***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Corticosteroids and antiviral agents are widely used to treat the early stages of idiopathic facial paralysis ( i.e. , Bell 's palsy ) , but their effectiveness is uncertain . METHODS We conducted a double-blind , placebo-controlled , r and omized , factorial trial involving patients with Bell 's palsy who were recruited within 72 hours after the onset of symptoms . Patients were r and omly assigned to receive 10 days of treatment with prednisolone , acyclovir , both agents , or placebo . The primary outcome was recovery of facial function , as rated on the House-Brackmann scale . Secondary outcomes included quality of life , appearance , and pain . RESULTS Final outcomes were assessed for 496 of 551 patients who underwent r and omization . At 3 months , the proportions of patients who had recovered facial function were 83.0 % in the prednisolone group as compared with 63.6 % among patients who did not receive prednisolone ( P<0.001 ) and 71.2 % in the acyclovir group as compared with 75.7 % among patients who did not receive acyclovir ( adjusted P=0.50 ) . After 9 months , these proportions were 94.4 % for prednisolone and 81.6 % for no prednisolone ( P<0.001 ) and 85.4 % for acyclovir and 90.8 % for no acyclovir ( adjusted P=0.10 ) . For patients treated with both drugs , the proportions were 79.7 % at 3 months ( P<0.001 ) and 92.7 % at 9 months ( P<0.001 ) . There were no clinical ly significant differences between the treatment groups in secondary outcomes . There were no serious adverse events in any group . CONCLUSIONS In patients with Bell 's palsy , early treatment with prednisolone significantly improves the chances of complete recovery at 3 and 9 months . There is no evidence of a benefit of acyclovir given alone or an additional benefit of acyclovir in combination with prednisolone . ( Current Controlled Trials number , IS RCT N71548196 [ controlled-trials.com ] . ) In a double-blind study , we compared the final outcome of 99 Bell 's palsy patients treated with either acyclovir-prednisone ( 53 patients ) or placebo-prednisone ( 46 patients ) . For patients receiving acyclovir , the dosage was 2,000 mg ( 400 mg 5 times daily ) for 10 days . Electrical tests included  electroneurography and the maximal stimulation test .  Univariate comparisons of outcome and electrical tests between the two groups were made with χ2 analysis , Fisher 's exact test , and t-tests . The outcome in acyclovir-prednisone-treated patients was superior to that in placebo-prednisone-treated patients . Treatment with acyclovir-prednisone was statistically more effective in returning volitional muscle motion ( recovery profile of 10 ; p = .02 ) and in preventing partial nerve degeneration ( p = .05 ) than placebo-prednisone treatment . The t-tests indicated that the recovery profile and index means were significantly better for the acyclovir-treated group ( recovery profile t = 1.99 , p = .051 ; recovery index t = 2.10 , p = .040 ) . We conclude that acyclovir-prednisone is superior to prednisone alone in treating Bell 's palsy patients and suggest that herpes simplex is the probable cause of Bell 's palsy OBJECTIVES Bell 's palsy ( BP ) , which causes facial paralysis , affects 11 - 40 people per 100 000 per annum in the UK . Its cause is unknown but as many as 30 % of patients have continuing facial disfigurement , psychological difficulties and occasionally facial pain . We present an r and omised controlled trial ( RCT ) -based economic evaluation of the early administration of steroids ( prednisolone ) and /or antivirals ( acyclovir ) compared to placebo , for treatment of BP . METHODS The RCT was not powered to detect differences in the cost-effectiveness ; therefore , we adopted a decision analytic model approach as a way of gaining precision in our cost-effectiveness comparisons [ e.g. prednisolone only ( PO ) versus acyclovir only versus prednisolone and acyclovir versus placebo , prednisolone versus no prednisolone ( NP ) and acyclovir versus no acyclovir ] . We assumed that trial interventions affect the probability of being cured/not cured but their consequences are independent of the initial therapy . We used the percentage of individuals with a complete recovery ( based on House-Brackmann grade = 1 ) at 9 months and Quality Adjusted Life Years ( e.g. derived on responses to the Health Utilities Index III ) as measures of effectiveness . Other parameter estimates were obtained from trial data . RESULTS PO dominated-i.e . was less costly and more effective-all other therapy strategies in the four arms model [ 77 % probability of cost-effective ( CE ) ] . Moreover , Prednisolone dominated NP ( 77 % probability of being CE at 30 000 UK pounds threshold ) while no acyclovir dominated aciclovir ( 85 % chance of CE ) , in the two arms models , respectively . CONCLUSIONS Treatment of BP with prednisolone is likely to be considered CE while treatment with acyclovir is highly unlikely to be considered CE . Further data on costs and utilities would be useful to confirm findings There is insufficient evidence concerning the efficacy of antiviral treatment of Bell ’s palsy ( BP ) . We therefore compared the efficacy of prednisone and famciclovir to prednisone treatment alone in BP . A total of 167 consecutive patients with untreated acute BP were included .  Severity of BP was evaluated using the House-Brackmann scale ( HBS ) and virus antibody tests ( herpes simplex virus , varicella zoster virus ) were performed . Patients admitted on even date s were treated with prednisone ( “ P group ” ) and patients admitted on odd date s were treated with prednisone and famciclovir ( “ P+F group ” ) . 117 patients completed the follow-up after 3 months or later ( 67 P/51 P+F ) . While most patients showed at least partial recovery with both treatment types , improvement of at least 4 grade s in the HBS was more common in the “ P+F group ” ( 29.4 % vs. 11.9 % ) , whereas smaller changes of less than 3 grade s were more common in the “ P group ” ( 29.9 % vs. 17.6 % ; Chi-square test , p = 0.02 ) . Patients with complete BP ( HBS grade of 5 or 6 ) had significantly better chances of reaching normal function if treated with famciclovir additionally instead with prednisone alone ( 73.7 % vs. 47.1 % ; Cochran-Armitage trend test , p = 0.03 ) . These results suggest that the combined treatment of famciclovir and prednisolone should be considered ( at least ) in patients with severe BP Objective Bell ’s palsy is a rapid onset , usually , unilateral paralysis of the facial nerve that causes significant changes in an individual ’s life such as a decline in personal , social , and educational performance . This study compared efficacy of combined prednisolone and acyclovir therapy with prednisolone alone . Material s & Methods This study is a r and omized controlled trial conducted on 43 Children ( 2–18 years old ) with Bell ’s palsy . The first group of 23 patients was treated with prednisolone and the remaining patients were treated with a combination of prednisolone and acyclovir . The required data were extracted , using an informational form based on the House-Brackmann Scale , which grade s facial nerve paralysis . The data were analyzed with Mann-Whitney test using SPSS version 16 . Results The mean age of the first and second group were 8.65 ± 5.07 and 8.35 ± 4.92 years , respectively , ( p=0.84 ) . Sixty one percent and 39 % of patients in the first group , and 45 % and 55 % of patients in the second group were male and female , respectively . No significant differences exist between the groups in terms of age and gender . The rate of complete recovery was 65.2 % in group I and 90 % in the group II ( p=0.04 ) . Conclusion The results of this study showed that the combined prednisolone and acyclovir therapy of patients with Bell ’s palsy is far more effective than treatment with prednisolone alone . Actually , age and gender had no impact on the rate of recovery Objective : To investigate the effects of valacyclovir and prednisolone in comparison with those of placebo and prednisolone for the treatment of Bell 's palsy , excluding zoster sine herpete . Study Design : Prospect i ve , multicenter , r and omized placebo-controlled study . Setting : Six academic tertiary referral centers . Patients : Ultimately , 221 patients with Bell 's palsy who were treated within 7 days of the onset . Serological and polymerase chain reaction examinations were performed to distinguish Bell 's palsy from zoster sine herpete . Intervention : The patients were treated with either valacyclovir ( dosage , 1,000 mg/d for 5 days ) plus prednisolone ( VP [ n = 114 ] ) or placebo plus prednisolone ( PP [ n = 107 ] ) administered orally . Main Outcome Measure : Recovery from the palsy was defined as a score higher than 36 using Yanagihara 40-point scoring system without facial contracture or synkinesis . The patients were followed up until complete recovery occurred or for more than 6 months in cases with a poor prognosis . Results : The overall rate of patient recovery among those treated with VP ( 96.5 % ) was significantly better ( p < 0.05 ) than the rate among those treated with PP ( 89.7 % ) . The rate of patient recovery was also analyzed by classifying the initial severity of facial palsy . In cases of complete or severe palsy , the rates of patients treated with VP and PP who recovered were 95.7 % ( n = 92 ) and 86.6 % ( n = 82 ) , respectively ; the recovery rate for treatment with VP was significantly better than that with PP ( p < 0.05 ) . Conclusion : The valacyclovir and prednisolone therapy was more effective in treating Bell 's palsy , excluding zoster sine herpete , than the conventional prednisolone therapy . To our knowledge , this is the first controlled study of an antiviral agent in the treatment of a sufficient number of Bell 's palsy cases based on an etiologic background Objective Transient ischaemic attack ( TIA ) is a recognised risk factor for stroke in the older population requiring timely assessment and treatment by a specialist . The need for such TIA services is driven by the epidemiology of transient neurological symptoms , which may not be caused by TIA . We report prevalence and incidence of transient neurological symptoms in a large UK cohort study of older people . Design Longitudinal cohort study Setting The Medical Research Council Cognitive Function and Aging Study ( CFAS ) is a population representative study based on six centres across Engl and and Wales . Participants R and om sample s of people in their 65th year were obtained from Family Health Service Authority lists . The participation rate was 80 % ( n=13 004 ) . Interview at baseline included questions about stroke and three transient neurological symptoms , repeated in a sub sample after 2 years . Patients were flagged for mortality . Main outcome measures Prevalence and 2-year incidence of transient neurological symptoms . Results In 11 903 participants without a history of stroke , 271 ( 2.3 % ) reported transient problems with speech , 872 ( 7.6 % ) with sight and 596 ( 5.1 % ) weakness in a limb with 1456 ( 12.7 % ) reporting at least one symptom . Of those reinterviewed ( n=6748 ) , 675 ( 9.8 % ) reported at least one symptom over 2 years . Conclusions Lifetime prevalence and incidence of transient neurological symptoms in people aged 65 years and over is high and is substantially greater than the incidence of TIA in hospital-based and population -based studies . These high rates of transient neurological symptoms in the community in the older population should be considered when planning TIA services The antiviral drug acyclovir or its analogue , valacyclovir , has been applied in various trials on Bell 's palsy with inconsistent results . We compared the therapeutic effect of famciclovir plus prednisolone with prednisolone alone , in patients with Bell 's palsy . In a r and omized , prospect i ve trial , 68 patients were r and omized to treatment with famciclovir and prednisolone ( 34 patients ) or prednisolone alone ( 34 patients ) . All patients underwent supportive therapy . Severity of Bell 's palsy was evaluated using the House-Brackmann scale ( HBS ) . Follow-up was done after 1 week , 1 month and 3 months , with complete recovery defined as House-Brackmann grade I. The analysis revealed that recovery rates at month 1 and 3 were significantly higher in combination group than that of prednisolone only group ( 94.1 % vs. 61.8 % and 97.1 % vs. 74.5 % respectively ) . Again recovery from mild to moderate ( HBS-II , III , IV ) Bell 's palsy occurred completely at month 3 and that of severe ( HBS-V , VI ) Bell 's palsy was 
    Output:
    
We could find no correlation with specific treatment within these results .
Low- quality evidence from r and omised controlled trials showed a benefit from the combination of antivirals with corticosteroids compared to corticosteroids alone for the treatment of Bell 's palsy of various degrees of severity .
Low- quality evidence showed a benefit of combination therapy compared with corticosteroids alone in severe Bell 's palsy .
Corticosteroids alone were more effective than antivirals alone and antivirals plus corticosteroids were more effective than placebo or no treatment .
There was no benefit from antivirals alone over placebo .
Moderate- quality evidence indicated that the combination of antivirals and corticosteroids reduced sequelae of Bell 's palsy compared with corticosteroids alone .
We found no significant increase in adverse events from the use of antivirals compared with either placebo or corticosteroids , based on low- quality evidence