Corticosteroid and antiviral agents for idiopathic facial nerve paralysis: a network meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

LIU Chunyu ¹ , ZHOU Muke ¹ , CAI Zhaolun ² , CHEN Ning ¹ ,  HE Li ¹

1. Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;
2. Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

HE Li, Email: heli2003new@126.com

Keywords：

Corticosteroid; Antiviral agent; Idiopathic facial nerve paralysis; Randomized controlled trial; Controlled clinical trial; Network meta-analysis

DOI：

10.7507/1672-2531.201803021

Video：

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Abstract Full text Figures/Tables Video References Cited by

ObjectivesTo assess the efficacy and safety of corticosteroid and antiviral agents for idiopathic facial nerve paralysis (IFNP) by network meta-analysis.MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI, WangFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) of corticosteroid and antiviral agents for IFNP from inception to January 31^th, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. The meta-analysis was performed by R 3.3.3 and Stata 13.0 software.ResultsA total of 16 RCTs involving 3 061 patients were included. The results of network meta-analysis showed that: for the facial function recovery rates, corticosteroid plus antiviral agents was superior to placebo and antiviral agents alone at 3-month follow-up. Corticosteroid plus antiviral agents was superior to placebo, antiviral agents or corticosteroid alone at 6-month follow-up (if the satisfactory recovery was defined as a House-Brackmann grade class Ⅱ or below). When the follow-up exceeded 6 months, corticosteroid alone was superior to placebo and antiviral agents alone, corticosteroid plus antiviral agents was superior to placebo and antiviral agents alone. All of the differences above were statistically significant. For the sequelae, corticosteroid plus antiviral agents and corticosteroid alone were superior to placebo and antiviral agents alone. Corticosteroid plus antiviral agents was superior to corticosteroid alone. The differences were statistically significant. For the adverse events, there were no significant differences between any other pairwise comparisons of these different interventions.ConclusionConsidering the efficacy and safety, patients with IFNP treated corticosteroid plus antiviral agents are more likely to have a better recovery of facial function and less likely to develop sequelae, followed by corticosteroid alone. More high-quality, large scaled and multicenter RCTs are required to verify the conclusions above, and focus on the treatment of children and patients with severe facial paralysis.

Citation： LIU Chunyu, ZHOU Muke, CAI Zhaolun, CHEN Ning, HE Li. Corticosteroid and antiviral agents for idiopathic facial nerve paralysis: a network meta-analysis. Chinese Journal of Evidence-Based Medicine, 2018, 18(6): 587-597. doi: 10.7507/1672-2531.201803021 Copy

1.	Salman MS, MacGregor DL. Should children with Bell's palsy be treated with corticosteroids? A systematic review. J Child Neurol, 2001, 16(8): 565-568.
2.	Baugh RF, Basura GJ, Ishii LE, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg, 2013, 149(3 Suppl): S1-S27.
3.	Madhok VB, Gagyor I, Daly F, et al. Corticosteroids for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev, 2016, (7): CD001942.
4.	Bauer CA, Coker NJ. Update on facial nerve disorders. Otolaryngol Clin North Am, 1996, 29(3): 445-454.
5.	Gilden DH, Tyler KL. Bell's palsy-is glucocorticoid treatment enough? N Engl J Med, 2007, 357(16): 1653-1655.
6.	Yetiser S, Kazkayas M, Altinok D, et al. Magnetic resonance imaging of the intratemporal facial nerve in idiopathic peripheral facial palsy. Clin Imaging, 2003, 27(2): 77-81.
7.	Gronseth GS, Paduga R, American Academy of Neurology. Evidence-based guideline update: steroids and antivirals for Bell palsy: report of the guideline development subcommittee of the American academy of neurology. Neurology, 2012, 79(22): 2209-2213.
8.	de Almeida JR, Guyatt GH, Sud S, et al. Management of Bell palsy: clinical practice guideline. CMAJ, 2014, 186(12): 917-922.
9.	Gilden DH. Clinical practice. Bell's Palsy. N Engl J Med, 2004, 351(13): 1323-1331.
10.	De Diego JI, Prim MP, De Sarriá MJ, et al. Idiopathic facial paralysis: a randomized, prospective, and controlled study using single-dose prednisone versus acyclovir three times daily. Laryngoscope, 1998, 108(4 Pt 1): 573-575.
11.	Rowlands S, Hooper R, Hughes R, et al. The epidemiology and treatment of Bell's palsy in the UK. Eur J Neurol, 2002, 9(1): 63-67.
12.	Numthavaj P, Thakkinstian A, Dejthevaporn C, et al. Corticosteroid and antiviral therapy for Bell's palsy: a network meta-analysis. BMC Neurol, 2011, 11: 1.
13.	Lee HY, Byun JY, Park MS, et al. Steroid-antiviral treatment improves the recovery rate in patients with severe Bell's palsy. Am J Med, 2013, 126(4): 336-341.
14.	Khedr EM, Badry R, Ali AM, et al. Steroid/antiviral for the treatment of Bell's palsy: Double blind randomized clinical trial. Restor Neurol Neurosci, 2016, 34(6): 897-905.
15.	House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg, 1985, 93(2): 146-147.
16.	Higgins JP, Altman DG, Gøtzsche PC, et al. The Cochrane collaboration's tool for assessing risk of bias in randomised trials. BMJ, 2011, 343: d5928.
17.	Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
18.	van Valkenhoef G, Dias S, Ades AE, et al. Automated generation of node-splitting models for assessment of inconsistency in network meta-analysis. Res Synth Methods, 2016, 7(1): 80-93.
19.	Chaimani A, Higgins JP, Mavridis D, et al. Graphical tools for network meta-analysis in STATA. PLoS One, 2013, 8(10): e76654.
20.	TAVERNER D. Cortisone treatment of Bell's palsy. Lancet, 1954, 267(6847): 1052-1054.
21.	May M, Wette R, Hardin WB Jr, et al. The use of steroids in Bell's palsy: a prospective controlled study. Laryngoscope, 1976, 86(8): 1111-1122.
22.	Austin JR, Peskind SP, Austin SG, et al. Idiopathic facial nerve paralysis: a randomized double blind controlled study of placebo versus prednisone. Laryngoscope, 1993, 103(12): 1326-1333.
23.	Shafshak TS, Essa AY, Bakey FA. The possible contributing factors for the success of steroid therapy in Bell's palsy: a clinical and electrophysiological study. J Laryngol Otol, 1994, 108(11): 940-943.
24.	Adour KK, Ruboyianes JM, Von Doersten PG, et al. Bell's palsy treatment with acyclovir and prednisone compared with prednisone alone: a double-blind, randomized, controlled trial. Ann Otol Rhinol Laryngol, 1996, 105(5): 371-378.
25.	Unüvar E, Oğuz F, Sidal M, et al. Corticosteroid treatment of childhood Bell's palsy. Pediatr Neurol, 1999, 21(5): 814-816.
26.	Lagalla G, Logullo F, Di Bella P, et al. Influence of early high-dose steroid treatment on Bell's palsy evolution. Neurol Sci, 2002, 23(3): 107-112.
27.	Hato N, Yamada H, Kohno H, et al. Valacyclovir and prednisolone treatment for Bell's palsy: a multicenter, randomized, placebo-controlled study. Otol Neurotol, 2007, 28(3): 408-413.
28.	Kawaguchi K, Inamura H, Abe Y, et al. Reactivation of herpes simplex virus type 1 and varicella-zoster virus and therapeutic effects of combination therapy with prednisolone and valacyclovir in patients with Bell's palsy. Laryngoscope, 2007, 117(1): 147-156.
29.	Sullivan FM, Swan IR, Donnan PT, et al. Early treatment with prednisolone or acyclovir in Bell's palsy. N Engl J Med, 2007, 357(16): 1598-1607.
30.	Engström M, Berg T, Stjernquist-Desatnik A, et al. Prednisolone and valaciclovir in Bell's palsy: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet Neurol, 2008, 7(11): 993-1000.
31.	Minnerop M, Herbst M, Fimmers R, et al. Bell's palsy: combined treatment of famciclovir and prednisone is superior to prednisone alone. J Neurol, 2008, 255(11): 1726-1730.
32.	Yeo SG, Lee YC, Park DC, et al. Acyclovir plus steroid vs steroid alone in the treatment of Bell's palsy. Am J Otolaryngol, 2008, 29(3): 163-166.
33.	de Ru JA, van Benthem PP, Janssen LM. Is antiviral medication for severe Bell's palsy still useful? Lancet Neurol, 2009, 8(6): 509.
34.	Lockhart P, Daly F, Pitkethly M, et al. Antiviral treatment for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev, 2009, (4): CD001869.
35.	戚丽华. 阿昔洛韦和伐昔洛韦治疗带状疱疹的疗效比较. 当代医学, 2014, (23): 145-146.
36.	叶兴东, 张锡宝. 阿昔洛韦和伐昔洛韦的临床应用及其安全性研究进展. 中国麻风皮肤病杂志, 2007, 23(8): 705-707.
37.	张曙浩. 泛昔洛韦片治疗带状疱疹疗效观察. 中国实用医药, 2016, 11(4): 183-184.
38.	Hato N, Murakami S, Gyo K. Steroid and antiviral treatment for Bell's palsy. Lancet, 2008, 371(9627): 1818-1820.
39.	Saito H, Takeda T, Kishimoto S. Facial nerve to facial canal cross-sectional area ratio in children. Laryngoscope, 1992, 102(10): 1172-1176.
40.	Peitersen E. The natural history of Bell's palsy. Am J Otol, 1982, 4(2): 107-111.
41.	May M, Fria TJ, Blumenthal F, et al. Facial paralysis in children: differential diagnosis. Otolaryngol Head Neck Surg, 1981, 89(5): 841-848.
42.	Prescott CA. Idiopathic facial nerve palsy in children and the effect of treatment with steroids. Int J Pediatr Otorhinolaryngol, 1987, 13(3): 257-264.
43.	Peitersen E. Bell's palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Otolaryngol Suppl, 2002, (549): 4-30.
44.	Leeder JS. Translating pharmacogenetics and pharmacogenomics into drug development for clinical pediatrics and beyond. Drug Discov Today, 2004, 9(13): 567-573.
45.	Falco NA, Eriksson E. Facial nerve palsy in the newborn: incidence and outcome. Plast Reconstr Surg, 1990, 85(1): 1-4.
46.	屈会起, 林珊, 邱明才. 浅谈系统评价的文献偏倚问题. 中国循证医学, 2001, 1(2): 114-116.
47.	Leizorovicz A, Haugh MC, Chapuis FR, et al. Low molecular weight heparin in prevention of perioperative thrombosis. BMJ, 1992, 305(6859): 913-920.
48.	Nurmohamed MT, Rosendaal FR, Büller HR, et al. Low-molecular-weight heparin versus standard heparin in general and orthopaedic surgery: a meta-analysis. Lancet, 1992, 340(8812): 152-156.
49.	Egger M, Smith GD. Bias in location and selection of studies. BMJ, 1998, 316(7124): 61-66.
50.	孙鑫, 王莉, 李幼平. 使用个体病例数据进行 Meta 分析评价医疗干预措施的效果. 中国循证医学杂志, 2010, 10(8): 998-1003.
51.	Ades AE, Caldwell DM, Reken S, et al. Evidence synthesis for decision making 7: a reviewer's checklist. Med Decis Making, 2013, 33(5): 679-691.
52.	Jansen JP, Fleurence R, Devine B, et al. Interpreting indirect treatment comparisons and network meta-analysis for health-care decision making: report of the ISPOR task force on indirect treatment comparisons good research practices: part 1. Value Health, 2011, 14(4): 417-428.
53.	Ohlssen D, Price KL, Xia HA, et al. Guidance on the implementation and reporting of a drug safety Bayesian network meta-analysis. Pharm Stat, 2014, 13(1): 55-70.
54.	Tan SH, Bujkiewicz S, Sutton A, et al. Presentational approaches used in the UK for reporting evidence synthesis using indirect and mixed treatment comparisons. J Health Serv Res Policy, 2013, 18(4): 224-232.
55.	Thorlund K, Druyts E, Aviña-Zubieta JA, et al. Why the findings of published multiple treatment comparison meta-analyses of biologic treatments for rheumatoid arthritis are different: an overview of recurrent methodological shortcomings. Ann Rheum Dis, 2013, 72(9): 1524-1535.
56.	Hutton B, Salanti G, Chaimani A, et al. The quality of reporting methods and results in network meta-analyses: an overview of reviews and suggestions for improvement. PLoS One, 2014, 9(3): e92508.
57.	李伦, 田金徽, 杨克虎. 网状 Meta 分析的报告规范现状分析. 中国循证儿科杂志, 2014, 9(6): 467-471.
58.	Altman DG, Schulz KF, Moher D, et al. The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med, 2001, 134(8): 663-694.
59.	VanSwearingen JM, Brach JS. The facial disability index: reliability and validity of a disability assessment instrument for disorders of the facial neuromuscular system. Phys Ther, 1996, 76(12): 1288-1298.
60.	Kahn JB, Gliklich RE, Boyev KP, et al. Validation of a patient-graded instrument for facial nerve paralysis: the FaCE scale. Laryngoscope, 2001, 111(3): 387-398.

1. Salman MS, MacGregor DL. Should children with Bell's palsy be treated with corticosteroids? A systematic review. J Child Neurol, 2001, 16(8): 565-568.
2. Baugh RF, Basura GJ, Ishii LE, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg, 2013, 149(3 Suppl): S1-S27.
3. Madhok VB, Gagyor I, Daly F, et al. Corticosteroids for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev, 2016, (7): CD001942.
4. Bauer CA, Coker NJ. Update on facial nerve disorders. Otolaryngol Clin North Am, 1996, 29(3): 445-454.
5. Gilden DH, Tyler KL. Bell's palsy-is glucocorticoid treatment enough? N Engl J Med, 2007, 357(16): 1653-1655.
6. Yetiser S, Kazkayas M, Altinok D, et al. Magnetic resonance imaging of the intratemporal facial nerve in idiopathic peripheral facial palsy. Clin Imaging, 2003, 27(2): 77-81.
7. Gronseth GS, Paduga R, American Academy of Neurology. Evidence-based guideline update: steroids and antivirals for Bell palsy: report of the guideline development subcommittee of the American academy of neurology. Neurology, 2012, 79(22): 2209-2213.
8. de Almeida JR, Guyatt GH, Sud S, et al. Management of Bell palsy: clinical practice guideline. CMAJ, 2014, 186(12): 917-922.
9. Gilden DH. Clinical practice. Bell's Palsy. N Engl J Med, 2004, 351(13): 1323-1331.
10. De Diego JI, Prim MP, De Sarriá MJ, et al. Idiopathic facial paralysis: a randomized, prospective, and controlled study using single-dose prednisone versus acyclovir three times daily. Laryngoscope, 1998, 108(4 Pt 1): 573-575.
11. Rowlands S, Hooper R, Hughes R, et al. The epidemiology and treatment of Bell's palsy in the UK. Eur J Neurol, 2002, 9(1): 63-67.
12. Numthavaj P, Thakkinstian A, Dejthevaporn C, et al. Corticosteroid and antiviral therapy for Bell's palsy: a network meta-analysis. BMC Neurol, 2011, 11: 1.
13. Lee HY, Byun JY, Park MS, et al. Steroid-antiviral treatment improves the recovery rate in patients with severe Bell's palsy. Am J Med, 2013, 126(4): 336-341.
14. Khedr EM, Badry R, Ali AM, et al. Steroid/antiviral for the treatment of Bell's palsy: Double blind randomized clinical trial. Restor Neurol Neurosci, 2016, 34(6): 897-905.
15. House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg, 1985, 93(2): 146-147.
16. Higgins JP, Altman DG, Gøtzsche PC, et al. The Cochrane collaboration's tool for assessing risk of bias in randomised trials. BMJ, 2011, 343: d5928.
17. Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
18. van Valkenhoef G, Dias S, Ades AE, et al. Automated generation of node-splitting models for assessment of inconsistency in network meta-analysis. Res Synth Methods, 2016, 7(1): 80-93.
19. Chaimani A, Higgins JP, Mavridis D, et al. Graphical tools for network meta-analysis in STATA. PLoS One, 2013, 8(10): e76654.
20. TAVERNER D. Cortisone treatment of Bell's palsy. Lancet, 1954, 267(6847): 1052-1054.
21. May M, Wette R, Hardin WB Jr, et al. The use of steroids in Bell's palsy: a prospective controlled study. Laryngoscope, 1976, 86(8): 1111-1122.
22. Austin JR, Peskind SP, Austin SG, et al. Idiopathic facial nerve paralysis: a randomized double blind controlled study of placebo versus prednisone. Laryngoscope, 1993, 103(12): 1326-1333.
23. Shafshak TS, Essa AY, Bakey FA. The possible contributing factors for the success of steroid therapy in Bell's palsy: a clinical and electrophysiological study. J Laryngol Otol, 1994, 108(11): 940-943.
24. Adour KK, Ruboyianes JM, Von Doersten PG, et al. Bell's palsy treatment with acyclovir and prednisone compared with prednisone alone: a double-blind, randomized, controlled trial. Ann Otol Rhinol Laryngol, 1996, 105(5): 371-378.
25. Unüvar E, Oğuz F, Sidal M, et al. Corticosteroid treatment of childhood Bell's palsy. Pediatr Neurol, 1999, 21(5): 814-816.
26. Lagalla G, Logullo F, Di Bella P, et al. Influence of early high-dose steroid treatment on Bell's palsy evolution. Neurol Sci, 2002, 23(3): 107-112.
27. Hato N, Yamada H, Kohno H, et al. Valacyclovir and prednisolone treatment for Bell's palsy: a multicenter, randomized, placebo-controlled study. Otol Neurotol, 2007, 28(3): 408-413.
28. Kawaguchi K, Inamura H, Abe Y, et al. Reactivation of herpes simplex virus type 1 and varicella-zoster virus and therapeutic effects of combination therapy with prednisolone and valacyclovir in patients with Bell's palsy. Laryngoscope, 2007, 117(1): 147-156.
29. Sullivan FM, Swan IR, Donnan PT, et al. Early treatment with prednisolone or acyclovir in Bell's palsy. N Engl J Med, 2007, 357(16): 1598-1607.
30. Engström M, Berg T, Stjernquist-Desatnik A, et al. Prednisolone and valaciclovir in Bell's palsy: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet Neurol, 2008, 7(11): 993-1000.
31. Minnerop M, Herbst M, Fimmers R, et al. Bell's palsy: combined treatment of famciclovir and prednisone is superior to prednisone alone. J Neurol, 2008, 255(11): 1726-1730.
32. Yeo SG, Lee YC, Park DC, et al. Acyclovir plus steroid vs steroid alone in the treatment of Bell's palsy. Am J Otolaryngol, 2008, 29(3): 163-166.
33. de Ru JA, van Benthem PP, Janssen LM. Is antiviral medication for severe Bell's palsy still useful? Lancet Neurol, 2009, 8(6): 509.
34. Lockhart P, Daly F, Pitkethly M, et al. Antiviral treatment for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev, 2009, (4): CD001869.
35. 戚丽华. 阿昔洛韦和伐昔洛韦治疗带状疱疹的疗效比较. 当代医学, 2014, (23): 145-146.
36. 叶兴东, 张锡宝. 阿昔洛韦和伐昔洛韦的临床应用及其安全性研究进展. 中国麻风皮肤病杂志, 2007, 23(8): 705-707.
37. 张曙浩. 泛昔洛韦片治疗带状疱疹疗效观察. 中国实用医药, 2016, 11(4): 183-184.
38. Hato N, Murakami S, Gyo K. Steroid and antiviral treatment for Bell's palsy. Lancet, 2008, 371(9627): 1818-1820.
39. Saito H, Takeda T, Kishimoto S. Facial nerve to facial canal cross-sectional area ratio in children. Laryngoscope, 1992, 102(10): 1172-1176.
40. Peitersen E. The natural history of Bell's palsy. Am J Otol, 1982, 4(2): 107-111.
41. May M, Fria TJ, Blumenthal F, et al. Facial paralysis in children: differential diagnosis. Otolaryngol Head Neck Surg, 1981, 89(5): 841-848.
42. Prescott CA. Idiopathic facial nerve palsy in children and the effect of treatment with steroids. Int J Pediatr Otorhinolaryngol, 1987, 13(3): 257-264.
43. Peitersen E. Bell's palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Otolaryngol Suppl, 2002, (549): 4-30.
44. Leeder JS. Translating pharmacogenetics and pharmacogenomics into drug development for clinical pediatrics and beyond. Drug Discov Today, 2004, 9(13): 567-573.
45. Falco NA, Eriksson E. Facial nerve palsy in the newborn: incidence and outcome. Plast Reconstr Surg, 1990, 85(1): 1-4.
46. 屈会起, 林珊, 邱明才. 浅谈系统评价的文献偏倚问题. 中国循证医学, 2001, 1(2): 114-116.
47. Leizorovicz A, Haugh MC, Chapuis FR, et al. Low molecular weight heparin in prevention of perioperative thrombosis. BMJ, 1992, 305(6859): 913-920.
48. Nurmohamed MT, Rosendaal FR, Büller HR, et al. Low-molecular-weight heparin versus standard heparin in general and orthopaedic surgery: a meta-analysis. Lancet, 1992, 340(8812): 152-156.
49. Egger M, Smith GD. Bias in location and selection of studies. BMJ, 1998, 316(7124): 61-66.
50. 孙鑫, 王莉, 李幼平. 使用个体病例数据进行 Meta 分析评价医疗干预措施的效果. 中国循证医学杂志, 2010, 10(8): 998-1003.
51. Ades AE, Caldwell DM, Reken S, et al. Evidence synthesis for decision making 7: a reviewer's checklist. Med Decis Making, 2013, 33(5): 679-691.
52. Jansen JP, Fleurence R, Devine B, et al. Interpreting indirect treatment comparisons and network meta-analysis for health-care decision making: report of the ISPOR task force on indirect treatment comparisons good research practices: part 1. Value Health, 2011, 14(4): 417-428.
53. Ohlssen D, Price KL, Xia HA, et al. Guidance on the implementation and reporting of a drug safety Bayesian network meta-analysis. Pharm Stat, 2014, 13(1): 55-70.
54. Tan SH, Bujkiewicz S, Sutton A, et al. Presentational approaches used in the UK for reporting evidence synthesis using indirect and mixed treatment comparisons. J Health Serv Res Policy, 2013, 18(4): 224-232.
55. Thorlund K, Druyts E, Aviña-Zubieta JA, et al. Why the findings of published multiple treatment comparison meta-analyses of biologic treatments for rheumatoid arthritis are different: an overview of recurrent methodological shortcomings. Ann Rheum Dis, 2013, 72(9): 1524-1535.
56. Hutton B, Salanti G, Chaimani A, et al. The quality of reporting methods and results in network meta-analyses: an overview of reviews and suggestions for improvement. PLoS One, 2014, 9(3): e92508.
57. 李伦, 田金徽, 杨克虎. 网状 Meta 分析的报告规范现状分析. 中国循证儿科杂志, 2014, 9(6): 467-471.
58. Altman DG, Schulz KF, Moher D, et al. The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med, 2001, 134(8): 663-694.
59. VanSwearingen JM, Brach JS. The facial disability index: reliability and validity of a disability assessment instrument for disorders of the facial neuromuscular system. Phys Ther, 1996, 76(12): 1288-1298.
60. Kahn JB, Gliklich RE, Boyev KP, et al. Validation of a patient-graded instrument for facial nerve paralysis: the FaCE scale. Laryngoscope, 2001, 111(3): 387-398.

Chinese Journal of Evidence-Based Medicine

Corticosteroid and antiviral agents for idiopathic facial nerve paralysis: a network meta-analysis

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