title: Bell's palsy - the effect of prednisolone and/or valaciclovir versus placebo in relation to baseline severity in a randomised controlled trial.
abstract: OBJECTIVE
  To evaluate the treatment effect of prednisolone and/or valaciclovir in Bell's palsy patients with different baseline severity of palsy.
  
  
  METHODS
  Patient data were collected from the Scandinavian Bell's Palsy Study, a prospective, randomised, double-blind, placebo-controlled, multi-centre trial.
  
  
  METHODS
  Sixteen otorhinolaryngological centres in Sweden and one in Finland.
  
  
  METHODS
  Altogether, 829 patients aged 18-75 years were treated within 72 h of palsy onset. Patients were randomly assigned to treatment with prednisolone plus placebo (n = 210), valaciclovir plus placebo (n = 207), prednisolone plus valaciclovir (n = 206), placebo plus placebo (n = 206). Follow-up was 12 months.
  
  
  METHODS
  Facial function was assessed using the Sunnybrook grading scale at baseline and at 12 months. Complete recovery was defined as Sunnybrook score = 100.
  
  
  RESULTS
  All patients, regardless of baseline severity, showed significantly higher complete recovery rates if treated with prednisolone compared with no prednisolone. In patients with severe palsy, recovery at 12 months was 51% with prednisolone treatment versus 31% without prednisolone (P = 0.02). Corresponding results were 68%versus 51% (P = 0.004) for moderate, and 83%versus 73% (P = 0.02) for mild palsy. In patient groups with moderate and mild palsy at baseline, significantly fewer prednisolone-treated patients had synkinesis at 12 months (P = 0.04 and P < 0.0001, respectively). For patients with severe palsy at baseline, prednisolone versus no prednisolone made no significant difference regarding synkinesis at 12 months. Valaciclovir did not add any significant effect to prednisolone regarding recovery rate or synkinesis at 12 months.
  
  
  CONCLUSIONS
  Prednisolone treatment resulted in higher complete recovery rates, regardless of severity at baseline. Prednisolone treatment should be considered in all patients irrespective of degree of palsy.
authors: Department of Otorhinolaryngology and Head & Neck Surgery, Lund University Hospital, Lund, Sweden. sara.axelsson@skane.se
authors: S
authors: S
authors: Axelsson
authors: T
authors: T
authors: Berg
authors: L
authors: L
authors: Jonsson
authors: M
authors: M
authors: Engström
authors: M
authors: M
authors: Kanerva
authors: A
authors: A
authors: Stjernquist-Desatnik
mesh_terms: D000212:Acyclovir / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D020330:Bell Palsy / Q000188:drug therapy* / Q000503:physiopathology; D004311:Double-Blind Method; D005260:Female; D005387:Finland; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010919:Placebos; D011239:Prednisolone / Q000627:therapeutic use*; D011446:Prospective Studies; D020127:Recovery of Function; D012720:Severity of Illness Index; D013548:Sweden; D016896:Treatment Outcome; D000077483:Valacyclovir; D014633:Valine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; D005938:Glucocorticoids; D010919:Placebos; D011239:Prednisolone; D014633:Valine; D000077483:Valacyclovir; D000212:Acyclovir