recovery offacial function in patients with new-onsetBell palsy. Thus, the authors of the AANupdated guideline recommend that earlycorticosteroid therapy be offered to pa-tients who do not have contraindications,such as brittle diabetes mellitus, morbidobesity, osteopenia, and a previous histo-

ry of corticosteroid intolerance.4Ant iviral therapy alone has not

been shown in well-designed studies toincrease the likelihood of full facial re-

covery. Antiviral agents (eg, acyclovir,famciclovir, and valacyclovir) may be of-fered as an addition to oral corticosteroidtherapy, but patients should be informedthat the benefit of combination therapyhas not been strongly demonstrated.4

In the studies examined in theguideline, treatment had the greatest ef-fect when it was administered within 1week of symptom onset. However, thestudies also showed that corticosteroids

and antivirals had limited effectiveness inpatients with Bell palsy who had severepalsy at presentation and in those whohad suspected zoster sine herpete.

REFERENCES:1.Karnath B. Bells palsy: update on causes, recog-

nition, management. Consultant.2003;43(5):

601-605.2.Peitersen E. The natural history of Bells palsy.

Am J Otol.1982;4:107-111.

3.Grogan PM, Gronseth GS. Practice parameter:steroids, acyclovir, and surgery for Bells palsy

(an evidence-based review): report of the

Quality Standards Subcommittee of the AmericanAcademy of Neurology. Neurology.2001;56:

830-836.

4.Gronseth GS, Paduga R; American Academy ofNeurology. Evidence-based guideline update:

steroids and antivirals for Bell palsy: report

of the Guideline Development Subcommittee of

the American Academy of Neurology.Neurology.2012;79(22):2209-2213. doi:

10.1212/WNL.0b013e318275978c. Epub 2012

Nov 7.

Figure This 75-year-old woman presented with weakness of the right side of the face. She

was unable to close the right eye and drooled from the right side of the mouth. Bell palsy

was diagnosed. Observation was considered sufficient for this patient, and the facial palsy

resolved after 6 weeks. (Courtesy of Steven Manuli, MD.)