The Guideline Development Subcommittee of the AAN provides an update of the 2001 evidence-based practice guideline for the treatment of Bell palsy. A search of Medline and the Cochrane Database of Controlled Clinical Trials for articles published since January 2000 identified 9 studies (2 rated Class I) of patients with new-onset Bell palsy who received steroids/antiviral agents. The committee concludes as follows: 1) Steroids are highly likely to be effective and should be offered to increase the probability of recovery of facial nerve function; 2) antiviral agents in combination with steroids do not increase the probability of facial functional recovery by >7%. Antivirals may be offered in addition to steroids because of a possible modest increase in recovery, but patients should be counseled that a benefit from antivirals has not been established. [1]

COMMENT. The committee suggests for further research, large randomized trials comparing outcomes after steroids with or without antivirals, including patients with zoster sine herpete. The optimal dose and timing of steroids and their effects in children should be determined.