In a recent issue of the New England Journal of Medicine (2004;351:1323-1331), there was a review article on the diagnosis and management of Bell's palsy. In keeping with the tradition of certain major medical journals of either ignoring or misrepresenting the evidence supporting natural therapies, this article did not mention that intramuscular vitamin B12 appears to be an effective treatment.
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In a 1959 report, two patients with Bell's palsy of 1.5 and 4 years' duration, respectively, experienced complete or almost complete recovery within 20 days after beginning a series of daily or every-other-day cyanocobalamin injections. More recently, methylcobalamin (500 mcg intramuscularly, 3 times a week) was compared with prednisolone and with the combination of methylcobalamin and prednisolone in a randomized trial. The mean time until complete recovery of facial nerve function was significantly less (p < 0.001) in patients receiving methylcobalamin (1.95 weeks) or methylcobalamin plus prednisolone (2.05 weeks) than in those receiving prednisolone alone (9.60 weeks).
Comment: I sent a letter to NEJM, pointing out the potential importance of this safe and inexpensive alternative to acyclovir and glucocorticoids. While it has been my experience that sending letters to NEJM or JAMA typically results in a polite rejection letter, on rare occasions these journals behave unpredictably and actually publish my letter. So, I keep writing letters, because variable-interval reinforcement is difficult to extinguish, and because if you don't try to promote an attitude shift, you don't have a right to complain. Actually, complaining has gotten to be less fun over the years, but the need to set a dysfunctional healthcare system straight remains.
Mitra M, Nandi AK. Cyanocobalamin in chronic Bell's paisy. J Indian Med Assoc 1959;33:129-31.
Jalaludin MA. Methylcobalamin treatment of Bell's palsy. Methods Find Exp Clin Pharmacol 1995;17:539-44.
by Alan R. Gaby, MD
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