On Sun 25 Jan, Robert Treharne Jones wrote:
> Chap turned up the other evening with a vague ache down the left side of his neck, no
> nodes, and some tingling at the angle of his mouth - on the other side. I had no idea
> what it was, and told him so - see SOS etc.
>
> The next day, presumably cliically advanced, he presents in A&E and the make the diagn
> osis of Bell's palsy. They give him a week's course of high-dose oral steroids. Who di
> d they do this?
>
> a. Tried, trusted, and medically approved, according to recent EBM
> b. They had to do something, and it seemed like a good idea
> c. Something else.
I saw a lady with Bell's palsy recently, given Acyclovir by hospital, immediate
good result. Unfortunately she has now gone on to get it the other side so has had
another course, with good results so far.
Is bilateral Bell's very rare? I've never seen it before. She is off for an MRI as
next investigation.
Our local ?EBM approach has been to give Acyclovir or one of the equivalents at full
shingles dose for a week. From my experience it works better than the steroids ever did
and if as proposed this is a herpes viral infection the logic is impeccable, even if it
does hammer the drug budget.
I'm always fairly keen on the antivirals with zoster, I'm sure it saves a lot of future
grief and pain. A poor result from Bell's palsy is cosmetically very disfiguring so if
it works we should use it.
--
Allan Harris, GP, Haxby, York YO3 3PH
tel 01904-768666
work 01904-760125, fax 750168
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