Doctors have long been puzzled about how to help patients whose faces have become paralyzed by Bell's palsy. Now, a new Canadian study suggests a combination of drugs works best on the mysterious condition.

Bell palsy typically weakens or paralyzes a central facial nerve on one side of the face, leaving patients suddenly unable to either open or close their eye, or to work their mouth properly. While it's a relatively rare condition, many Canadians have heard of it because it's what caused the droop in former prime minister Jean Chretien's face.

It's not clear what causes Bell palsy, but what is known is that a central facial nerve becomes swollen. When it begins to press on the bone, paralysis results.

Ruth Heathcote came down with the condition one night in April, 2004. She tells CTV she thought at first she was having a stroke.

"It started with my tongue going numb and then went into my neck," she recalls. "It was a serious case, like it was complete and total paralysis."

In Chretien's case, he never recovered. But other patients do recover, often with no treatment; in fact most recover within a couple of weeks. But questions have remained about how to treat the 30 per cent or so of patients whose symptoms linger.

For years, the standard treatment has been with corticosteroids, which reduce swelling of the nerve. But since many suspect Bell palsy is caused by a herpes virus infection, some have found that antiviral medications can work too.

Now, Canadian researchers say their review confirms that combining both kinds of medications works best.

The researchers were led by ear-nose-and throat specialist Dr. John R. de Almeida from Sunnybrook Hospital and the University of Toronto. He and colleagues reviewed the medical literature looking for studies that compared treatment with either corticosteroids or antiviral medications. They narrowed down their search to 18 studies that included almost 2,800 patients in 12 countries.

The studies they looked at found that among those patients given steroids along with an antiviral to slow the spread of the virus infection, 85 per cent saw the paralysis improve. The results are published in the latest issue of the Journal of the American Medical Association.

"There was a benefit of 25 per cent when we treat with both agents," de Almeida told CTV News.

"We are showing a clear benefit of steroids and a likely benefit from antivirals," he says.

Dr. John F. Steiner, of Kaiser Permanente Colorado, Denver, writes in an accompanying editorial that de Almeida's review "helps resolve lingering doubt about the benefits of corticosteroids." But he says the review "raises questions about the adjunctive role of antiviral medications," noting that the added benefits of the antiviral drugs did not appear significant.

But de Almeida says he's convinced antiviral medications improve the recovery rate and says doctors should be advised, because right now the standard of practice is not clear.

"So we should put this into practice," he says.

With a report from CTV medical specialist Avis Favaro