title: Early deterioration in Bell's palsy: prognosis and effect of prednisolone.
abstract: OBJECTIVE
  To assess if early deterioration is a negative prognostic factor in Bell's palsy and if prednisolone treatment reduces early progression and enhances recovery.
  
  
  METHODS
  Data extracted from the randomized, double-blind, placebo-controlled multicenter, Scandinavian Bell's palsy study.
  
  
  METHODS
  Sixteen tertiary referral centers in Sweden and one in Finland.
  
  
  METHODS
  A total of 829 patients aged 18 to 75 years with Bell's palsy.
  
  
  METHODS
  The study design was factorial; 416 patients were given prednisolone, whereas 413 did not receive the drug. Data were analyzed with a modified intention-to-treat principle and the last-observation-carried-forward method.
  
  
  METHODS
  Facial function was assessed within 72 hours before treatment start, at Days 11 to 17, and at 12 months. Sunnybrook was used as the main facial grading system with complete recovery defined as Sunnybrook 100.
  
  
  RESULTS
  In 236 (28%) of 829 patients, the palsy deteriorated from baseline to the first follow-up at Days 11 to 17. Complete recovery at 12 months was 45% among subjects with early deterioration compared with 73% in patients with no initial deterioration (p < 0.0001). In the early deterioration group, complete recovery at 12 months was 62% in patients treated with prednisolone and 31% in those not treated (p < 0.0001).
  
  
  CONCLUSIONS
  Early deterioration in Bell's palsy is a negative prognostic factor for complete recovery at 12 months. Prednisolone given within 72 hours may reduce early progression and improve the outcome of palsy.
authors.affiliation: Department of Otorhinolaryngology and Head & Neck Surgery, Karolinska University Hospital, Stockholm, Sweden. elin.marsk@karolinska.se
authors.forename: Elin
authors.initials: E
authors.lastname: Marsk
authors.forename: Lalle
authors.initials: L
authors.lastname: Hammarstedt
authors.forename: Thomas
authors.initials: T
authors.lastname: Berg
authors.forename: Mats
authors.initials: M
authors.lastname: Engström
authors.forename: Lars
authors.initials: L
authors.lastname: Jonsson
authors.forename: Malou
authors.initials: M
authors.lastname: Hultcrantz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D020330:Bell Palsy / Q000188:drug therapy* / Q000473:pathology*; D004311:Double-Blind Method; D005154:Facial Nerve / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use*; D011379:Prognosis; D020127:Recovery of Function; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D011239:Prednisolone