title: Synkinesis in Bell's palsy in a randomised controlled trial.
abstract: OBJECTIVE
  To study the development of synkinesis in Bell's palsy. Frequency, severity, gender aspects and predictors were analysed.
  
  
  METHODS
  Data from the randomised controlled Scandinavian Bell's palsy trial including 829 patients.
  
  
  METHODS
  Frequency and severity of synkinesis at 12 months were the main outcome measures. Mean Sunnybrook synkinesis scores, voluntary movement scores and composite scores between 6 and 12 months were compared.
  
  
  RESULTS
  In 743 patients with a 12-month follow-up, synkinesis frequency was 21.3%. There was no gender difference. Synkinesis was moderate to severe in 6.6% of patients. Those with synkinesis at 6 months had a synkinesis score of 4.1 (±2.8 sd), which increased to 4.7 (±3.2) (P = 0.047) at 12 months (n = 93). Sunnybrook composite score at 1 month was the best predictor for synkinesis development with receiver operating characteristics and area under the curve (AUC) 0.87. Risk for synkinesis increased with a lower Sunnybrook composite score. Furthermore, at 1 month, symmetry of voluntary movement had higher predictive value for synkinesis than resting symmetry with AUC 0.87 and 0.77, respectively. Gentle eye closure and open-mouth smile were the only independent significant predictive items (AUC 0.86).
  
  
  CONCLUSIONS
  Moderate-to-severe synkinesis was present in 6.6% of patients. The mean synkinesis score increased between 6 and 12 months, and outcome should therefore be evaluated after at least 12 months. Sunnybrook composite score and symmetry of voluntary movement at 1 month were good predictors for synkinesis.
authors.affiliation: Department of Surgical Sciences, Otorhinolaryngology and Head and Neck Surgery, Uppsala University, Uppsala, Sweden.
authors.forename: N
authors.initials: N
authors.lastname: Bylund
authors.affiliation: Department of Surgical Sciences, Plastic and Maxillofacial Surgery, Uppsala University, Uppsala, Sweden.
authors.forename: D
authors.initials: D
authors.lastname: Jensson
authors.affiliation: Department of Surgical Sciences, Otorhinolaryngology and Head and Neck Surgery, Uppsala University, Uppsala, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Enghag
authors.affiliation: Department of Plastic and Reconstructive Surgery and the Institute for Surgical Research, Oslo University Hospital Rikshospitalet, Oslo, Norway.
authors.forename: T
authors.initials: T
authors.lastname: Berg
authors.affiliation: Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: E
authors.initials: E
authors.lastname: Marsk
authors.affiliation: Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Hultcrantz
authors.affiliation: Uppsala Clinical Research Centre, Uppsala, Sweden.
authors.forename: N
authors.initials: N
authors.lastname: Hadziosmanovic
authors.affiliation: Department of Surgical Sciences, Plastic and Maxillofacial Surgery, Uppsala University, Uppsala, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Rodriguez-Lorenzo
authors.affiliation: Department of Surgical Sciences, Otorhinolaryngology and Head and Neck Surgery, Uppsala University, Uppsala, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Jonsson
mesh_terms: D000212:Acyclovir / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage; D020330:Bell Palsy / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage*; D046608:Synkinesis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D013997:Time Factors; D016896:Treatment Outcome; D000077483:Valacyclovir; D014633:Valine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D005938:Glucocorticoids; D011239:Prednisolone; D014633:Valine; D000077483:Valacyclovir; D000212:Acyclovir