Steroids to the rescue

Treatment with steroids can help people recover from a common and distressing disorder which paralyses the facial muscles, new research has confirmed.

What do we know already?

Bell’s palsy is a temporary paralysis of one side of the face, which gives a lop-sided appearance. It’s quite common, affecting about 1 in 60 people. It’s thought to be caused by the herpes simplex virus, which also causes cold sores.

Many people with Bell’s palsy recover completely within three weeks. But about 3 in 10 people are left with muscle weakness in their face, or a slightly altered appearance because some muscles have shortened slightly.

Two types of drugs are available for this condition, but so far it’s been uncertain how well they work, so doctors don’t always prescribe them. One study from 2002 showed that only about 1 in 3 people with Bell’s palsy in the UK are treated with these medicines.
The two drugs are steroids (full name corticosteroids) and antiviral medicines. Steroid tablets reduce inflammation, which may protect the nerves and muscles affected by the virus infection, preventing damage. Antivirals may work against the virus that causes the infection.

What does the new study say?

Steroid tablets definitely help people recover completely from Bell’s palsy, without getting long-term problems with their facial muscles such as a changed appearance. In studies looking at steroids alone, 16 per cent of people who took steroids got some type of long-term problem, compared to 24 per cent of people who didn’t take steroids.
Antiviral tablets didn’t cut the chances of long-term problems when taken alone. Taking both steroid tablets and antiviral tablets might work a little better than taking steroid tablets alone, but the research isn’t clear.

Where does the study come from?

The research was done at the University of Toronto in Canada. It was published in the Journal of the American Medical Association. It was funded by a number of Canadian research institutes.

How reliable are the findings?

The findings should be reliable. This type of research is called a meta-analysis, and it’s one of the most reliable ways to find out whether a treatment works. The researchers said all the included studies were of high or moderate quality. They included 18 trials with 2,786 people in total.

They found many more studies looking at steroid tablets than antiviral tablets, and said the studies looking at steroids were better-quality. So we can be sure that steroid tablets work.

What should I do now?

If you have sudden weakness in your facial muscles (usually on one side of your face), it could be a sign of Bell’s palsy. Make an appointment to see your doctor as soon as possible, as treatments usually work best if they’re given within three days of it happening.