Many Factors Tied to Better Outcome in Bell Palsy

By Reuters Staff

February 01, 2020

NEW YORK (Reuters Health) - Multiple clinical factors are associated with improved treatment outcomes in adults with Bell palsy, researchers in South Korea have found.

Bell palsy, also known as idiopathic facial paralysis (IFP), is the most common cause of unilateral facial paralysis. It's commonly treated with corticosteroids and antiviral drugs, but there are no clear guidelines for treatment and knowledge on the prognosis after treatment remains limited, according to Dr. Seung Geun Yeo of Kyung Hee University in Seoul and colleagues.

They analyzed variables potentially associated with treatment outcome in 1,364 patients (mean age, 47) with primary Bell palsy treated at the outpatient clinic of Kyung Hee University Hospital, over more than a decade. A little more than half were women.

Sixty-one patients refused corticosteroid treatment, opting instead for conservative treatment such as acupuncture or physical therapy. All others began treatment with an oral corticosteroid or a corticosteroid plus an antiviral drug within a week from the onset of paralysis, the authors report in JAMA Otolaryngology-Head and Neck Surgery.

The corticosteroid treatment consisted of oral prednisolone tapered over 10 days. The antiviral treatment consisted of oral acyclovir, 1,000-2,400 mg/d for five days or famciclovir 750 mg/d for seven days. Physical therapy consisted of facial massage, facial expression practice, and treatment with an electrical stimulator.

The overall rate of favorable outcome - defined as House-Brackmann (H-B) grade of I or II at the six-month follow-up visit - was 80.6%.

In multivariable analysis, factors significantly associated with favorable outcome were age younger than 40 years (odds ratio, 1.56), an initial H-B grade of III or IV (OR, 2.62), good electromyography results after two weeks of treatment (OR, 3.38), absence of diabetes (OR, 1.43), and control of hypertension (OR, 1.64).

These results "may help identify patients likely to have favorable outcomes based on specific factors, which may aid clinicians in selecting patients for therapeutic clinical trials," Dr. Yeo and colleagues conclude.

The study had no commercial funding and the authors have no relevant disclosures.

Dr. Yeo did not respond to a request for comment by press time.

SOURCE: JAMA Otolaryngology - Head and Neck Surgery, online January 23, 2020.