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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):

    • Give steroids (prednisone 1 mg/kg PO daily × 7 d) to increase the probability of facial nerve recovery.

    • Consider antivirals (eg, acyclovir or valacyclovir) × 7 d, which given with steroids marginally improve outcomes.

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

  • Do not routinely obtain lab studies for unequivocal Bell’s palsy. Consider Lyme disease (neuroborreliosis) 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

  • Obtain noncontrast CT indicated for loss of consciousness or post-traumatic amnesia. There is no evidence to prefer MRI over CT.

  • Mild TBI with negative intracranial process is low risk.

  • All patients must be educated and given materials about concussions and postconcussive syndrome. Use of tools such as the Acute Concussion Evaluation (ACE) care plan developed by Gioia and Collins for follow-up management.

Sources

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 2018

  • Educate adults about all aspects of epilepsy.

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

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