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Background:
Cochrane review*:
“There is insufficient evidence about the effects of corticosteroids
for people with Bell's palsy, although their anti-inflammatory effect
might prevent nerve damage.”
*Salinas RA, Alvarez G, Ferreira J. Corticosteroids for Bell's palsy (idiopathic facial
paralysis). Cochrane Database of Systematic Reviews 2004, Issue 4. Art. No.:
CD001942.
Management, Antivirals
Antivirals:
Cochrane review*:
“More evidence is needed to show whether the antiviral drugs
acyclovir or valacyclovir are effective in aiding recovery from
Bell's palsy.”
* Allen D, Dunn L. Acyclovir or valaciclovir for Bell's palsy (idiopathic facial paralysis).
Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD001869.
Outcomes:
Electroneurography: ENoG :
Indication: complete paralysis<3wks
Interpretation: < 90% degeneration:
prognosis is good; > or = 90%:
prognosis is question
Limitation: False-positive results in
deblocking phase.
Labs:
Electromyography: EMG
Indication: Acute paralysis less than 1 week or
chronic paralysis longer than 2 weeks
Interpretation:
● Active mu: intact motor axons
● Mu + fibrillation potentials: partial degeneration
● Polyphasic mu: regenerating nerve
Limitation: cannot assess degree of degeneration or
prognosis for recovery.