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Oral prednisolone, given early, is the best treatment for Bell's palsy, according to a randomised trial from Scotland. Among patients treated within 72 hours, 10 days of prednisolone 50 mg increased the chances of full recovery at three months from 63.6% to 83.0%, compared with placebo (P<0.001). Treatment also increased the chance of a full recovery at nine months (94.4% v 81.6%, P<0.001). Aciclovir, another common treatment for Bell's palsy, worked no better than placebo in this trial. The combination of aciclovir and prednisolone worked no better than prednisolone alonealone.
These findings provide good evidence to support what doctors have been doing for years—giving glucocorticoids as early as possible to people with Bell's palsy, says an editorial (p 1653). They also confirm that most people get better from this distressing disfigurement within nine months or so, even without treatment.
The poor performance of aciclovir was more of a surprise. Bioavailability may be part of the problem, says the editorial. It is still worth investigating valaciclovir, a prodrug of aciclovir that increases bioavailability threefold to fivefold.