Department of Otorhinolaryngology and Head & Neck Surgery, Karolinska University Hospital, Stockholm, Sweden.
Otol Neurotol. 2010 Dec;31(9):1503-7. doi: 10.1097/MAO.0b013e3181f2f21f.
To assess if early deterioration is a negative prognostic factor in Bell's palsy and if prednisolone treatment reduces early progression and enhances recovery.
Data extracted from the randomized, double-blind, placebo-controlled multicenter, Scandinavian Bell's palsy study.
Sixteen tertiary referral centers in Sweden and one in Finland.
A total of 829 patients aged 18 to 75 years with Bell's palsy.
The study design was factorial; 416 patients were given prednisolone, whereas 413 did not receive the drug. Data were analyzed with a modified intention-to-treat principle and the last-observation-carried-forward method.
Facial function was assessed within 72 hours before treatment start, at Days 11 to 17, and at 12 months. Sunnybrook was used as the main facial grading system with complete recovery defined as Sunnybrook 100.
In 236 (28%) of 829 patients, the palsy deteriorated from baseline to the first follow-up at Days 11 to 17. Complete recovery at 12 months was 45% among subjects with early deterioration compared with 73% in patients with no initial deterioration (p < 0.0001). In the early deterioration group, complete recovery at 12 months was 62% in patients treated with prednisolone and 31% in those not treated (p < 0.0001).
Early deterioration in Bell's palsy is a negative prognostic factor for complete recovery at 12 months. Prednisolone given within 72 hours may reduce early progression and improve the outcome of palsy.
评估早期恶化是否是贝尔面瘫的一个负性预后因素，以及泼尼松龙治疗是否能减少早期进展并促进恢复。
从随机、双盲、安慰剂对照的多中心斯堪的纳维亚贝尔面瘫研究中提取的数据。
瑞典的 16 个三级转诊中心和芬兰的 1 个。
共 829 名年龄在 18 至 75 岁之间的贝尔面瘫患者。
该研究设计为析因设计；416 名患者接受泼尼松龙治疗，而 413 名患者未接受该药物治疗。数据采用改良意向治疗原则和最后观察向前结转法进行分析。
治疗开始前 72 小时内、第 11 至 17 天以及 12 个月时评估面部功能。Sunnybrook 被用作主要的面部分级系统，完全恢复定义为 Sunnybrook 100。
在 829 名患者中的 236 名（28%）患者中，面瘫从基线到第 11 至 17 天的首次随访时恶化。在早期恶化组中，在接受泼尼松龙治疗的患者中，12 个月时完全恢复的比例为 62%，而未接受治疗的患者为 31%（p<0.0001）。在早期恶化组中，在接受泼尼松龙治疗的患者中，12 个月时完全恢复的比例为 62%，而未接受治疗的患者为 31%（p<0.0001）。
贝尔面瘫的早期恶化是 12 个月时完全恢复的负性预后因素。在 72 小时内给予泼尼松龙可能会减少早期进展并改善面瘫的预后。
