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Prompt prednisolone treatment improves some outcomes of Bell’s palsy

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Mild and moderate sequelae of Bell’s palsy at 12 months are reduced when prednisolone is given within 72 hours of symptom onset, according to a Scandinavian study reported in the May issue of the Archives of Otolaryngology–Head & Neck Surgery.

“Prednisolone did not reduce the number of patients with severe sequelae,” the authors note.

They point out that it’s known that corticosteroids improve complete recovery rates in Bell’s palsy, but the effect on severity of sequelae is unknown. Also, the value of adding antiviral agents to corticosteroids is unclear.

Dr. Thomas Berg, of Oslo University Hospital Rikshospitalet, Norway, and colleagues therefore conducted a study in which 829 patients with Bell’s palsy were randomized within 72 hours to one of four treatment arms: placebo plus placebo; prednisolone, 60 mg/d for 5 days then tapered for 5 days, plus placebo; valacyclovir hydrochloride, 1000 mg 3 times daily for 7 days, plus placebo; or prednisolone plus valacyclovir.

Facial function at 12 months was assessed with the Sunnybrook score, in which 0 equals complete paralysis and 100 indicates normal function, and the House-Brackmann grade, in which I equates with normal function and VI with complete paralysis.

At 12 months, 184 of the patients had a Sunnybrook score less than 90. In this group, 71 had been treated with prednisolone and 113 had not (p<0.001), the authors report. On the other hand, there was no significant difference in receipt of prednisolone or not among patients with a Sunnybrook score less than 50.

Similarly, among patients with a House-Brackmann grade higher than I, 92 received prednisolone and 147 did not (p<0.001), while there was no significant difference in the number who received prednisolone or not among patient with a grade higher than III.

Regarding the value of antiviral therapy, “We found no additive effect of valacyclovir to prednisolone on sequelae,” Dr. Berg and colleagues report.

“To conclude,” they write, “treatment with prednisolone significantly reduced mild and moderate sequelae in Bell’s palsy at 12 months. Prednisolone did not reduce the number of patients with severe sequelae. Valacyclovir alone did not affect the severity of sequelae. The combination of prednisolone plus valacyclovir did not reduce the number of patients with sequelae compared with prednisolone alone,”

SOURCE:

Arch Otolaryngol Head Neck Surg 2012;138:445-449.