The effect of study design and analysis methods on recovery rates in Bell's palsy

Berg, Thomas; Marsk, Elin; Engström, Mats; Hultcrantz, Malou; Hadziosmanovic, Nermin; Jönsson, Lars

doi:10.1002/lary.20626

Cited by 31 publications

(17 citation statements)

References 22 publications

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“…The sole exception is the clinical trial of Engström et al 5 giving an outcome for prednisolone therapy of 72% ( patients with a Sunnybrook score of 100) or 78% (HB I) for complete recovery after 12 months. 17 In Engström's study, the proportions of complete palsy cases seem to be in the range of the present study (number not given in the publication, but the median HB at onset was IV in the Swedish study vs III½ in the present study). Besides, Engström's study is the only prospective trial calculating the probability of recovery by the Kaplan-Meier curves.…”

Section: Strengths and Weaknesses Of This Studysupporting

confidence: 41%

“…3 5 In the present study, only 93 patients (36%) started the treatment within 72 h. Finally, the recovery rates in acute facial palsy studies are substantially affected by the choice of analysis method and definition of recovery. 17 We used electromyography in the follow-up of the patients. This might be a more precise method than to perform only a clinical evaluation.…”

Section: Strengths and Weaknesses Of This Studymentioning

confidence: 99%

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Prognostication of recovery time after acute peripheral facial palsy: a prospective cohort study

et al. 2013

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ObjectiveOwing to a lack of prospective studies, our aim was to evaluate diagnostic factors, in particular, motor and non-motor function tests, for prognostication of recovery time in patients with acute facial palsy (AFP).DesignProspective cohort study.SettingUniversity hospital.Participants259 patients with AFP.MeasurementsClinical data, facial grading, electrophysiological motor function tests and other non-motor function tests were assessed for their contribution to recovery time.ResultsThe predominant origin of AFP was idiopathic (59%) and traumatic (21%). At baseline, the House-Brackmann scale (HB) was >III in 46% of patients. Follow-up time was 5.6±9.8 months with a complete recovery rate of 49%. The median recovery time was 3.5 months (95% CI 2.2 to 4.7 months). The following variables were associated with faster recovery: Interval between onset of AFP and treatment <6 days versus ≥6 days (median recovery time in months 2.1 vs 6.5; p<0.0001); HB ≤III vs >III (2.2 vs 4.6; p=0.001); no versus presence of pathological spontaneous activity in first electromyography (EMG; 2.8 vs probability of recovery <50%; p<0.0001); no versus voluntary activity in EMG (probability of recovery <50% vs 3.1; p<0.0001); normal versus pathological ipsilateral electroneurography (1.9 vs 6.5; p=0.008), normal versus pathological stapedius reflexes (1.6 vs 3.3; p=0.003).ConclusionsStart of treatment and grading, but most importantly EMG evaluated for pathological spontaneous activity and the stapedius reflex test are powerful prognosticators for estimating the recovery time from AFP. These results need confirmation in larger datasets.

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Section: Strengths and Weaknesses Of This Studysupporting

confidence: 41%

Section: Strengths and Weaknesses Of This Studymentioning

confidence: 99%

Prognostication of recovery time after acute peripheral facial palsy: a prospective cohort study

et al. 2013

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“…Without treatment, about 30% of patients do not recover completely [3] after 6 months. However, recovery rates in a Bell's palsy study are substantially aVected by deWnition of recovery, choice of analysis method [4], medicinal treatment plan, and in particular the onset of therapy. Early treatment within 72 h after the onset of symptoms is crucial for patient outcome and increases recovery rates signiWcantly (¸85% after 6 months) [5,6].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the early phase of Bell’s palsy using 3 T MRI

Burmeister

Baltzer

Volk

et al. 2011

Eur Arch Otorhinolaryngol

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This prospective study on Bell's palsy investigated the value of 3 T MRI as a diagnostic tool to evaluate pathophysiological changes (i.e. edema) of facial nerve segments and the possibility to differentiate patients with high risk for incomplete recovery from patients who recover completely within 3 days after symptoms onset. For this institutional review board approved investigation, thirty patients (14 male, 16 female, mean age 44 years) with Bell's palsy underwent pre and postcontrast 3 T MRI of the cerebellopontine angle. T1-weighted imaging was performed (TR 20.0 ms, TE 2.46 ms, isotropic voxel size: 0.6 mm). Region-of-interest measurements were performed on the healthy and paralyzed side. To obtain normalized values, signal intensity increase percentage (SIIP) values were divided by contralateral results of the healthy side. Signal intensity measurements of examined nerve segments were compared using Wilcoxon and Mann-Whitney U tests and correlated to clinical findings categorized by the House-Brackmann score. The lesion side showed significantly higher signal intensities in the premeatal segment before and after contrast agent administration (P < 0.001). SIIP was highest in the premeatal segment compared to the geniculate ganglion (P < 0.001). Correlation analyses revealed no association between signal intensity measurements, clinical findings or early recovery rates after 3 months (P > 0.05). According to our results, early palsy-associated pathophysiological changes in the facial nerve premeatal segment might also be related to accumulation of proteins and not exclusively to edema. However, contrast agent enhancement quantification was not suitable as a diagnostic tool to distinguish different prognostic groups.

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“…(1) It is the most common cause of facial nerve palsy, with an approximate incidence of 11-40 patients per 100,000…”

Section: Introductionmentioning

confidence: 99%

“…(1,3,(5)(6)(7) However, antivirals have not been shown to effect a significant difference in outcome. (2) Aside from preventive therapy, much resources and research have been dedicated to the treatment of incomplete recovery among patients with Bell's palsy.…”

Section: Introductionmentioning

confidence: 99%

Bell’s palsy in Singapore: a view from the patient’s perspective

Charn¹,

Subramaniam²,

Yuen³

2013

SMedJ

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RESUlTSA total of 52 patients were recruited, of which 41 were available for analysis. 78.0% of patients were concerned that they were having a stroke upon presentation of the symptoms. Other beliefs about the cause of the disease included overwork or stress (36.6%), something that the patient had eaten (9.8%) and supernatural forces (2.4%). About 50% of patients had tried some form of complementary or alternative therapy other than the steroids/ medicines prescribed by their general practitioner or emergency physician. While 39.0% of patients agreed that the Internet had helped them understand more about their condition in addition to the information provided by the physician, 9.8% of them specifically disagreed with this statement. CONClUSIONWe have found that patients with Bell's palsy in Singapore are not very knowledgeable about the disease.Although the Internet is a useful resource, a physician's explanation of the disease and its natural progression remains of utmost importance.

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The effect of study design and analysis methods on recovery rates in Bell's palsy

Abstract: Recovery rates in a Bell's palsy study are substantially affected by the choice of analysis method and definition of recovery.

Cited by 31 publications

References 22 publications

Prognostication of recovery time after acute peripheral facial palsy: a prospective cohort study

Prognostication of recovery time after acute peripheral facial palsy: a prospective cohort study

Evaluation of the early phase of Bell’s palsy using 3 T MRI

Bell’s palsy in Singapore: a view from the patient’s perspective

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