Clinical Prognostic Factors for Treatment Outcome in Bell’s Palsy: A Prospective Study
Pornchai Sathirapanya MD*, Chutarat Sathirapanya BSc (Nursing), MSc (Public Health), DrPH (Health Education)**
Affiliation : * Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla ** Faculty of Health and Sports Science, Thaksin University, Muang, Songkhla
Objective : To evaluate the clinical factors for predicting the outcome in Bell’s palsy patients treated by oral
prednisolone.
Results : Prospective study in a tertiary-care neurological hospital.
Material and Method: Three hundred and eighty cases of acute unilateral lower motor neuron type of facial
palsy were enrolled initially from a neurological clinic. After exclusion of the unfulfilled criteria cases, 201
cases of Bell’s palsy completed the study protocol and were followed for six months after a seven-day course of
60 mg/day followed by a five-day taper-off dosage of oral prednisolone. A modified House-Brackman facial
paralysis grading system was used to evaluate the recovery of facial weakness in the serial follow-up examination.
Correlation between demographic data, clinical presenting symptoms and signs, and the final outcome were
analyzed by multiple logistic regressions to determine the significant clinical prognostic factors.
Results : There was a significant overall recovery of the facial weakness in succession throughout the 12 weeks
of the follow-up period. The mean facial muscle scores approached the level of favorable outcome at the
twelfth week after treatment. Duration between onset and treatment longer than seven days (RR = 18.87, 95%
CI = 4.97-71.53), severe facial paralysis (RR = 5.01, 95% CI = 2.52 – 9.95), hearing defect (RR = 3.01, 95%
CI = 1.16-7.84), and history of recurrence (RR = 3.75, 95% CI=1.21 – 11.59) were the significant prognostic
factors for unfavorable outcome of treatment (p < 0.05).
Conclusion : Delayed in initiation of oral prednisolone, severe facial weakness, hearing defect, and history of
recurrence were significant prognostic factors determining the poor outcome. To yield a satisfactory thera-
peutic result, early treatment of Bell’s palsy with oral prednisolone should be recommended in cases of severe
facial paralysis.
Keywords : Bell’s palsy, Clinical prognostic factors
