The Upstate New York Experience of Managing Bell's Palsy: A Review of 3000 Patient Charts to Determine an Ideal Treatment
Alap U. Patel, BA, Dahlia M. Rice, MD, Drew M. Mitchell, BA, Miranda A. Chacon, BS, Luoying Yang, BS, Raissa Villanueva, MD and Jonathan I. Leckenby, MD, University of Rochester Medical Center, Rochester, NY
Bell's Palsy is an idiopathic, acute onset (typically less than 72 hours) dysfunction of the seventh cranial nerve resulting in either partial or total ipsilateral facial paralysis. It is the most common cause of peripheral facial weakness, and accounts for 60-75% of all cases of unilateral facial paralysis. Despite this, the etiology of Bell's Palsy remains unclear. While medical management of the disease would include oral steroids and/or antivirals, the prescribing habits of providers vary tremendously. This study aims to augment the currently available information by providing the population data of a large health network in upstate New York. Our purpose is to specifically describe the prescribing habits for the treatment of Bell's Palsy.
Materials and Methods:
Patient charts were retrospectively reviewed, and data were obtained on demographics, physical exam, location of presentation, clinical recovery, and treatment (medication, dose, duration, tapering method).
Of the 3027 patient charts reviewed between 2011 and 2019, 906 (30%) met inclusion criteria. Patients with Bell's Palsy were separated into the following treatment groups: 'Antiviral only' (n=13), 'Steroids only' (n=448), 'Steroids+Antivirals' (n=313), and “Other” that included physical therapy and/or reassurance (n=132). At 6 weeks, the 'Antiviral only' group had 17% recovery, the 'Steroids only' group had 29% recovery, the 'Steroids+Antiviral' group had 22% and the 'Other' group had 25%. At 6 months the 'Antiviral only' group had 100% recovery, the 'Steroids only' group had 69% recovery, the 'Steroids+Antiviral' group had 67% and the 'Other' group had 73%. There were no statistically significant differences between the groups (p=0.34). Patients presenting to the ED (55%) or their PCP (48%) were mostly treated with 'Steroids only'. Treatment regimens varied greatly in both dosage and duration: in the 'steroids only' group starting doses ranged from 40mg (14%) to 80 mg (8%) with 60 mg being the most widely used (74%). Most patients were prescribed 1 week of treatment (61%), though some were prescribed 2 weeks of steroid treatment (27%) with a variance in tapering regimes. There were no significant differences demonstrated between the treatment variations within the individual treatment groups.
Our study demonstrates that although treatment regimens widely vary, there is no significance between them. The results support the need for a well-designed randomized controlled trial to determine whether there is any benefit of medical treatment of Bell's Palsy and if there is, what is the best protocol.
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