Original Article
Early Treatment with Prednisolone or Acyclovir in Bell's Palsy
N Engl J Med 2007; 357:1598-1607October 18, 2007DOI: 10.1056/NEJMoa072006
- Abstract
Background
Corticosteroids and antiviral agents are widely used to treat the early stages of idiopathic facial paralysis (i.e., Bell's palsy), but their effectiveness is uncertain.
Methods
We conducted a double-blind, placebo-controlled, randomized, factorial trial involving patients with Bell's palsy who were recruited within 72 hours after the onset of symptoms. Patients were randomly assigned to receive 10 days of treatment with prednisolone, acyclovir, both agents, or placebo. The primary outcome was recovery of facial function, as rated on the House–Brackmann scale. Secondary outcomes included quality of life, appearance, and pain.
Results
Final outcomes were assessed for 496 of 551 patients who underwent randomization. At 3 months, the proportions of patients who had recovered facial function were 83.0% in the prednisolone group as compared with 63.6% among patients who did not receive prednisolone (P<0.001) and 71.2% in the acyclovir group as compared with 75.7% among patients who did not receive acyclovir (adjusted P=0.50). After 9 months, these proportions were 94.4% for prednisolone and 81.6% for no prednisolone (P<0.001) and 85.4% for acyclovir and 90.8% for no acyclovir (adjusted P=0.10). For patients treated with both drugs, the proportions were 79.7% at 3 months (P<0.001) and 92.7% at 9 months (P<0.001). There were no clinically significant differences between the treatment groups in secondary outcomes. There were no serious adverse events in any group.
Conclusions
In patients with Bell's palsy, early treatment with prednisolone significantly improves the chances of complete recovery at 3 and 9 months. There is no evidence of a benefit of acyclovir given alone or an additional benefit of acyclovir in combination with prednisolone. (Current Controlled Trials number, ISRCTN71548196.)
Media in This Article
Figure 1
Enrollment and Outcomes.Figure 2
Patients Who Had a Full Recovery at 3 Months and 9 Months, According to Study Group.Article Activity
- Article
Bell's palsy is acute, idiopathic, unilateral paralysis of the facial nerve.1 Vascular, inflammatory, and viral causes have been suggested from paired serologic analyses and studies of the cerebral ganglia, suggesting an association between herpes infection and the onset of facial paralysis.2-4 Epidemiologic studies show that 11 to 40 persons per 100,000 are affected each year, most commonly between the ages of 30 and 45 years.5 Although most patients recover well, up to 30% of patients have a poor recovery, with continuing facial disfigurement, psychological difficulties, and facial pain.6,7 Treatment remains controversial and variable.8 Prednisolone and acyclovir are commonly prescribed separately and in combination, although evidence of their effectiveness is weak.9,10
Two recent Cochrane reviews assessed the effectiveness of corticosteroids and antiviral agents in patients with Bell's palsy. The analysis of corticosteroid treatment pooled the results of four randomized, controlled trials with a total of 179 patients.11 The review of antiviral treatment included three studies involving 246 patients.12 Both reviews independently concluded that insufficient data exist to support the use of either or both therapies.
Given this lack of evidence, the Health Technology Assessment Program of the National Institute for Health Research commissioned an independent academic group to determine whether prednisolone or acyclovir used early in the course of Bell's palsy improves the chances of recovery.13
Methods
Patients
We established receiving centers at 17 hospitals throughout Scotland, to which potential patients with Bell's palsy were referred. Eligible patients with a confirmed diagnosis who consented to join the study were randomly assigned to study groups and were followed for 9 months. Complete details of the study design and the analysis plan have been published previously.14 The complete study protocol appears in the Supplementary Appendix, available with the full text of this article at www.nejm.org.
We recruited adults 16 years of age or older with unilateral facial-nerve weakness of no identifiable cause who presented to primary care or the emergency department and could be referred to a collaborating otorhinolaryngologist within 72 hours after the onset of symptoms. Exclusion criteria were pregnancy, breast-feeding, uncontrolled diabetes (glycated hemoglobin level, >8%), peptic ulcer disease, suppurative otitis media, herpes zoster, multiple sclerosis, systemic infection, sarcoidosis and other rare conditions, and an inability to provide informed consent.
All patients provided written informed consent after the aims and methods of the study had been described to them and after they had received an information sheet. The study was approved by the Multicenter Research Ethics Committee for Scotland and was conducted in accordance with the provisions of the Declaration of Helsinki and Good Clinical Practice guidelines. Drugs (including placebo) were purchased from Tayside Pharmaceuticals, an organization that manufactures special medicines for the National Health Service in Scotland and for commercial customers.
Study Design
From June 2004 to June 2006, we conducted a two-by-two factorial study across the whole of mainland Scotland (total population, 5.1 million), with referrals mainly from primary care to 17 hospitals serving 88% of the country's total population. Follow-up was continued until March 2007, when the last patients to be recruited underwent their 9-month assessments. Patients were recruited through their family doctors, emergency departments, the national 24-hour medical telephone consultancy service, and dentists' offices. Patients, recruiters, study visitors, and outcome assessors were all unaware of study-group assignments.
As soon as the senior otorhinolaryngologist who had been trained in the study procedures at the trial site confirmed a patient's eligibility to participate and consent was obtained, the patient was randomly assigned to a study group by an independent, secure, automated telephone-randomization service provided by the University of Aberdeen's Health Services Research Unit.15 Randomization was performed with the use of a permuted-block technique, with block sizes of four or eight and no stratification. Patients were instructed to take the first dose of the study drug before leaving the hospital and the remaining doses at home during the next 10 days.
Patients underwent randomization twice, which resulted in four study groups that each received two preparations: prednisolone (at a dose of 25 mg twice daily) and placebo (lactose), acyclovir (400 mg five times daily) and placebo, prednisolone and acyclovir, and two placebo capsules. Tayside Pharmaceuticals managed the preparation of active and placebo ingredients in cellulose capsules and the drug bottling, labeling, and distribution to clinical sites. Only Tayside Pharmaceuticals and the 17 hospital pharmacies had access to the codes. Thus, each patient received two bottles of odorless capsules with an identical appearance.
Within 3 to 5 days after randomization, a researcher visited patients at home or, if preferred, at a doctor's office to complete a baseline assessment. Repeat visits to assess recovery occurred at 3 months. If recovery was incomplete (which was defined as grade 2 or more on the House–Brackmann scale) at this visit, the visit was repeated at 9 months. Researchers analyzed clinical records for 15% of patients to validate primary care and hospital-consultation data, toxic effects, and coexisting illnesses after the final visit. An independent data and safety monitoring committee performed a review 14 months after recruitment began.
Outcome Measurements
The primary outcome measure was the House–Brackmann grading system for facial-nerve function (see the Supplementary Appendix),16 an easily administered, widely used clinical system for grading recovery from facial-nerve paralysis caused by damage to lower motor neurons. The scoring system assigns patients to one of six categories on the basis of the degree of facial-nerve function, with grade 1 indicating normal function. The primary outcome was assessed by documenting the facial appearance of patients in digital photographic images in four standard poses: at rest, with a forced smile, with raised eyebrows, and with eyes tightly closed. (Images of a patient at enrollment are available in the Supplementary Appendix.) The photographs were assessed and graded independently by a panel of three experts — an otorhinolaryngologist, a neurologist, and a plastic surgeon — who were unaware of study-group assignments and the stage of assessment. Ninety-two percent of the panel members' assessments differed by no more than one House–Brackmann grade. Discrepancies of more than one grade were reassessed. The median of the three grades provided a final determination.
Secondary outcomes were health-related quality of life, as measured with the Health Utilities Index Mark 3; facial appearance, as measured with the Derriford Appearance Scale 59; and pain, as measured with the Brief Pain Inventory. The Health Utilities Index Mark 3 provides a system for the classification of health-related quality of life status in eight dimensions: vision, hearing, speech, ambulation, dexterity, emotion, cognition, and pain, with five or six levels of severity per dimension. A preference-based scoring system is used, and responses are commonly converted into a single score ranging from –0.36 to 1.00, with 1 indicating full health; a negative score indicates a quality of life that is considered by the patient to be worse than death. The questionnaire is designed for use in clinical practice and research, health policy evaluation, and general population surveys.17 The Derriford Appearance Scale contains 59 questions covering aspects of self-consciousness and confidence, with scores ranging from 8 to 262 and higher scores indicating a greater severity of distress and dysfunction.18 The Brief Pain Inventory measures both the severity of pain and the extent to which pain interferes with normal activities; scores range from 0 to 110, with higher scores indicating greater severity.19
Adverse Events
Adverse events were reviewed at each study visit. Compliance with the drug regimen was reviewed at the first visit and during telephone calls on day 7 after randomization and within a week after the final day of the study (10 days after randomization). Patients were instructed to return pill containers and any unused capsules in the container to the study center at the University of Dundee.
Statistical Analysis
All analyses were based on the intention-to-treat principle, and specific comparisons were prespecified in the protocol. We initially tested the data for any interaction among study groups. If the results were not significant, we compared the primary outcome measure of complete recovery (grade 1 on the House–Brackmann scale) at 3 months and 9 months between patients who did and those who did not receive prednisolone, using a two-sided Fisher's exact test. We repeated this procedure for acyclovir. In addition, we then compared prednisolone with placebo, acyclovir with placebo, and the combination of the two drugs with placebo. Prespecified secondary analyses compared scores on quality of life, facial appearance, and pain with the use of t-tests or Mann–Whitney tests in cases in which the data were not normally distributed. Then we used logistic regression to adjust the analysis for all baseline characteristics that we measured: age, sex, the time from the onset of symptoms to the initiation of treatment, scores on the House–Brackmann scale, and scores for quality of life, appearance, and pain. The significance of baseline factors was assessed with the use of Wald tests, with a P value of less than 0.05 considered to indicate statistical significance.
The results were also assessed for sensitivity to dropout, assuming that the dropouts were missing at random. A propensity score for dropout at 9 months was estimated with the use of logistic regression, and a further analysis was carried out to weight results according to the reciprocal of the probability of remaining in the study.20
The relevant Cochrane reviews suggested that 32 to 37% of patients with Bell's palsy have incomplete recovery without treatment and that this percentage can be reduced to 22% with effective treatment. A between-group difference in the complete-recovery rate of at least 10 to 12 percentage points was considered to be clinically meaningful. The randomization of 236 patients per treatment (a total of 472 patients) provided a power of 80% to detect such a difference. Since the study design was factorial, the power was the same for each pairwise comparison of treatments (assuming there was no interaction between treatments).
Results
Study Population
Of 752 patients who were referred for participation in the study, 132 were found to be ineligible; of the remaining 620 patients, 551 (88.9%) underwent randomization. Of these patients, 415 had been referred by their family doctor (75.3%) and 41 by an emergency department (7.4%). Since 55 patients dropped out of the study before a final determination of the House–Brackmann grade, a final outcome was available for 496 patients (90.0%) (Figure 1Figure 1
Enrollment and Outcomes.).The patients were equally divided between men and women, the mean (±SD) age was 44.0±16.4 years, and the degree of initial facial paralysis was moderate to severe (Table 1Table 1
Baseline Characteristics of the Patients.). After the onset of symptoms, most patients (53.8%) initiated treatment within 24 hours, 32.1% within 48 hours, and 14.1% within 72 hours. A total of 426 patients (86%) returned pill containers; of these patients, 383 (90%) returned empty containers, indicating complete compliance, 32 (8%) returned doses for 5 days or less, and 11 patients (3%) returned doses for 6 days or more.There was no significant interaction between prednisolone and acyclovir at either 3 months or 9 months (P=0.32 and P=0.72, respectively). Table 2Table 2
Primary and Secondary Outcomes at 3 Months and 9 Months. presents the adjusted outcome data for the 496 patients who completed the study. Of these patients, 357 had recovered by 3 months and did not require a further visit. Of the remainder, 80 had recovered at 9 months, leaving 59 with a residual facial-nerve deficit.At 3 months, rates of complete recovery differed significantly between the prednisolone comparison groups: 83.0% for patients who received prednisolone and 63.6% for those who did not, a difference of 19.4 percentage points (95% confidence interval [CI], 11.7 to 27.1; P<0.001). There was no significant difference between the complete-recovery rates in the acyclovir comparison groups: 71.2% for patients who received acyclovir and 75.7% for those who did not, a difference of 4.5 percentage points (95% CI, –12.4 to 3.3; unadjusted P=0.30; adjusted P=0.50). At 9 months, the rates of complete recovery were 94.4% for patients who received prednisolone and 81.6% for those who did not, a difference of 12.8 percentage points (95% CI, 7.2 to 18.4; P<0.001) and 85.4% for patients who received acyclovir and 90.8% for those who did not, a difference of 5.4 percentage points (95% CI, –11.0 to 0.3; unadjusted P=0.07; adjusted P=0.10). When the analyses were repeated with the results weighted according to the propensity of patients to withdraw from the study, there was no appreciable change.
A total of 34 patients (6.9% of those who completed follow-up) were assessed as fully recovered at the time of the first assessment visit (i.e., within at most 8 days after the onset of symptoms). For patients receiving double placebo, 64.7% were fully recovered after 3 months, and 85.2% after 9 months. Table 3Table 3
Complete Recovery at 3 Months and 9 Months, According to Treatment Combination, Adjusted for Baseline Characteristics. gives comparisons of all four treatment groups relative to each other. Prednisolone was highly effective, both separately and in combination with acyclovir. Acyclovir was ineffective, both separately and as an addition to prednisolone. Figure 2Figure 2Patients Who Had a Full Recovery at 3 Months and 9 Months, According to Study Group. shows the proportion of patients assessed as having normal facial function at baseline, at 3 months, and at 9 months in the four study groups.Generally, there were no significant differences among the groups in secondary measures (Table 2). However, only patients who received prednisolone had an improvement in the appearance score over time. Also, pain scores tended to be lower in the prednisolone group than in the group that did not receive prednisolone. On the other hand, the quality of life at 9 months was significantly higher for patients who did not receive prednisolone than for those who did (P=0.04). Given that the secondary measures were obtained only in patients who had not recovered at 3 months and given the problem of multiple testing, this result should be interpreted with caution.
At 3 months, the absolute risk reduction associated with prednisolone treatment was 19%. Therefore, the number needed to treat in order to achieve one additional complete recovery was 6 (95% CI, 4 to 9). At 9 months, the equivalent numbers were an absolute risk reduction of 12% and a number needed to treat of 8 (95% CI, 6 to 14).
Adverse events included the expected range of minor symptoms associated with the drugs used (Table 4Table 4
Adverse Events.). During follow-up, three patients died. All three deaths were deemed to be unrelated to treatment: two patients had received double placebo and one had received acyclovir alone. No other major adverse events were reported. There was no need for patients or study personnel to be informed about study-group assignments.Discussion
In this large, randomized, controlled trial of the efficacy of treatment for Bell's palsy, we confirmed the generally favorable outcome for patients receiving double placebo, with 64.7% of patients fully recovered at 3 months and 85.2% at 9 months.9,10 Early treatment (within 72 hours after the onset of symptoms) with prednisolone increased these rates to 83.0% and 94.4%, respectively. Acyclovir produced no benefit over placebo, and there was no benefit in its addition to prednisolone.
The results of previous trials have been inconsistent.21 Our trial included twice as many patients as were included in the Cochrane systematic reviews.11,12 We recruited most patients from primary care practices, thus reducing the selection bias inherent in hospital-based studies. The high rate of acceptance of randomization and the low dropout rate during the study suggest that our results can probably be applied to other settings with similar populations. It is possible that genetic polymorphisms that are prevalent in some populations or environmental factors such as diet could alter the response. We used drugs that are relatively inexpensive and are readily available worldwide. The assessment of outcomes with the use of validated study tools was undertaken by observers who were unaware of the assignments to study groups.
We used the House–Brackmann scale to grade facial-nerve function because it reliably assigns patients to a recovery status. The scale has been criticized for insufficient sensitivity to change and difficulty in assigning grades because patients may have contrasting degrees of function in different parts of the face.22,23 This observation, as well as rapid recovery between randomization and the home visit in some cases, may explain why 34 patients received grade 1 on the House–Brackmann scale at their baseline assessment. Alternative scales, such as the Sydney and Sunnybrook facial grading systems, are available but are more difficult to use in clinical practice.24
We did not observe any benefits with respect to our secondary outcome measures (quality of life, appearance, and pain) in any study group, including patients who received prednisolone. There was some suggestion of a benefit from prednisolone in terms of reduced pain and improved appearance, but these differences were not significant. In the subgroup of patients who did not have a complete recovery at 3 months and who underwent the 9-month assessment, there were reduced quality-of-life scores among patients who were treated with prednisolone and also among those treated with acyclovir. Given the evidently reduced health status of those who required a health assessment at 9 months, this result is perhaps not surprising.
In conclusion, we have provided evidence that the early use of oral prednisolone in patients with Bell's palsy is an effective treatment. The mechanism of action may involve modulation of the immune response to the causative agent or direct reduction of edema around the facial nerve within the facial canal. Treatment with unesterified acyclovir at doses used in other trials either alone or with corticosteroids had no effect on the outcome. Therefore, we cannot recommend acyclovir for use in the treatment of Bell's palsy.25,26 A recent study in Japan suggested that valacyclovir (a prodrug that achieves a level of bioavailability that is three to five times that of acyclovir) may be a useful addition to prednisolone.27 However, the Japanese study was smaller than ours, patients were treated in tertiary centers, and the outcome assessors were aware of the study-group assignments; therefore, the results of that study should be interpreted with caution.
No data are available regarding how best to treat patients who present more than 72 hours after the onset of symptoms, so all patients with suspected Bell's palsy should be assessed as early as possible. Since most patients with this condition recover fully without any treatment, withholding treatment will remain an appropriate strategy for some patients. Our study showed that the administration of prednisolone can increase the probability of complete recovery at 9 months, a finding that should help inform discussions about the use of corticosteroids for patients with Bell's palsy.
Supported by a grant (02/09/04) from the Health Technology Assessment Programme of the National Institute for Health Research (Department of Health, England). The Scottish School of Primary Care was funded by the Scottish Executive (Chief Scientist Office and National Health Service Education for Scotland) during the study. Practices were reimbursed for their contributions through national Support for Science mechanisms.
The views and opinions expressed in this article are those of the authors and do not necessarily reflect those of the Department of Health (England).
Drs. Sullivan and Donnan report receiving grant support from GlaxoSmithKline for projects unrelated to this trial. No other potential conflict of interest relevant to this article was reported.
We thank all the patients, primary and secondary care doctors, dentists, and emergency staff members who contributed to this study.
Source Information
From the Scottish School of Primary Care (F.M.S.), Community Health Sciences (P.T.D., F.D.), and Dental Health Services Research Unit (J.E.C.), University of Dundee, Dundee; the Department of Otolaryngology (I.R.C.S.) and the Division of Community Based Sciences (J.M.M., S.H.), University of Glasgow, Glasgow; the Department of General Practice and Primary Care (B.H.S., A.M.) and the Health Economics Research Unit (L.D.V.), University of Aberdeen, Aberdeen; Community Health Sciences (B.M., V.H.) and the Department of Clinical Neurosciences (R.J.D.), University of Edinburgh, Edinburgh; and St. John's Hospital, National Health Service Lothian, Livingston (K.S.) — all in the United Kingdom.
Address reprint requests to Dr. Sullivan at the Scottish School of Primary Care, Mackenzie Bldg., University of Dundee, Kirsty Semple Way, Dundee DD2 4BF, United Kingdom, or at f.m.sullivan@chs.dundee.ac.uk.
Appendix
In addition to the authors, the following investigators participated in the study. Trial Steering Committee: C. van Weel, University of Nijmegen; I. Williamson, University of Southampton; S. Wyke, University of Stirling; C. Hamilton (patient representative); Temporary Researcher: D. Gray, University of Aberdeen. Local Principal Investigators: K. Ah-See, Aberdeen Royal Infirmary; N. Balaji, Monklands Hospital, Airdrie; H. Beg, Victoria Hospital, Kirkcaldy; Q. Gardiner, Perth Royal Infirmary; M. Hussain, Ninewells Hospital, Dundee; A. Kerr, Western General Hospital and Royal Infirmary, Edinburgh; J. Marshall, Southern General Hospital, Glasgow; W. McKerrow, Raigmore Hospital, Inverness; M. Shanks, Crosshouse Hospital, Kilmarnock; D. Simpson, Stobhill Hospital, Glasgow; G. Vernham, St. John's Hospital, Livingston; A. White, Royal Alexandra Hospital, Paisley. Scottish School of Primary Care: L. McCloughan, Scottish Primary Care Research Network; M. Pitkethly, East of Scotland Node; S. Campbell, North of Scotland Node; A. Cardy, North of Scotland Node; C. Fulton, East of Scotland Node; J. McGill, West of Scotland Node; K. Bell, National Health Service Ayrshire and Arran; B. Rae, North Glasgow Hospitals Trust. Data Monitoring and Ethics Committee: M. Campbell, C. Counsell, University of Aberdeen; R. Mountain, S. Ogston (statistician), University of Dundee.
- References
References
1
Gilden DH . Bell's palsy. N Engl J Med 2004;351:1323-1331
Full Text | Web of Science | Medline2
Adour KK ,Bell DN ,Hilsinger RL Jr . Herpes simplex virus in idiopathic facial paralysis (Bell palsy). JAMA 1975;233:527-530
CrossRef | Web of Science | Medline3
Stjernquist-Desatnik A ,Skoog E ,Aurelius E . Detection of herpes simplex and varicella-zoster viruses in patients with Bell's palsy by the polymerase chain reaction technique. Ann Otol Rhinol Laryngol 2006;115:306-311
Web of Science | Medline4
Theil D ,Arbusow V ,Derfuss T , et al. Prevalence of HSV-1 LAT in human trigeminal, geniculate, and vestibular ganglia and its implication for cranial nerve syndromes. Brain Pathol 2001;11:408-413
CrossRef | Web of Science | Medline5
De Diego-Sastre JI ,Prim-Espada MP ,Fernandez-Garcia F . The epidemiology of Bell's palsy. Rev Neurol 2005;41:287-290
Web of Science | Medline6
Peitersen E . Bell's palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Otolaryngol Suppl 2002;549:4-30
Medline7
Neely JG ,Neufeld PS . Defining functional limitation, disability, and societal limitations in patients with facial paresis: initial pilot questionnaire. Am J Otol 1996;17:340-342
CrossRef | Medline8
Williamson IG ,Whelan TR . The clinical problem of Bell's palsy: is treatment with steroids effective? Br J Gen Pract 1996;46:743-747
Web of Science | Medline9
Grogan PM ,Gronseth GS . Practice parameter: steroids, acyclovir, and surgery for Bell's palsy (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001;56:830-836
Web of Science | Medline10
Rowlands S ,Hooper R ,Hughes R ,Burney P . The epidemiology and treatment of Bell's palsy in the UK. Eur J Neurol 2002;9:63-67
CrossRef | Web of Science | Medline11
Salinas RA ,Alvarez G ,Ferreira J . Corticosteroids for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev 2004;4:CD001942-CD001942
Medline12
Allen D ,Dunn L . Aciclovir or valaciclovir for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev 2004;3:CD001869-CD001869
Medline13
Scottish Bell's Palsy Study (SBPS). Dundee, Scotland: SBPS. (Accessed September 21, 2007, at http://www.dundee.ac.uk/bells/.)
14
McKinstry B ,Hammersley V ,Daly F ,Sullivan F . Recruitment and retention in a multicentre randomised controlled trial in Bell's palsy: a case study. BMC Med Res Methodol 2007;7:15-15
CrossRef | Web of Science | Medline15
University of Aberdeen Health Services Research Unit home page. (Accessed September 21, 2007, at http://www.abdn.ac.uk/hsru/.)
16
House JW ,Brackmann DE . Facial nerve grading system. Otolaryngol Head Neck Surg 1985;93:146-147
Web of Science | Medline17
Furlong WJ ,Feeny DH ,Torrance GW ,Barr RD . The Health Utilities Index (HUI) system for assessing health-related quality of life in clinical studies. Ann Med 2001;33:375-384
CrossRef | Web of Science | Medline18
Harris DL ,Carr AT . The Derriford Appearance Scale (DAS59): a new psychometric scale for the evaluation of patients with disfigurements and aesthetic problems of appearance. Br J Plast Surg 2001;54:216-222
CrossRef | Medline19
Keller S ,Bann CM ,Dodd SL ,Schein J ,Mendoza TR ,Cleeland CS . Validity of the Brief Pain Inventory for use in documenting the outcomes of patients with noncancer pain. Clin J Pain 2004;20:309-318
CrossRef | Web of Science | Medline20
Preisser JS ,Lohman KK ,Rathouz PJ . Performance of weighted estimating equations for longitudinal binary data with drop-outs missing at random. Stat Med 2002;21:3035-3054
CrossRef | Web of Science | Medline21
Cave JA . Recent developments in Bell's palsy: does a more recent single research paper trump a systematic review? BMJ 2004;329:1103-1104
CrossRef | Web of Science | Medline22
Coulson SE ,Croxson GR ,Adams RD ,O'Dwyer NJ . Reliability of the “Sydney,” “Sunnybrook,” and “House Brackmann” facial grading systems to assess voluntary movement and synkinesis after facial nerve paralysis. Otolaryngol Head Neck Surg 2005;132:543-549
CrossRef | Web of Science | Medline23
Croxson G ,May M ,Mester SJ . Grading facial nerve function: House-Brackmann versus Burres-Fisch methods. Am J Otol 1990;11:240-246
Medline24
Ross BG ,Fradet G ,Nedzelski JM . Development of a sensitive clinical facial grading system. Otolaryngol Head Neck Surg 1996;114:380-386
CrossRef | Web of Science | Medline25
Hato N ,Matsumoto S ,Kisaki H , et al. Efficacy of early treatment of Bell's palsy with oral acyclovir and prednisolone. Otol Neurotol 2003;24:948-951
CrossRef | Web of Science | Medline26
Kawaguchi K ,Inamura H ,Abe Y , et al. Reactivation of herpes simplex virus type 1 and varicella-zoster virus and therapeutic effects of combination therapy with prednisolone and valacyclovir in patients with Bell's palsy. Laryngoscope 2007;117:147-156
CrossRef | Web of Science | Medline27
Hato N ,Yamada H ,Kohno H , et al. Valacyclovir and prednisolone treatment for Bell's palsy: a multicenter, randomized, placebo-controlled study. Otol Neurotol 2007;28:408-413
CrossRef | Web of Science | Medline
- Citing Articles (117)
Citing Articles
1
Ru-Lan Hsieh, Ling-Yi Wang, Wen-Chung Lee. (2013) Correlation between the incidence and severity of Bell's palsy and seasonal variations in Taiwan. International Journal of Neuroscience 123:7, 459-464
2
Marc H. Hohman, Linda N. Lee, Tessa A. Hadlock. (2013) Two-step highly selective neurectomy for refractory periocular synkinesis. The Laryngoscope 123:6, 1385-1388
3
R. McNamara, J. Doyle, M. Mc Kay, P. Keenan, F. E. Babl. (2013) Medium term outcome in Bell's palsy in children. Emergency Medicine Journal 30:6, 444-446
4
Ho Yun Lee, Jae Yong Byun, Moon Suh Park, Seung Geun Yeo. (2013) Steroid-antiviral Treatment Improves the Recovery Rate in Patients with Severe Bell's Palsy. The American Journal of Medicine 126:4, 336-341
5
Robert G. Kaniecki, Frederick R. Taylor, Stephen H. Landy. (2013) Abstracts and Citations. Headache: The Journal of Head and Face Pain 53:4, 689-698
6
Felicia D. Drack, Markus Weissert. (2013) Outcome of peripheral facial palsy in children – A catamnestic study. European Journal of Paediatric Neurology 17:2, 185-191
7
Thomas Berg, Lars Jonsson. (2013) Peripheral neuropathies: Corticosteroids and antivirals in Bell palsy. Nature Reviews Neurology
8
Joshua J. Thom, Matthew L. Carlson, Michael D. Olson, Brian A. Neff, Charles W. Beatty, George W. Facer, Colin L. W. Driscoll. (2013) The prevalence and clinical course of facial nerve paresis following cochlear implant surgery. The Laryngoscopen/a-n/a
9
B. In: Ferri's Clinical Advisor 2013. Elsevier, 2013:142-196.
10
Ho Yun Lee, Jae Yong Byun, Moon Suh Park, Seung Geun Yeo. (2013) Effect of Aging on the Prognosis of Bell’s Palsy. Otology & Neurotology1
11
Noha A. El Sawy, Enas M. Shahine, Abir S. Alhadidi, Ghada A. Achmawi, Nehal M. Alhabashy. (2012) Cellular immune response in prognosis of Bell’s palsy and its relation to clinical and electrophysiological findings. Alexandria Journal of Medicine 48:3, 233-240
12
J. Lagarde, A. Améri. (2012) Parálisis facial. EMC - Tratado de Medicina 16:3, 1-7
13
J. Lagarde, A. Améri. (2012) Paralisi facciale. EMC - AKOS - Trattato di Medicina 14:3, 1-7
14
Jacob Pitaro, Sofia Waissbluth, Sam J. Daniel. (2012) Do children with Bell's palsy benefit from steroid treatment? A systematic review. International Journal of Pediatric Otorhinolaryngology 76:7, 921-926
15
B. Jones. (2012) Bell's palsy: an overview. InnovAiT 5:7, 414-419
16
Mohammed Nadershah, Andrew Salama. (2012) Removal of Parotid, Submandibular, and Sublingual Glands. Oral and Maxillofacial Surgery Clinics of North America 24:2, 295-305
17
Eun Woong Ryu, Ho Yun Lee, So Yoon Lee, Moon Suh Park, Seung Geun Yeo. (2012) Clinical manifestations and prognosis of patients with Ramsay Hunt syndrome. American Journal of Otolaryngology 33:3, 313-318
18
Bo Huang, Shabei Xu, Jin Xiong, Guangying Huang, Min Zhang, Wei Wang. (2012) Psychological factors are closely associated with the Bell’s palsy: A case-control study. Journal of Huazhong University of Science and Technology [Medical Sciences] 32:2, 272-279
19
J. Lagarde, A. Améri. (2012) Paralysie faciale. EMC - Traité de médecine AKOS 7:2, 1-7
20
Fotios H. Tzermpos, Alina Cocos, Matthaios Kleftogiannis, Marissa Zarakas, Ioannis Iatrou. (2012) Transient Delayed Facial Nerve Palsy After Inferior Alveolar Nerve Block Anesthesia. Anesthesia Progress 59:1, 22-27
21
Robert D. M. Hadden. Peripheral nerve diseases. Informa Healthcare, 2012:242-248.
22
Glenn T. Clark. Top 60 Most Important Medications Used in an Orofacial Pain Treatment Center. In: Orofacial Pain. John Wiley & Sons, Inc., 2012:29-46.
23
N Julian Holland, Jonathan M Bernstein, John W Hamilton, N Julian Holland. Hyperbaric oxygen therapy for Bell's palsy. In: Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd, 2012.
24
Jean Tsai, Randall J. Cohrs, Maria A. Nagel, Ravi Mahalingam, D. Scott Schmid, Alexander Choe, Don Gilden. (2012) Reactivation of type 1 herpes simplex virus and varicella zoster virus in an immunosuppressed patient with acute peripheral facial weakness. Journal of the Neurological Sciences 313:1-2, 193-195
25
Keith McGinnis, Glen M. Bowen, Shawn Grimes, Randy G. Moon, Mark A. Hyde. (2012) Is this persistent tumor the cause of Bell palsy or something more severe?. Journal of the American Academy of Physician Assistants 25:2, E3-E5
26
Dae Han Chung, Dong Choon Park, Jae Yong Byun, Moon Suh Park, So Yoon Lee, Seung Geun Yeo. (2012) Prognosis of patients with recurrent facial palsy. European Archives of Oto-Rhino-Laryngology 269:1, 61-66
27
Noriko Kobayashi, Sachie Kawaguchi, Yasuo Ogawa, Koji Otsuka, Nobuhiro Nishiyama, Mamoru Suzuki. (2012) Facial Nerve Paralysis in Children: A Report of 29 Cases. Practica Oto-Rhino-Laryngologica 105:5, 417-422
28
The Nervous System. In: Conn's Current Therapy 2012. Elsevier, 2012:599-677.
29
Stephen A. Smith, Robert Ouvrier. Peripheral Neuropathies. In: Swaiman's Pediatric Neurology. Elsevier, 2012:1503-1531.
30
Michael E. Shy. Peripheral Neuropathies. In: Goldman's Cecil Medicine. Elsevier, 2012:2396-2409.
31
G. Wells, S. Williams, S. C. Davies. (2011) The Department of Health perspective on handling uncertainties in health sciences. Philosophical Transactions of the Royal Society A: Mathematical, Physical and Engineering Sciences 369:1956, 4853-4863
32
Lázaro J Teixeira, Juliana S Valbuza, Gilmar F Prado, Lázaro J Teixeira. Physical therapy for Bell's palsy (idiopathic facial paralysis). In: Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd, 2011.
33
Jonathan M. Fishman. (2011) Corticosteroids effective in idiopathic facial nerve palsy (Bell's Palsy) but not necessarily in idiopathic acute vestibular dysfunction (Vestibular Neuritis). The Laryngoscope 121:11, 2494-2495
34
M. Kunze, S. Arndt, A. Zimmer, M. Földi, A. Hanjalic-Beck, M. Echternach, R. Birkenhäger, A. Aschendorff. (2011) Periphere Fazialisparese in der Schwangerschaft. HNO
35
Hartmut Peter Burmeister, Pascal Andreas Thomas Baltzer, Gerd Fabian Volk, Carsten Michael Klingner, Anke Kraft, Matthias Dietzel, Otto Wilhelm Witte, Werner Alois Kaiser, Orlando Guntinas-Lichius. (2011) Evaluation of the early phase of Bell’s palsy using 3 T MRI. European Archives of Oto-Rhino-Laryngology 268:10, 1493-1500
36
Mikael L.-Å. Karlberg, Måns Magnusson. (2011) Treatment of Acute Vestibular Neuronitis With Glucocorticoids. Otology & Neurotology 32:7, 1140-1143
37
Susan Coulson, Glen R. Croxson, Roger Adams, Victoria Oey. (2011) Prognostic Factors in Herpes Zoster Oticus (Ramsay Hunt Syndrome). Otology & Neurotology 32:6, 1025-1030
38
Norihiko Takemoto, Arata Horii, Yoshiharu Sakata, Hidenori Inohara. (2011) Prognostic Factors of Peripheral Facial Palsy. Otology & Neurotology 32:6, 1031-1036
39
Jacob Alexander de Ru, Peter Paul G. van Benthem. (2011) Combination Therapy Is Preferable for Patients With Ramsay Hunt Syndrome. Otology & Neurotology 32:5, 852-855
40
Andreas Christoph Jenke, Lisa-Marie Stoek, Matthias Zilbauer, Stefan Wirth, Peter Borusiak. (2011) Facial palsy: Etiology, outcome and management in children. European Journal of Paediatric Neurology 15:3, 209-213
41
Valeria Pallavicini, Imma Danés Carreras. (2011) Eficacia de los glucocorticoides y los antivirales en el tratamiento de la parálisis de Bell. Medicina Clínica 136:11, 501-503
42
Pauline Lockhart, N Julian Holland, Iain Swan, Lázaro J Teixeira, Pauline Lockhart. Interventions for Bell's Palsy (idiopathic facial paralysis). In: Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd, 2011.
43
Kerrie McAllister, David Walker, Peter T Donnan, Iain Swan, Iain Swan. Surgical interventions for the early management of Bell's palsy. In: Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd, 2011.
44
Jong Dae Lee, Yang-Sun Cho, Ki Hong Jang, Ho Ki Lee, Ki Han Kwon. (2011) Acute Inflammatory Facial Nerve Paralysis. Korean Journal of Otorhinolaryngology-Head and Neck Surgery 54:6, 386
45
Daniel Bremell, Lars Hagberg. (2011) Clinical characteristics and cerebrospinal fluid parameters in patients with peripheral facial palsy caused by Lyme neuroborreliosis compared with facial palsy of unknown origin (Bell's palsy). BMC Infectious Diseases 11:1, 215
46
Sara Axelsson, Thomas Berg, Lars Jonsson, Mats Engström, Mervi Kanerva, Anne Pitkäranta, Anna Stjernquist-Desatnik. (2011) Prednisolone in Bell's Palsy Related to Treatment Start and Age. Otology & Neurotology 32:1, 141-146
47
Ho Yun Lee, Eun Woong Ryu, Soo Wan Park, Su Jin Kim, Seung Geun Yeo, Moon Suh Park. (2011) Analysis of Associated Symptoms of Bell's Palsy. Korean Journal of Otorhinolaryngology-Head and Neck Surgery 54:10, 683
48
Eric Smouha, Elizabeth Toh, Barry M. Schaitkin. (2011) Surgical treatment of Bell's palsy: Current attitudes. The Laryngoscopen/a-n/a
49
Kazuhiro Kawaguchi, Hiroo Inamura, Hiroyuki Maeyama, Hidehiro Kohsyu, Nobuaki Takahashi, Yasuhiro Abe, Kenichi Ishii, Takatoshi Furukawa, Masaru Aoyagi. (2011) Clinical Facial Nerve Clinic Survey. Practica oto-rhino-laryngologica. Suppl. 130, 18-25
50
Harvey B. Sarnat. Bell Palsy. In: Nelson Textbook of Pediatrics. Elsevier, 2011:2146-2147.
51
Christopher W. Mitchell, Tulio E. Bertorini. Principles and Guidelines of Immunotherapy in Neuromuscular Disorders. In: Neuromuscular Disorders: Treatment and Management. Elsevier, 2011:101-113.
52
Derek Power, Nancy Kemeny. Chemotherapy for metastatic colorectal cancer. In: Surgical Management of Hepatobiliary and Pancreatic Disorders, Second Edition. CRC Press, 2010:135-147.
53
Y Ramakrishnan, S Alam, A Kotecha, D Gillett, A D'Souza. (2010) Reanimation following facial palsy: present and future directions. The Journal of Laryngology & Otology 124:11, 1146-1152
54
M. Tariq Bhatti, Jade S. Schiffman, Anastas F. Pass, Rosa A. Tang. (2010) Neuro-ophthalmologic Complications and Manifestations of Upper and Lower Motor Neuron Facial Paresis. Current Neurology and Neuroscience Reports 10:6, 448-458
55
HV Worthington, A-M Glenny, L Fernandez Mauleffinch, F Daly, J Clarkson. (2010) Using Cochrane reviews for oral diseases. Oral Diseases 16:7, 592-596
56
Kalipso Chalkidou, Tom Walley. (2010) Using Comparative Effectiveness Research to Inform Policy and Practice in the UK NHS. PharmacoEconomics 28:10, 799-811
57
Elin Marsk, Lalle Hammarstedt, Thomas Berg, Mats Engström, Lars Jonsson, Malou Hultcrantz. (2010) Early Deterioration in Bell's Palsy. Otology & Neurotology1
58
Y. L. Lo, S. Fook-Chong, T.H. Leoh, Y. F. Dan, M. P. Lee, H. Y. Gan, L. L. Chan. (2010) High-resolution ultrasound in the evaluation and prognosis of Bell’s palsy. European Journal of Neurology 17:6, 885-889
59
M. Grosheva, D. Beutner, G.F. Volk, C. Wittekindt, O. Guntinas-Lichius. (2010) Die idiopathische Fazialisparese. HNO 58:5, 419-425
60
O. Guntinas-Lichius. (2010) Erkrankungen des N. facialis. HNO 58:5, 417-418
61
P. Wallace. (2010) Research in general practice and primary care. InnovAiT 3:5, 298-301
62
H E Cha, M K Baek, J H Yoon, B K Yoon, M J Kim, J H Lee. (2010) Clinical features and management of facial nerve paralysis in children: analysis of 24 cases. The Journal of Laryngology & Otology 124:04, 402
63
Rodrigo A Salinas, Gonzalo Alvarez, Fergus Daly, Joaquim Ferreira, Rodrigo A Salinas. Corticosteroids for Bell's palsy (idiopathic facial paralysis). In: Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd, 2010.
64
J.K. Hoang, J.D. Eastwood, C.M. Glastonbury. (2010) What's in a name? Eponyms in head and neck imaging. Clinical Radiology 65:3, 237-245
65
&NA;. (2010) Whatʼs in the Literature?. Journal of Clinical Neuromuscular Disease 11:3, 158-163
66
Greg M. Thaera, Kay E. Wellik, David M. Barrs, Erika D. Driver Dunckley, Dean M. Wingerchuk, Bart M. Demaerschalk. (2010) Are Corticosteroid and Antiviral Treatments Effective for Bell Palsy?. The Neurologist 16:2, 138-140
67
C Bodénez, I Bernat, J-C Willer, P Barré, G Lamas, F Tankéré. (2010) Facial nerve decompression for idiopathic Bell's palsy: report of 13 cases and literature review. The Journal of Laryngology & Otology 124:03, 272
68
Cheng-Hsien Wang, Yu-Che Chang, Hong-Mo Shih, Chun-Yu Chen, Jih-Chang Chen. (2010) Facial Palsy in Children. Pediatric Emergency Care 26:2, 121-125
69
Thomas E. Linder, Wael Abdelkafy, Sandra Cavero-Vanek. (2010) The Management of Peripheral Facial Nerve Palsy. Otology & Neurotology 31:2, 319-327
70
G.G. Browning. (2010) Bell’s palsy: a review of three systematic reviews of steroid and anti-viral therapy. Clinical Otolaryngology 35:1, 56-58
71
Jin Kim, In Seok Moon, Won-Sang Lee. (2010) Effect of delayed decompression after early steroid treatment on facial function of patients with facial paralysis. Acta Oto-laryngologica 130:1, 179-184
72
Brian A. Stettler. Brain and Cranial Nerve Disorders. In: Rosen's Emergency Medicine – Concepts and Clinical Practice. Elsevier, 2010:1379-1388.
73
JOSHUA T. SCHIFFER, LAWRENCE COREY. Herpes Simplex Virus. In: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. Elsevier, 2010:1943-1962.
74
FRED Y. AOKI, FREDERICK G. HAYDEN, RAPHAEL DOLIN. Antiviral Drugs (Other than Antiretrovirals). In: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. Elsevier, 2010:565-610.
75
Douglas E. Mattox. Clinical Disorders of the Facial Nerve. In: Cummings Otolaryngology - Head and Neck Surgery. Elsevier, 2010:2391-2402.
76
A. Varoquaux, P. Cassagneau, O. Monnet, F. Chapon, G. Moulin. Imagerie du nerf facial. In: Imagerie en ORL. Elsevier, 2010:353-365.
77
Jessica Robinson-Papp, David M. Simpson. (2009) Neuromuscular diseases associated with HIV-1 infection. Muscle & Nerve 40:6, 1043-1053
78
Ribhi Hazin, Babak Azizzadeh, M Tariq Bhatti. (2009) Medical and surgical management of facial nerve palsy. Current Opinion in Ophthalmology 20:6, 440-450
79
Pauline Lockhart, Fergus Daly, Marie Pitkethly, Natalia Comerford, Frank Sullivan, Pauline Lockhart. Antiviral treatment for Bell's palsy (idiopathic facial paralysis). In: Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd, 2009.
80
Thomas Berg, Elin Marsk, Mats Engström, Malou Hultcrantz, Nermin Hadziosmanovic, Lars Jonsson. (2009) The effect of study design and analysis methods on recovery rates in Bell's palsy. The Laryngoscope 119:10, 2046-2050
81
Thomas Berg, Sara Axelsson, Mats Engström, Anna Stjernquist-Desatnik, Anne Pitkäranta, Mervi Kanerva, Lars Jonsson. (2009) The Course of Pain in Bell's Palsy. Otology & Neurotology 30:6, 842-846
82
C. Simon. (2009) Peripheral neuropathy. InnovAiT 2:9, 538-545
83
Gregory S. Kosmorsky, Alyssa Fiddler. (2009) Selected lid problems in neurologic practice. Current Neurology and Neuroscience Reports 9:5, 390-395
84
Don Gilden. (2009) Is antiviral medication for severe Bell's palsy still useful? – Author's reply. The Lancet Neurology 8:6, 510
85
Robert S. Crausman, Eleanor M. Summerhill, F. Dennis McCool. (2009) Idiopathic Diaphragmatic Paralysis: Bell’s Palsy of the Diaphragm?. Lung 187:3, 153-157
86
Sebastian Oliver Decker, Frieder Keller, Jens Mayer, Sylvia Stracke. (2009) Twice Daily Fractionated Dose Administration of Prednisolone Compared to Standard Once Daily Administration to Patients with Glomerulonephritis or with Kidney Transplants*. Medizinische Klinik 104:6, 429-433
87
J Alexander de Ru, Peter Paul G van Benthem, Luuk M Janssen. (2009) Is antiviral medication for severe Bell's palsy still useful?. The Lancet Neurology 8:6, 509
88
Rodrigo A Salinas, Gonzalo Alvarez, Joaquim Ferreira, Rodrigo A Salinas. Corticosteroids for Bell's palsy (idiopathic facial paralysis). In: Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd, 2009.
89
R. Hernandez, F Sullivan, P Donnan, I Swan, L Vale, . (2009) Economic evaluation of early administration of prednisolone and/or aciclovir for the treatment of Bell's palsy. Family Practice 26:2, 137-144
90
Kenneth L Tyler. (2009) Prednisolone—but not antiviral drugs—improves outcome in patients with Bell's palsy. Nature Clinical Practice Neurology 5:2, 74-75
91
Shigeru Hoshida, Miyako Hatano, Mitsuru Furukawa, Makoto Ito. (2009) Neuroprotective effects of vitamin E on adult rat motor neurones following facial nerve avulsion. Acta Oto-laryngologica 129:3, 330-336
92
Won Sang Lee, Jin Kim. (2009) Facial Nerve Paralysis and Surgical Management. Journal of the Korean Medical Association 52:8, 807
93
F. Tankéré, C. Bodénez. (2009) Parálisis facial. EMC - Tratado de Medicina 13:2, 1-8
94
F. Tankéré, C. Bodénez. (2009) Paralysie faciale. EMC - Traité de médecine AKOS 4:1, 1-7
95
Don Gilden. (2008) Treatment of Bell's palsy—the pendulum has swung back to steroids alone. The Lancet Neurology 7:11, 976-977
96
Jong-Lyel Roh, Chan Il Park. (2008) A prospective, randomized trial for use of prednisolone in patients with facial nerve paralysis after parotidectomy. The American Journal of Surgery 196:5, 746-750
97
Mats Engström, Thomas Berg, Anna Stjernquist-Desatnik, Sara Axelsson, Anne Pitkäranta, Malou Hultcrantz, Mervi Kanerva, Per Hanner, Lars Jonsson. (2008) Prednisolone and valaciclovir in Bell's palsy: a randomised, double-blind, placebo-controlled, multicentre trial. The Lancet Neurology 7:11, 993-1000
98
Martina Minnerop, Martin Herbst, Rolf Fimmers, Bertfried Matz, Thomas Klockgether, Ullrich Wüllner. (2008) Bell’s palsy. Journal of Neurology 255:11, 1726-1730
99
Iain Swan, Peter Donnan, Kerrie McAllister, David Walker, Iain Swan. Surgical interventions for the early management of Bell's palsy. In: Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd, 2008.
100
Naohito Hato, Naoki Sawai, Masato Teraoka, Hiroyuki Wakisaka, Hirotaka Takahashi, Yasuyuki Hinohira, Kiyofumi Gyo. (2008) Valacyclovir for the treatment of Bell's palsy. Expert Opinion on Pharmacotherapy 9:14, 2531-2536
101
Naohito Hato, Shingo Murakami, Kiyofumi Gyo. (2008) Treatment for Bell's palsy – Authors' reply. The Lancet 372:9645, 1220-1221
102
Richard J Davenport, Frank Sullivan, Blair Smith, Jill Morrison, Brian McKinstry. (2008) Treatment for Bell's palsy. The Lancet 372:9645, 1219-1220
103
Daron Cope, Ronaldo Bova. (2008) Steroids in Otolaryngology. The Laryngoscope 118:9, 1556-1560
104
Lázaro Juliano Teixeira, Bernardo Garcia de Oliveira Soares, Vanessa Pedrosa Vieira, Gilmar F Prado, Lázaro Juliano Teixeira. Physical therapy for Bell´s palsy (idiopathic facial paralysis). In: Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd, 2008.
105
N Julian Holland, Jonathan M Bernstein, John Hamilton, N Julian Holland. Hyperbaric oxygen therapy for Bell's palsy. In: Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd, 2008.
106
Zainab A. Malik, Nathan Litman. (2008) A 17-Year-Old Boy With Facial Palsy and Hyperacusis. The Pediatric Infectious Disease Journal 27:7, 646, 674-675
107
P. Duhaut. (2008) L’examen national classant (ENC) quatre années après sa mise en place : qu’en penser ?. La Revue de Médecine Interne 29:7, 531-534
108
Josef Finsterer. (2008) Management of peripheral facial nerve palsy. European Archives of Oto-Rhino-Laryngology 265:7, 743-752
109
Richard A. C. Hughes. (2008) Treating nerves: a call to arms. Journal of the Peripheral Nervous System 13:2, 105-111
110
John J. Halperin. (2008) Nervous System Lyme Disease. Infectious Disease Clinics of North America 22:2, 261-274
111
Hnin Khine, Marguerite Mayers, Jeffrey R. Avner, Amy Fox, Betsy Herold, David L. Goldman. (2008) ASSOCIATION BETWEEN HERPES SIMPLEX VIRUS-1 INFECTION AND IDIOPATHIC UNILATERAL FACIAL PARALYSIS IN CHILDREN AND ADOLESCENTS. The Pediatric Infectious Disease Journal 27:5, 468-469
112
Naohito Hato, Shingo Murakami, Kiyofumi Gyo. (2008) Steroid and antiviral treatment for Bell's palsy. The Lancet 371:9627, 1818-1820
113
(2008) Prednisolone or Acyclovir in Bell's Palsy. New England Journal of Medicine 358:3, 306-307
Free Full Text114
A. Verma. (2008) Early Treatment with Prednisolone or Acyclovir in Bell's Palsy. Yearbook of Neurology and Neurosurgery 2008, 128-130
115
Kurt Samson. (2007) Antiviral Therapy Found to Have Little Benefit in Bell Palsy; Prednisolone Monotherapy Works Best. Neurology Today 7:22, 1,24-25
116
Gilden , Donald H. , Tyler , Kenneth L. , . (2007) Bell's Palsy — Is Glucocorticoid Treatment Enough?. New England Journal of Medicine 357:16, 1653-1655
Full Text117
Rodrigo A Salinas, Gonzalo Alvarez, Joaquim Ferreira, Rodrigo A Salinas. Corticosteroids for Bell's palsy (idiopathic facial paralysis). In: Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd, 2004.
- Letters
