Editor—I am a jobbing general practitioner, and the paper by Holland and Weiner on Bell's palsy left me confused.1 To treat somebody is a hard decision—not to treat somebody, even harder.
In 2002 the BMJ published an article about recent advances in neurology that proposed that there might be a case for prednisolone but none so far for antiviral agents.2 This was based on systematic reviews.
This article quotes from just two more recent papers (Axelsson et al and Murakami et al3,4) and says that now the evidence base is clearly in favour of using antivirals. Given that further randomised controlled trials are in the pipeline, the authors' full support of antiviral use is more opinion than evidence, is it not?
Does a single more recent research paper trump a previous systematic review?
I was also concerned by the statement in the blue box at the start of the paper that claimed under recent developments that treatment of partial Bell's palsy is controversial: a few patients don't recover if left untreated. Is it not also true that a few patients don't recover even if treated?
In addition, I thought the article muddled and unhelpful. Should patients be admitted? What do the authors mean by psychological support?
Every year or so when I see a case of Bell's palsy I phone my local teaching hospital and ask the neurology registrar what the latest news is. The only thing I learnt from this article is perhaps I also ought to ask the registrar in ear, nose, and throat medicine too: perhaps we could have a live debate?
Competing interests: None declared.
References
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