Bell's palsy : study design, prognosis and quality-of-life

Background: Bell’s palsy is an acute peripheral facial nerve dysfunction with unknown etiology, causing weakness or paralysis of the mimic muscles of the face. The disease can cause disfi gurement of the face, impair the ability to eat, drink and speak, and seriously affect the patient’s quality of life. Physicians have searched for tests or clinical signs that can predict the outcome of Bell’s palsy but none have proven powerful enough. Studies also show several methodological differences and interpretation of results is diffi cult. In addition, validated instruments measuring quality of life aspects in these patients in Swedish have not been available. Aims: To examine the effect of different analysis methods on a Bell’s palsy study, to fi nd prognostic clinical signs for non-recovery in Bell’s palsy using the Sunnybrook facial grading scale, and to translate and validate the Facial Disability Index (FDI) and Facial Clinimetric Evaluation (FaCE) scale questionnaires in Swedish. Data: Data for papers I-III were extracted from a prospective, controlled multicenter study including 829 patients with Bell’s palsy. Patients were randomized to treatment with prednisolone and/or valacyclovir or placebo. In paper IV, 93 patients with stable peripheral facial palsy had their facial function assessed with House- Brackmann and Sunnybrook scales and answered FDI and FaCE-scale questionnaires on two occasions with a 2-week interval. Results and conclusions: The choice of statistical method and defi nition of complete recovery substantially infl uence the calculated rate of recovery. These results emphasize the caution that must be exercised when interpreting clinical results in reported Bell’s palsy studies. Early deterioration in Sunnybrook scores between baseline and fi rst follow-up at days 11-17 is found to be a negative prognostic factor for complete recovery at 12 months. Early prednisolone treatment reduces this deterioration and improves outcome in patients with early deterioration. Sunnybrook grading at 1 month can accurately predict non-recovery (Sunnybrook< 70) at 12 months in Bell’s palsy. A prediction model and a simple-to-use risk curve for identifying patients at risk for sequelae based on the Sunnybrook score at 1 month are presented and both can be used in clinical practice. The Swedish versions of the FDI and FaCE-scale show high reliability and validity, and the questionnaires can be used for clinical evaluation and for studies on patients with peripheral facial palsy in Sweden

Quality of Life in Bell's Palsy : Correlation with Sunnybrook and House-Brackmann Over Time

Objectives To compare patient‐graded facial and social/well‐being function with physician‐graded facial function in Bell's palsy over time. Study Design A prospective follow‐up study at two tertiary otorhinolaryngological centers. Methods A total of 96 patients, 36 women and 60 men, aged 18–77 years, were included. Facial Clinimetric Evaluation (FaCE) scale and Facial Disability Index (FDI) scores were compared with Sunnybrook and House‐Brackmann scores. Results Inclusion was on mean day 7 (96 patients) and follow‐up on days 53 (81 patients) and 137 (32 patients). Initially, correlations between FaCE total score, FaCE domains, FDI physical function, FDI social/well‐being function and Sunnybrook and House‐Brackmann scores were low to fair, except for FaCE facial movement (r = 0.55). Correlations between FaCE total score and Sunnybrook score were very good to excellent at visits 2 (r = 0.83) and 3 (r = 0.81). Women scored FaCE social and FDI social/well‐being function lower than men, despite similar Sunnybrook scores. Conclusion In early stages of Bell's palsy, there were low to fair correlations between FaCE/FDI (except for facial movement) and Sunnybrook score. This implies that the design of the quality of life (QoL) instruments is less suited for the acute phase. The high correlations at follow‐ups suggest that the questionnaires can be used for evaluation of QoL over time. Our results indicate that women experience more facial palsy‐related psychosocial dysfunction. Level of Evidence 4 Laryngoscope, 131:E612–E618, 202

The facial nerve palsy and cortisone evaluation (FACE) study in children : protocol for a randomized, placebo-controlled, multicenter trial, in a Borrelia burgdorferi endemic area

Background: Children with acute peripheral facial nerve palsy cannot yet be recommended corticosteroid treatment based on evidence. Adults with idiopathic facial nerve palsy are treated with corticosteroids, according to guidelines resulting from a meta-analysis comprising two major randomized placebo-controlled trials. Corresponding trials in children are lacking. Furthermore, acute facial nerve palsy in childhood is frequently associated with Lyme neuroborreliosis, caused by the spirochete Borrelia burgdorferi. The efficacy and safety of corticosteroid treatment of acute facial nerve palsy associated with Lyme neuroborreliosis, has not yet been determined in prospective trials in children, nor in adults. Method: This randomized double-blind, placebo-controlled study will include a total of 500 Swedish children aged 1-17 years, presenting with acute facial nerve palsy of either idiopathic etiology or associated with Lyme neuroborreliosis. Inclusion is ongoing at 12 pediatric departments, all situated in Borrelia burgdorferi endemic areas. Participants are randomized into active treatment with prednisolone 1 mg/kg/day (maximum 50 mg/day) or placebo for oral intake once daily during 10 days without taper. Cases associated with Lyme neuroborreliosis are treated with antibiotics in addition to the study treatment. The House-Brackmann grading scale and the Sunnybrook facial grading system are used for physician-assessed evaluation of facial impairment at baseline, and at the 1- and 12-month follow-ups. Primary outcome is complete recovery, measured by House-Brackmann grading scale, at the 12-month follow-up. Child/parent-assessed questionnaires are used for evaluation of disease-specific quality of life and facial disability and its correlation to physician-assessed facial impairment will be evaluated. Furthermore, the study will evaluate factors of importance for predicting recovery, as well as the safety profile for short-term prednisolone treatment in children with acute facial nerve palsy. Discussion: This article presents the rationale, design and content of a protocol for a study that will determine the efficacy of corticosteroid treatment in children with acute facial nerve palsy of idiopathic etiology, or associated with Lyme neuroborreliosis. Future results will attribute to evidence-based treatment guidelines applicable also in Borrelia burgdorferi endemic areas