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BELL’S PALSY

Population

  • –Adults with Bell’s palsy.

Recommendation

AAN 2012, reaffirmed in 2014

  • –For patients with recent-onset Bell’s palsy (<72 h of symptoms):

    • Steroids are recommended to increase the probability of facial nerve recovery—Level A.

      • Prednisone 1 mg/kg PO daily × 7 d.

    • Antivirals (eg, acyclovir or valacyclovir) × 7 d given with steroids marginally improves outcomes compared with steroid monotherapy—Level C.

Source

Comment

  1. Antivirals are thought to have a marginal effect at best of facial nerve recovery when added to steroids. The benefit is <7%.

Population

  • –Adult and children with Bell’s palsy.

Recommendations

AAO 2013, Cochrane Database of Systematic Reviews 2015

  • –No routine lab studies needed for unequivocal Bell’s palsy, consider Lyme disease testing in children <15 y.

  • –Recommend against routine diagnostic imaging for straightforward Bell’s palsy.

  • –Recommend oral steroids for Bell’s palsy with or without antiviral medications if initiated within 72 h of symptom onset in patients 16 y and older.

  • –Recommend against antiviral monotherapy for Bell’s palsy.

  • –Recommend eye protection for patients with incomplete eye closure.

  • –Inadequate evidence to support surgical decompression with Bell’s palsy.

  • –Recommend against electrodiagnostic testing for Bell’s palsy with incomplete facial paralysis.

  • –Recommend against physical therapy or acupuncture for Bell’s palsy.

Sources

Comment

  1. Cochrane analysis found no benefit of adding antivirals to corticosteroids vs. corticosteroid monotherapy.

CONCUSSIONS

Population

  • –Children and young adults.

Recommendations

CDC 2016, ACEP 2016

  • –No evidence MRI is better than CT.

  • –Noncontrast CT indicated for loss of consciousness or post-traumatic amnesia.

  • –Mild TBI with negative intracranial process is low risk.

  • –All patients must be educated and given materials about concussions and postconcussive syndrome.

Source

AAN 2013

  • –Standardized sideline assessment tools should be used to assess athletes with suspected concussions.

  • –Teams should immediately remove from play any athlete with a suspected concussion.

  • –Teams should not permit an athlete to return to play until he/she has been cleared to play by a licensed health care professional.

Source

EPILEPSY

Population

  • –Children and adults.

Recommendations

NICE 2012

  • –Educate adults about all aspects of epilepsy.

  • –Diagnosis of epilepsy should be made by a specialist in epilepsy.

  • –Evaluation of epilepsy

    • Electroencephalogram.

    • Sleep-deprived EEG if standard EEG is inconclusive.

    • Neuroimaging to evaluate for any structural brain abnormalities.

      • MRI is preferred for children <2 y, adults, refractory seizures, and focal seizures.

    • Measurement of prolactin is not recommended.

    • Chemistry ...

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