Evidence-based guideline update: Steroids and antivirals for Bell palsy Report of the Guideline Development Subcommittee of the American Academy of Neurology
Evidence-based guideline update: Steroids and antivirals for Bell palsy Report of the Guideline Development Subcommittee of the American Academy of Neurology
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DOI：
10.1212/wnl.0b013e318275978c
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发表时间：
2012-11-01
期刊：
影响因子：
9.9
通讯作者：
Paduga, Remia
中科院分区：
文献类型：
--
作者：
Gronseth, Gary S.;Paduga, Remia
目的：回顾自2001年美国神经病学学会（AAN）实践参数以来发表的关于类固醇和抗病毒剂治疗贝尔麻痹的有效性、安全性和耐受性的证据。我们检索了Medline和科克伦对照临床试验数据库，以查找自2000年1月以来发表的比较贝尔麻痹患者接受类固醇治疗与非类固醇治疗的面部功能结局的研究。与未接受这些药物治疗的患者一起使用抗病毒药物。我们使用AAN治疗证据分类方案对每项研究（I-IV类）进行分级。我们比较了治疗组中面部功能恢复的患者比例与对照组中面部功能恢复的患者比例。结果：自2000年6月以来发表的9项关于贝尔麻痹患者接受类固醇/抗病毒药物的研究被确定。这些研究中的两个被评为I类，因为高的方法学quality.Conclusions和建议：对于新发贝尔麻痹患者，类固醇很可能是有效的，应提供面神经功能恢复的概率增加（2 I类研究，A级）（风险差异12.8%-15%）。对于新发贝尔麻痹患者，抗病毒药物联合类固醇不会使面部功能恢复的概率增加> 7%。由于恢复的可能性略有增加，可能会向患者提供抗病毒药物（除类固醇外）（C级）。应告知接受抗病毒药物治疗的患者，抗病毒药物的益处尚未确定，即使有益处，也可能是适度的。神经病学（R）2012;79：2209-2213
Objective: To review evidence published since the 2001 American Academy of Neurology (AAN) practice parameter regarding the effectiveness, safety, and tolerability of steroids and antiviral agents for Bell palsy.Methods: We searched Medline and the Cochrane Database of Controlled Clinical Trials for studies published since January 2000 that compared facial functional outcomes in patients with Bell palsy receiving steroids/antivirals with patients not receiving these medications. We graded each study (Class I-IV) using the AAN therapeutic classification of evidence scheme. We compared the proportion of patients recovering facial function in the treated group with the proportion of patients recovering facial function in the control group.Results: Nine studies published since June 2000 on patients with Bell palsy receiving steroids/antiviral agents were identified. Two of these studies were rated Class I because of high methodologic quality.Conclusions and Recommendations: For patients with new-onset Bell palsy, steroids are highly likely to be effective and should be offered to increase the probability of recovery of facial nerve function (2 Class I studies, Level A) (risk difference 12.8%-15%). For patients with new-onset Bell palsy, antiviral agents in combination with steroids do not increase the probability of facial functional recovery by >7%. Because of the possibility of a modest increase in recovery, patients might be offered antivirals (in addition to steroids) (Level C). Patients offered antivirals should be counseled that a benefit from antivirals has not been established, and, if there is a benefit, it is likely that it is modest at best. Neurology (R) 2012;79:2209-2213