On 7 October 2014 we searched the Cochrane
Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE, EMBASE, LILACS, DARE, NHS EED, and HTA. We also reviewed the bibliographies of the identified trials and contacted trial authors and known experts in the field and relevant
drug companies to identify additional published or unpublished data. We searched clinical trials registries for ongoing studies.
SELECTION CRITERIA: Pairs of authors independently assessed trials for relevance, eligibility, and risk of bias, using standard Cochrane procedures.
MAIN RESULTS: Eleven trials, including 2883 participants, met the inclusion criteria and are included in the final analysis. We added four studies to the previous review for this update. Some of the trials were small, and a number were at high or unclear risk of bias. Other trials did not meet current best standards in allocation concealment and blinding. Incomplete recoveryWe found no significant benefit from adding
antivirals to
corticosteroids in comparison with
corticosteroids alone for people with
Bell's palsy (risk ratio (RR) 0.69, 95% confidence interval (CI) 0.47 to 1.02, n = 1715). For people with severe
Bell's palsy (House-Brackmann scores of 5 and 6 or the equivalent in other scales), we found a reduction in the rate of incomplete recovery at month six when
antivirals plus
corticosteroids were used (RR 0.64, 95% CI 0.41 to 0.99, n = 478). The outcome for the participants receiving
corticosteroids alone was significantly better than for those receiving
antivirals alone (RR 2.09, 95% CI 1.36 to 3.20, n = 1169). The treatment effect of placebo was significantly lower than that of
antivirals plus
corticosteroids (RR 0.56, 95% CI 0.41 to 0.76, n = 658).
Antivirals alone had a non-significant detrimental effect on the outcome compared with placebo (RR 1.10, 95% CI 0.87 to 1.40, n = 658). Motor
synkinesis or crocodile tearsIn three trials comparing
antivirals and
corticosteroids with
corticosteroids and placebo that assessed this outcome, we found a significant difference in long-term sequelae in favour or
antivirals plus
corticosteroids (RR 0.73, 95% CI 0.54 to 0.99, n = 869). Three trials comparing
antivirals alone with
corticosteroids alone investigating this outcome showed fewer sequelae with
corticosteroids (RR 1.44, 95% CI 1.11 to 1.85, n = 873). We found no data on long-term sequelae for other comparisons. Adverse events Adverse event data were available in three studies giving comparison data on 1528 participants. None of the four comparisons (
antivirals plus
corticosteroids versus
corticosteroids plus placebo or no treatment;
antivirals versus
corticosteroids;
antivirals plus
corticosteroids versus placebo;
antivirals versus placebo) showed significant differences in adverse events between treatment and control arms. We could find no correlation with specific treatment within these results.
AUTHORS' CONCLUSIONS: