Comparing the Use of High-Dose to Standard-Dose Corticosteroids for the Treatment of Bell’s Palsy in Adults—A Systematic Review and Meta-analysis

Abstract

ObjectiveBell’s palsy is typically treated with oral corticosteroids (40–60 mg daily). Concomitant antivirals are currently not recommended. The objective of this systematic review and meta-analysis was to examine the effect of high-dose versus standard-dose corticosteroids, without antivirals, in the management of Bell’s palsy.Databases ReviewedEmbase, MEDLINE, PubMed, CINAHL, Cochrane Library.MethodsA systematic review and meta-analysis was performed according to PRISMA guidelines. Studies comparing high-dose (≥80 mg) or standard-dose (40–60 mg) corticosteroid therapy for Bell’s palsy were included. Exclusion criteria were coexisting antiviral treatment, nonoral drug delivery, and facial palsy due to other causes. Risk of bias was assessed using ROBINS-I. A weighted estimate of treatment effects across trials as odds ratios (OR) using a Mantel–Haenzel random-effects model was calculated.ResultsThree articles were included in the analysis, representing 485 patients. There was a significant decrease in nonrecovery with high-dose, compared with standard-dose, corticosteroids at 6 months follow-up (OR = 0.17, 95% confidence interval = 0.05–0.56, p = 0.004). Overall adverse events were 5.8% (n = 28), all reported in one study in the high-dose group (transient elevated liver enzymes and fecal occult blood).ConclusionsOur analysis shows a favorable effect of high-dose corticosteroid in the treatment of Bell’s palsy. It is the first to evaluate this effect without the use of antivirals in keeping with current treatment recommendations. As all included studies had a serious risk of bias, future research should focus on larger trials with more robust methodology. This will allow for more up-to-date and large-scale analyses where more valid conclusions can be drawn that may potentially influence treatment protocols.

The Impact of the COVID-19 Pandemic on Bell’s Palsy and Ramsay-Hunt Syndrome: A Multicenter Retrospective Study

“… 7 These findings not only underscore the rising incidence of Bell’s palsy, but also suggest that facial palsy can manifest as the sole symptom or initial sign of COVID-19, further substantiating SARS-CoV-2 as a potential viral cause of Bell’s palsy. 8 9 …”

“…Facial palsy has been reported as the first or sole symptom in patients with COVID-19. 9 25 26 The proposed mechanisms of facial palsy related to SARS-CoV-2 include decreased blood circulation and vascular changes, leading to ischemic neuropathy and acute inflammation-induced demyelination of the facial nerve. 27 Direct viral toxicity or immune-mediated mechanisms may play a role in facial nerve damage.…”

Development of a clinical diagnostic model for Bell's palsy in patients with facial muscle weakness

“…In contrast to these studies, a notable feature of this research is the comparison of diagnostic models based on two reference standards. Both Model (i) and Model (ii) retain four crucial predictive factors considered key indicators in clinical practice for diagnosing Bell's palsy [36,59]. Specifically, the importance of "forehead wrinkling" as a significant clinical proxy distinguishing Bell's palsy from central facial palsy has been reported in other diagnostic models as well [1,2,36,60].…”

Contrast-Enhanced MRI Is Useful for Prognostic Prediction on Idiopathic Bilateral Simultaneous Facial Nerve Palsy: A Case Report and Literature Review

“…Edema of the damaged facial nerve and subsequent degeneration and ischemia caused by compression are considered to be related to prognosis [ 3 ]. Corticosteroids are a commonly used treatment in the early stages of palsy [ 4 ]. Surgical decompression of a damaged facial nerve has been performed as a salvage treatment option [ 5 ].…”