Clinical prognostic factors for treatment outcome in Bell's palsy: a prospective study.
OBJECTIVE
To evaluate the clinical factors for predicting the outcome in Bell's palsy patients treated by oral prednisolone.


METHODS
Prospective study in a tertiary-care neurological hospital.


METHODS
Three hundred and eighty cases of acute unilateral lower motor neuron type of facial palsy were enrolled initially from a neurological clinic. After exclusion of the unfulfilled criteria cases, 201 cases of Bell's palsy completed the study protocol and were followed for six months after a seven-day course of 60 mg/day followed by a five-day taper-off dosage of oral prednisolone. A modified House-Brackman facial paralysis grading system was used to evaluate the recovery of facial weakness in the serial follow-up examination. Correlation between demographic data, clinical presenting symptoms and signs, and the final outcome were analyzed by multiple logistic regressions to determine the significant clinical prognostic factors.


RESULTS
There was a significant overall recovery of the facial weakness in succession throughout the 12 weeks of the follow-up period. The mean facial muscle scores approached the level of favorable outcome at the twelfth week after treatment. Duration between onset and treatment longer than seven days (RR = 18.87, 95% CI = 4.97-71.53), severe facial paralysis (RR = 5.01, 95% CI = 2.52-9.95), hearing defect (RR = 3.01, 95% CI = 1.16-7.84), and history of recurrence (RR = 3.75, 95% CI=1.21-11.59) were the significant prognostic factors for unfavorable outcome of treatment (p < 0. 05).


CONCLUSIONS
Delayed in initiation of oral prednisolone, severe facial weakness, hearing defect, and history of recurrence were significant prognostic factors determining the poor outcome. To yield a satisfactory therapeutic result, early treatment of Bell's palsy with oral prednisolone should be recommended in cases of severe facial paralysis.
Sathirapanya
Pornchai
P
Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand. sporncha@medicine.psu.ac.th
Sathirapanya
Chutarat
C
D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D020330:Bell Palsy / Q000188:drug therapy*; D005152:Facial Muscles; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012306:Risk; D018434:Sickness Impact Profile; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D011239:Prednisolone