***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: 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 The therapeutic effect of corticosteroids in acute idiopathic peripheral nerve paralysis ( Bell 's palsy ) in children is controversial . The authors evaluated the effect of steroids on the early and late outcome of children with Bell 's palsy in a prospect i ve r and omized controlled setting . Forty-two patients ( 21 females , 21 males ) with complete paralysis were enrolled in the study . Group 1 ( n = 21 ) received methylprednisolone ( 1 mg/kg daily for 10 days orally ) ; Group 2 ( n = 21 ) did not . All patients were observed in the first 3 days of the disease and at 4 , 6 , and 12 months of follow-up . The mean age of Group 1 was 52.4 + /- 4.3 months , not significantly different from that of Group 2 . In Group 1 , 86 % and 100 % exhibited normal nerve function at 4 and 6 months of follow-up , respectively ; in Group 2 , 72 % and 86 % demonstrated complete recovery at 4 and 6 months , respectively , with improvement in all patients by 12 months . The improvement rates between the treated and untreated groups did not differ significantly . No side effects necessitated steroid withdrawal . The results of this study indicate that steroid therapy initiated at an early stage of childhood Bell 's palsy does not significantly improve the outcome 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 Abstract . The objective of this double-blind , r and omized , placebo-controlled study was to test the efficacy of high-dose prednisone , administered as early as possible , in modifying the natural progression of Bell 's palsy . Sixty-two consecutive patients , enrolled within 72 hours of facial palsy onset , were assigned to high dose intravenous prednisone in combination with intramuscular polyvitaminic therapy ( group A ) or polyvitaminic therapy alone ( group B ) . Clinical grading of facial muscle strength and length of absence from work were evaluated . An early worsening of facial muscle strength was observed in controls , leading to the divergence in the trends of the grading scores in the two groups ; this result was not confirmed in the long-term follow-up . Treated patients returned to work earlier than controls . In conclusion , early treatment based on high-dose corticosteroids slightly accelerates spontaneous improvement in Bell 's palsy Objective : To assess the agreement between the Sunnybrook facial nerve grading system and the House-Brackmann and Yanagihara systems . Study Design : Prospect i ve clinical facial nerve grading . Setting : Tertiary referral center . Patients : One-hundred assessment s , 94 in patients with Bell ’s palsy and 6 with herpes zoster . Intervention : Diagnostic . Main Outcome Measures : Evaluation according to the weighted regional Sunnybrook system , the gross House-Brackmann system , and the unweighted regional Yanagihara system . Weighted κ statistics was used to measure agreement between the grading systems . Results : The average weighted κ value between the Sunny-brook , House-Brackmann , and Yanagihara grading systems  was 0.65 ; κ values increased temporally ( but not statistically significantly ) up to day 180 . The highest agreement value , 0.72 , was found between the Sunnybrook and Yanagihara grading systems . The weighted κ value between the Sunnybrook and House-Brackmann systems was 0.59 . In Sunnybrook gradings less than 63 , there was an overlap between House-Brackmann scores of III to VI . Reliable conversion tables between the gross House-Brackmann system and the regional Sunnybrook and Yanagihara systems could not be established . Conclusion : The Sunnybrook system scores at the same agreement level as the House-Brackmann and Yanagihara grading systems . There is an evaluative difference between the weighted regional Sunnybrook and the gross House-Brackmann systems . Substantial agreement was found between the regional Sunnybrook and Yanagihara scales . Sunnybrook grading is easy and quick . By adding objective measurements and additional secondary defects , the Sunnybrook system can be an alternative to the other predominating grading systems 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 Idiopathic facial nerve paralysis ( IFNP ) is a common malady . Because its etiology is unclear , there are a variety of treatment options . Studies to date have not clearly established the benefits of treatment with oral steroids ( prednisone ) . The authors performed a r and omized double-blind controlled study comparing the use of placebo versus prednisone which shows that  prednisone-treated  patients benefit from early treatment . Seventy-six patients met inclusion criteria and completed follow-up until recovery ; 35 patients received prednisone and 41 received placebo . Their mean age was 36.8 years .  Facial nerve function was assessed using the House-Brackmann facial nerve grading scale , as well as a variety of other measures . Patients were evaluated pretreatment , regularly post-treatment until judged recovered ( return of facial function to a grade III or better ) , and at 6 months after recovery . Difference in mean time to resolution for the prednisone ( 51.4 days ) and placebo ( 69.3 days ) groups was not statistically significant . There was a significant difference in grade at recovery , with the placebo group having a higher proportion of grade III results ( P < .03 ) . Eight of 10 patients with electroneurography ( ENOG ) evidence of denervation were in the placebo group and accounted for 6 of the 7 grade III results . However , the difference in proportion of patients with evidence of denervation for the prednisone ( 5.7 % ) and placebo ( 19.5 % ) groups did not achieve statistical significance . This study shows that patients treated with prednisone have less denervation than placebo-treated patients . They also have a significant improvement in facial grade at recovery compared to placebo-treated patients . Therefore , the authors recommend that all patients at risk for developing denervation receive prednisone treatment A prospect i ve , controlled , double-blind study was design ed to evaluate the effect of steroid treatment  on the natural history of Bell 's palsy . Fifty-one patients were included in the study between 1972 and 1974 . The patients were evaluated and started on treatment within two days of onset of Bell 's palsy and followed for six months . Treatment was given in r and omized double-blind fashion and consisted of either vitamins or a total of 410 mg of prednisone plus vitamins in descending doses over 10 days . The recovery of facial motor function was determined by three physicians who had no knowledge of the treatment received by the patients . They examined photographs of the patients taken six months after onset of paralysis in eight positions of facial function and categorized them as to complete fair , or poor recovery of facial function . These results of this evaluation were su bmi tted to the biostatistician who broke the treatment code . The results of this study demonstrate no statistically significant beneficial effect of steroid therapy  upon recovery from Bell 's palsy . Factors considered included the patients ' age , sex , the presence of pain , ageusia , hyperacusis , diabetes , hypertension , the progression and degree of palsy , the results of nerve excitability and salivary flow tests , and the time at which recovery was first noted or became complete . Bell 's palsy remains without a proven efficacious treatment Idiopathic facial palsy ( Bell ’s palsy ) was first described by Charles Bell in 1883 [ 1 ] . Since then , the treatments employed have been empirical in some way , as no etiological cause has been well established . Some theories are widely accepted such as viral , ischemic , and autoimmune origin [ 2–4 ] . All of them are based on vascular changes causing edema with neural compression and then neuropraxia . The drug most commonly used is cortisone , with the finality of aging on the edema . In the literature we have found no citations about the use of dexamethasone , although it is known to have an excellent effect in acute processes of the central nervous system because of its fast efficacy and aggregation on neuronal membrane . We observed that many patients treated with different drugs had a good evolution too . The aim of this study is to find out the real advantage of treating patients with dexamethasone by analyzing the final evolution of the paralysis and the recuperation time OBJECTIVES To determine whether reactivation of herpes simplex virus ( HSV ) type 1 or varicella-zoster virus ( VZV ) is the main cause of Bell 's palsy and whether antiviral drugs bring about recovery from Bell 
    Output:
    
In Bell palsy , corticosteroids are associated with a reduced risk of unsatisfactory recovery .
Antiviral agents , when administered with corticosteroids , may be associated with additional benefit