A 10-day course of prednisolone soon after paralysis begins seems to be your best choice for treating Bell’s palsy. That protocol significantly beat both an anti-viral agent and placebo in a recent double-blind trial.

Researchers at the University of Dundee in Scotland recruited 496 patients within 72 hours of developing symptoms. “For many years, clinicians have based their decision to prescribe steroids and/or antivirals on anecdotal evidence. This study provides evidence that prednisolone is beneficial, while acyclovir is not, and therefore answers a persistent clinical uncertainty,” said lead author Frank M. Sullivan, PhD, director of the Scottish School of Primary Care.

Participants were randomly assigned to 10-day regimens to compare the effectiveness of prednisolone (25 mg twice a day) with acyclovir (Zovirax 400 mg five times a day), both separately and together. A fifth group took only placebo (lactose). At the three-month mark, 83% of those who received the steroid had recovered, compared with 63.6% of those who did not.

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The acyclovir arm was less impressive. The recovery rates for those who took it compared with those who didn’t were 71.2% vs. 75.7%. No one reported significant side effects (N Engl J Med. 2007;357:1598-1607).