The Role of Diabetes Mellitus in the Clinical Presentation and Prognosis of Bell Palsy

Abstract

Background: Bell palsy is considered to be an entrapment neuropathy resulting from inflammation, edema, and strangulation. Diabetes, hypertension, and hypercholesterolemia have all been related to microangiopathies. However, the relationship between the frequency, severity, and recovery course of Bell palsy in patients with these pathologies is a matter of controversy.Methods: Fifty-six patients with Bell palsy were evaluated according to the House-Brackmann grading system a few days after the onset of the disease and 6 months later and correlated to their hypertension, hypercholesterolemia, and diabetes records. Diabetes was evaluated by the use of serum glycosylated hemoglobin (HbA1c).Results: The 20 patients with abnormal HbA1c values were more frequently diagnosed with Bell palsy of grade V/VI (P ‫؍‬ .008; odds ratio, 4.7; 95% CI, 1.4 -15.2). However, their House-Brackmann scores were not found to be worse at the 6-month follow-up visit (P ‫؍‬ .9). No correlations were found for hypertension and hypercholesterolemia.Conclusions: A relationship between the severity of Bell palsy and abnormal HbA1c values seems to be demonstrated. However, the prognosis of these patients does not seem to be worse because at the 6-month follow-up visit they present similar scores to nondiabetic patients. (J Am Board Fam Med 2012;25:819 -826.)

Do diabetic patients with Bell's palsy benefit from corticosteroids?

“…These results were different from the previous studies that showed a beneficial effect of corticosteroids on prognosis in diabetic patients with BP. [14][15][16][17] The discrepancy between our study and the previous studies was possibly due to differences in the study design. In the studies of Kanazawa et al [14] and Akkuzu et al, [15] the comparison was performed between diabetic and non-diabetic BP patients, whereas Riga et al [16] reported the results of steroid therapy for BP within the group of patients who had DM, hypertension, and hyperlipidemia in their study.…”

“…[14][15][16][17] The discrepancy between our study and the previous studies was possibly due to differences in the study design. In the studies of Kanazawa et al [14] and Akkuzu et al, [15] the comparison was performed between diabetic and non-diabetic BP patients, whereas Riga et al [16] reported the results of steroid therapy for BP within the group of patients who had DM, hypertension, and hyperlipidemia in their study. Saito et al [17] had a high cure rate in diabetic patients with the administration of a higher dose steroid regimen than our study.…”

“…In contrast, Akkuzu et al [15] reported that DM was not a poor prognostic indicator if treated with corticosteroids in diabetic BP patients. Riga et al [16] demonstrated full recovery at six months after the onset of facial paralysis in 17 of 20 diabetic patients with BP who were treated with steroid therapy. They stated that preexisting nerve ischemia may act as a preconditioning nerve lesion and may explain the good recovery of diabetic patients, similar to non-diabetic patients.…”

“…[14][15][16][17] In the study of Kanazawa et al, [14] which involved 19 diabetics and 57 non-diabetic BP patients treated with corticosteroids, the facial movement was found to be significantly poorer in the diabetic group than the non-diabetic group at three and six months after the onset of paralysis. They also showed that the recovery rate in the diabetic group was much lower than that in the nondiabetic group.…”

“…However, studies investigating the relationship between BP and DM regarding incidence, disease severity and prognosis demonstrated conflicting results in the literature. [14][15][16][17][18] Although corticosteroids have a well-known adverse effect on blood sugar levels, regulation of blood sugar can be ensured with the administration of adequate insulin and close monitoring of blood sugar during steroid therapy. [15] In the present study, we aimed to evaluate the beneficial effect of steroid therapy in the treatment of diabetic patients with BP.…”