Recurrent Bell’s palsy: outcomes and correlation with clinical comorbidities

Abstract

SUMMARYRecurrent Bell’s palsy (RBP) has been reported to range from 2.6 to 15.2% of primary Bell’s palsy (BP) and has been associated with systemic comorbidities such as diabetes and hypertension. A retrospective analysis of patients affected by BP and RBP were performed to define the signs and symptoms associated with recurrence and the outcomes. Clinical and subjective characteristics of 341 patients affected by facial palsy were analysed. Facial function was assessed via House-Brackmann and Sunnybrook grading system. Characteristics of the palsy and systemic comorbidities (diabetes, hypertension, herpetic infections, autoimmunity disorders, audio-vestibular symptoms) were analysed in BP and RBP patients applying Fisher exact and the Mann-Whitney U tests, while time to recovery was explored with univariate and multivariate analysis. Twenty-four patients presented two or more episodes of facial palsy, representing a recurrence rate of 7%. Associated symptoms (e.g. retroauricular pain, taste disorder, dry eye etc.) were similar between BP and RBP patients. RBP occurred at older age than primary episode (p = 0.03). Recurrence was a risk factor for delayed recovery (p = 0.02), although final facial function was similar between the two groups. In conclusion, no significant differences were found between primary BP patients and RBP patients in terms of symptoms, palsy severity and presence of comorbidities. Delayed facial nerve function recovery in RBP did not affect the final outcome. Treatment of facial nerve recurrences must be the same of the primary episode, although the presence of prodromal symptoms may alert the patient and early corticosteroid treatment may be commenced even before the onset of paresis.

Epidemiological trends of Bell's palsy treated with steroids in Korea between 2008 and 2018

“…27,29,30 The results of the present study correspond with those of earlier studies that reported no association between comorbidities and recurrent Bell's palsy. 26,29 No high-quality trials have been conducted to explore the effectiveness of physiotherapy. 19,20,31 A large body of research has suggested that physiotherapy is not harmful and has small benefits in patients with severe Bell's palsy, such as those who have synkinesis.…”

“…There has been considerable disagreement regarding the role of underlying comorbidities such as diabetes mellitus and hypertension in the recurrence of Bell's palsy. 27,29,30 The results of the present study correspond with those of earlier studies that reported no association between comorbidities and recurrent Bell's palsy. 26,29 No high-quality trials have been conducted to explore the effectiveness of physiotherapy.…”

“…As most prior studies included patients who had visited a facial palsy specialist or referral hospital, 26‐29 the recurrence rate may have been overestimated. There has been considerable disagreement regarding the role of underlying comorbidities such as diabetes mellitus and hypertension in the recurrence of Bell's palsy 27,29,30 . The results of the present study correspond with those of earlier studies that reported no association between comorbidities and recurrent Bell's palsy 26,29 …”

“…8 The recurrence rate of Bell's palsy treated with steroids in the present study was slightly higher than the lowest reported recurrence rate of 0.8%. As most prior studies included patients who had visited a facial palsy specialist or referral hospital, [26][27][28][29] the recurrence rate may have been overestimated. There has been considerable disagreement regarding the role of underlying comorbidities such as diabetes mellitus and hypertension in the recurrence of Bell's palsy.…”

A Case of Recurrent Facial Palsy Associated with Anti-GM2: is it anyway Guillain-barré syndrome?

“…Recurrent Facial palsy have just a few know comorbidities risk factors, such as diabetes and hypertension [4] . On the other hand, there are a few known factors which can explain higher risk to get sick with Guillain-Barre syndrome, such as immune-mediated and rheumatological disease, cancer, transfusion, surgical procedures, and preeclampsia [3] .…”