Prednisolone--but not antiviral drugs--improves outcome in patients with Bell's palsy.

Randomized, double-blind, placebo-controlled trials have provided compelling evidence that treatment with prednisolone improves outcome in patients with acute idiopathic peripheral facial (Bell's) palsy. The low rate of adverse effects, the small number needed to treat, and the modest cost of therapy indicate that prednisolone should be used in all patients with facial palsy of <72 h duration who do not have contraindications to steroid therapy. By contrast, the best-designed recent clinical trials have failed to suggest any significant beneficial effect on Bell's palsy of treatment with acyclovir or valacyclovir, either as single agents or in combination with prednisolone. Antiviral therapy should not, therefore, be routinely used in the treatment of Bell's palsy.