Each year in the UK around 1 in 5,000 people develop Bell's palsy—idiopathic unilateral lower motor neurone facial weakness of rapid onset. Although about 70% recover spontaneously, the remaining 30% are at risk of complications;1 13% have residual slight weakness and about 16% have persistent moderate to severe weakness if not treated.2 As we have discussed in two previous articles there has been longstanding controversy about the best form of treatment.2,3 In 2006 we concluded that published trials on the efficacy of drug treatments have been poor and no firm conclusions can be drawn about the benefit of any single drug;2 in 2008 we noted that evidence suggests oral prednisolone started within 72 hours of symptom onset makes recovery more likely and that there was little good evidence that an antiviral drug helps.3 The place of antivirals in the management of Bell's palsy remains a controversial issue. In this article we review the evidence for antiviral therapy alone or in conjunction with corticosteroid treatment.
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