{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T02:15:19Z","timestamp":1783476919594,"version":"3.55.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,4,18]],"date-time":"2022-04-18T00:00:00Z","timestamp":1650240000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>The objective was to comprehensively assess the efficacy and safety of all pharmacological and physical treatments (short-term, \u2264 1 month) for patients with acute Bell's palsy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The electronic databases PubMed, Web of Science, Embase, Cochrane Library, and CNKI were searched for the randomized controlled trials comparing two or more regimens in patients with the Bell's palsy to be included in a Bayesian network meta-analysis. Odds ratios and CIs for the primary outcome of the House\u2013Brackmann scale and secondary outcomes of sequelae (synkinesis and crocodile tears) and adverse events were obtained and subgroup analyses of steroids and antivirals were conducted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 26 studies representing 3,609 patients having undergone 15 treatments matched our eligibility criteria. For facial recovery, acupuncture plus electrical stimulation, steroid plus antiviral plus Kabat treatment, and steroid plus antiviral plus electrical stimulation were the top three options based on analysis of the treatment ranking (probability = 84, 80, and 77%, respectively). Steroid plus antiviral plus electrical stimulation had the lowest rate of sequelae but were more likely to lead to mild adverse events. Subgroup analysis revealed that methylprednisolone and acyclovir were likely to be the preferred option.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This network meta-analysis indicated that combined therapies, especially steroid plus antiviral plus Kabat treatment, were associated with a better facial function recovery outcome than single therapy. Other physical therapies, such as acupuncture plus electrical stimulation, may be a good alternative for people with systemic disease or allergies. More high-quality trials of physical regimens are needed in the future.<\/jats:p><\/jats:sec><jats:sec><jats:title>Systematic Review Registration<\/jats:title><jats:p>Our registered PROSPERO number is CRD42021275486 and detailed information can be found at <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/<\/jats:ext-link>.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2022.868121","type":"journal-article","created":{"date-parts":[[2022,4,18]],"date-time":"2022-04-18T04:53:28Z","timestamp":1650257608000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":15,"title":["Efficacy and Safety of Pharmacological and Physical Therapies for Bell's Palsy: A Bayesian Network Meta-Analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Jianwei","family":"Shi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dafeng","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hairong","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingzhu","family":"Shu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaojiao","family":"Qian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ke","family":"Ouyang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huaying","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhengxiang","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunhui","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yansong","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,4,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1080\/000164802320401694","article-title":"Acta Otolaryngol Suppl","year":"2002"},{"key":"B2","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1177\/0194599813506835","article-title":"Clinical practice guideline: Bell's palsy","volume":"149","author":"Baugh","year":"2013","journal-title":"Otolaryngol Head Neck Surg."},{"key":"B3","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1136\/bmj.329.7465.553","article-title":"Recent developments in Bell's palsy","volume":"329","author":"Holland","year":"2004","journal-title":"BMJ."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1582","DOI":"10.1002\/jmv.21849","article-title":"Early and reliable detection of herpes simplex virus type 1 and varicella zoster virus DNAs in oral fluid of patients with idiopathic peripheral facial nerve palsy: decision support regarding antiviral treatment?","volume":"82","author":"Lackner","year":"2010","journal-title":"J Med Virol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1356","DOI":"10.1136\/jnnp-2014-309563","article-title":"Bell's palsy: aetiology, clinical features and multidisciplinary care","volume":"86","author":"Eviston","year":"2015","journal-title":"J Neurol Neurosurg Psychiatry."},{"key":"B6","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1016\/S0140-6736(72)91499-7","article-title":"Herpes-simplex virus as a cause of Bell's palsy","volume":"1","author":"McCormick","year":"1972","journal-title":"Lancet."},{"key":"B7","doi-asserted-by":"publisher","first-page":"692","DOI":"10.3238\/arztebl.2019.0692","article-title":"The diagnosis and treatment of idiopathic facial paresis (Bell's Palsy)","volume":"116","author":"Heckmann","year":"2019","journal-title":"Dtsch Arztebl Int."},{"key":"B8","doi-asserted-by":"publisher","first-page":"CD006283","DOI":"10.1002\/14651858.CD006283.pub3","article-title":"Physical therapy for Bell's palsy (idiopathic facial paralysis)","volume":"12","author":"Teixeira","year":"2011","journal-title":"Cochr Database Syst Rev"},{"key":"B9","doi-asserted-by":"publisher","first-page":"CD001942","DOI":"10.1002\/14651858.CD001942.pub5","article-title":"Corticosteroids for Bell's palsy (idiopathic facial paralysis)","volume":"7","author":"Madhok","year":"2016","journal-title":"Cochrane Database Syst Rev."},{"key":"B10","doi-asserted-by":"publisher","first-page":"CD001869","DOI":"10.1002\/14651858.CD001869.pub9","article-title":"Antiviral treatment for Bell's palsy (idiopathic facial paralysis)","volume":"9","author":"Gagyor","year":"2019","journal-title":"Cochrane Database Syst Rev."},{"key":"B11","doi-asserted-by":"publisher","first-page":"985","DOI":"10.1001\/jama.2009.1243","article-title":"Combined corticosteroid and antiviral treatment for Bell palsy: a systematic review and meta-analysis","volume":"302","author":"de Almeida","year":"2009","journal-title":"JAMA."},{"key":"B12","doi-asserted-by":"publisher","first-page":"559","DOI":"10.36076\/ppj.2018.6.559","article-title":"A Network meta-analysis to compare the efficacy of steroid and antiviral medications for facial paralysis from Bell's palsy","volume":"21","author":"Fu","year":"2018","journal-title":"Pain Physician."},{"key":"B13","doi-asserted-by":"publisher","first-page":"CD001942","DOI":"10.1002\/14651858.CD001942.pub4","article-title":"Corticosteroids for Bell's palsy (idiopathic facial paralysis)","volume":"17","author":"Salinas","year":"2010","journal-title":"Cochrane Database Syst Rev"},{"key":"B14","doi-asserted-by":"publisher","first-page":"917","DOI":"10.1503\/cmaj.131801","article-title":"Management of Bell palsy: clinical practice guideline","volume":"186","author":"de Almeida","year":"2014","journal-title":"CMAJ."},{"key":"B15","doi-asserted-by":"publisher","first-page":"2209","DOI":"10.1212\/WNL.0b013e318275978c","article-title":"American Academy of N. Evidence-based guideline update: steroids and antivirals for Bell palsy: report of the Guideline Development Subcommittee of the American Academy of Neurology","volume":"79","author":"Gronseth","year":"2012","journal-title":"Neurology."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3109\/13550280903552446","article-title":"Herpes simplex virus type 1 and Bell's palsy-a current assessment of the controversy","volume":"16","author":"Kennedy","year":"2010","journal-title":"J Neurovirol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"CD002914","DOI":"10.1002\/14651858.CD002914.pub5","article-title":"Acupuncture for Bell's palsy","volume":"8","author":"Chen","year":"2010","journal-title":"Cochrane Database Syst Rev."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1615","DOI":"10.1002\/lary.29368","article-title":"Pharmacological treatments of Bell's palsy in adults: a systematic review and network meta-analysis","volume":"131","author":"Jalali","year":"2021","journal-title":"Laryngoscope."},{"key":"B19","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1016\/j.jclinepi.2017.10.005","article-title":"Advances in the GRADE approach to rate the certainty in estimates from a network meta-analysis","volume":"93","author":"Brignardello-Petersen","year":"2018","journal-title":"J Clin Epidemiol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1002\/jrsm.1044","article-title":"Consistency and inconsistency in network meta-analysis: concepts and models for multi-arm studies","volume":"3","author":"Higgins","year":"2012","journal-title":"Res Synth Methods."},{"key":"B21","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1186\/s12874-015-0060-8","article-title":"Ranking treatments in frequentist network meta-analysis works without resampling methods","volume":"15","author":"R\u00fccker","year":"2015","journal-title":"BMC Med Res Methodol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1086\/313721","article-title":"High prevalence of varicella-zoster virus reactivation in herpes simplex virus-seronegative patients with acute peripheral facial palsy","volume":"30","author":"Furuta","year":"2000","journal-title":"Clin Infect Dis."},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-021-10487-9","article-title":"Effectiveness comparisons of antiviral treatments for Bell palsy: a systematic review and network meta-analysis","author":"Cao","year":"2021","journal-title":"J Neurol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1927","DOI":"10.1212\/WNL.0000000000000463","article-title":"Reconciling the clinical practice guidelines on Bell's palsy from the AAO-HNSF and the AAN","volume":"82","author":"Schwartz","year":"2014","journal-title":"Neurology."},{"key":"B25","doi-asserted-by":"publisher","first-page":"993","DOI":"10.1016\/S1474-4422(08)70221-7","article-title":"Prednisolone and valaciclovir in Bell's palsy: a randomised, double-blind, placebo-controlled, multicentre trial","volume":"7","author":"Engstr\u00f6m","year":"2008","journal-title":"The Lancet Neurology."},{"key":"B26","doi-asserted-by":"publisher","first-page":"3083","DOI":"10.1007\/s00405-016-3927-3","article-title":"Comparison of acyclovir and famciclovir for the treatment of Bell's palsy","volume":"273","author":"Kim","year":"2016","journal-title":"Eur Arch Oto Rhino Laryngol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"813748","DOI":"10.3389\/fimmu.2021.813748","article-title":"Anti-inflammatory effects of acupuncture at ST36 point: a literature review in animal studies","volume":"12","author":"Oh","year":"2021","journal-title":"Front Immunol."},{"key":"B28","doi-asserted-by":"publisher","first-page":"222","DOI":"10.3389\/fneur.2020.00222","article-title":"Systematic review of physical rehabilitation of facial palsy","volume":"11","author":"Vaughan","year":"2020","journal-title":"Front Neurol."},{"key":"B29","doi-asserted-by":"publisher","first-page":"929","DOI":"10.2165\/00007256-200636110-00002","article-title":"Proprioceptive neuromuscular facilitation stretching: mechanisms and clinical implications","volume":"36","author":"Sharman","year":"2006","journal-title":"Sports medicine (Auckland, NZ)."},{"key":"B30","doi-asserted-by":"publisher","first-page":"865","DOI":"10.3233\/BMR-171031","article-title":"Efficacy of electrotherapy in Bell's palsy treatment: a systematic review","volume":"33","author":"Burelo-Peregrino","year":"2020","journal-title":"J Back Musculoskelet Rehabil."},{"key":"B31","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1055\/s-0040-1721824","article-title":"Modern management of facial nerve disorders","volume":"34","author":"Shokri","year":"2020","journal-title":"Semin Plast Surg."},{"key":"B32","doi-asserted-by":"publisher","first-page":"e067475","DOI":"10.1136\/bmj-2021-067475","article-title":"Evidence on acupuncture therapies is underused in clinical practice and health policy","volume":"376","author":"Lu","year":"2022","journal-title":"BMJ (Clinical research ed)."},{"key":"B33","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1038\/s41586-021-04001-4","article-title":"A neuroanatomical basis for electroacupuncture to drive the vagal-adrenal axis","volume":"598","author":"Liu","year":"2021","journal-title":"Nature."},{"key":"B34","doi-asserted-by":"publisher","first-page":"947","DOI":"10.13703\/j.0255-2930.2012.10.026","article-title":"Acupoint catgut-embedding therapy: superiorities and principles of application","volume":"32","author":"Zhang","year":"2012","journal-title":"Zhongguo Zhen Jiu."}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2022.868121\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,22]],"date-time":"2022-04-22T13:41:41Z","timestamp":1650634901000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2022.868121\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,18]]},"references-count":34,"alternative-id":["10.3389\/fneur.2022.868121"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2022.868121","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,18]]},"article-number":"868121"}}