Does Bell's palsy (Idiopathic Facial Paralysis) have a recurrence rate in patients treated with 7 days of steroid (corticosteroid) therapy, with a 2-month follow-up?

From the Guidelines

Bell's Palsy can indeed recur in some patients, with recurrence rates estimated, but the patient's 7-day steroid treatment is a standard approach, and a 2-month follow-up is appropriate to assess recovery, as supported by high-quality studies such as the one by Sullivan et al 1. The patient's treatment with 7 days of steroid treatment is in line with the clinical practice guideline that recommends oral steroids within 72 hours of symptom onset for Bell’s palsy patients 16 years and older, as stated in the study by Sullivan et al 1. Some key points to consider in the patient's follow-up include:

• Evaluating facial nerve function to assess the extent of recovery
• Checking for any residual weakness or symptoms that may have persisted
• Assessing if symptoms have fully resolved, and if not, considering additional evaluation or treatment
• Being aware of the potential for recurrence, which may warrant further investigation for underlying conditions The study by Sullivan et al 1 reported significant improvement of facial nerve function in patients treated with prednisolone within 72 hours of onset, with 83% of participants recovering facial nerve function 3 months after treatment, compared to 63.6% of those randomized to placebo. In the follow-up appointment, the physician should be vigilant for any signs of recurrence or incomplete recovery, and consider prompt treatment with steroids if necessary, to maximize chances of complete recovery, as supported by the study by Engstrom et al, which compared the short- and long-term effects of prednisolone and valacyclovir in facial nerve recovery attributed to Bell’s palsy, and found statistically significant shorter times to recovery in patients treated with prednisolone 1.

From the Research

Bell's Palsy Recurrence and Treatment

• The provided studies do not directly address the recurrence of Bell's palsy after a patient has been given 7 days of steroid treatment and a 2-month follow-up 2, 3, 4, 5, 6.
• However, the studies suggest that steroid treatment is effective in improving recovery rates for Bell's palsy patients, with some studies indicating that the combination of steroid and antiviral treatment may be more effective than steroid treatment alone 2, 3, 5.
• One study found that initiating steroid treatment within 72 hours of symptom onset resulted in higher recovery rates 4.
• Another study found that intratympanic steroid injection (ITSI) was effective and safe in treating Bell's palsy in patients with comorbid diseases, with no major adverse events reported 6.
• The studies also suggest that individualized treatment approaches may be important in managing Bell's palsy, taking into account factors such as age, electroneurography (ENoG) and electromyography (EMG) results, and comorbid conditions 4.

Treatment Outcomes

• The studies report varying recovery rates for Bell's palsy patients, with some studies finding that the combination of steroid and antiviral treatment resulted in higher recovery rates than steroid treatment alone 2, 3, 5.
• One study found that the recovery rate was higher in patients who received steroid monotherapy than combined therapy (86.32% vs. 79.25%) 4.
• Another study found that ITSI resulted in complete recovery rates of 47.5% at 1 month, 70.5% at 3 months, and 96.7% at 6 months 6.

Adverse Events

• The studies report few adverse events associated with steroid treatment, with one study finding no significant increase in adverse events from the use of antivirals compared with either placebo or corticosteroids 2.
• Another study found that ITSI was safe and effective, with no major adverse events reported 6.