High-dose corticosteroids improve the prognosis of Bell's palsy compared with low-dose corticosteroids: A propensity score analysis.

OBJECTIVE

The aim of this study was to evaluate the effectiveness of high-dose corticosteroid (120mg prednisolone equivalent daily) in Bell's palsy compared with low-dose corticosteroid (60mg PSL equivalent).

METHODS

A single-center retrospective observational study was performed. We included adult Bell's palsy patients who were treated within 7days after disease onset. We compared high- and low-dose corticosteroid for the non-recovery rate at 6 months after disease onset using inverse probability-weighted propensity score analysis (IPW-PS).

RESULTS

A total of 368 Bell's palsy patients (281 in the high-dose and 87 in the low-dose group) were included. The non-recovery rate without IPW-PS was 13.8% in the low-dose and 8.2% in the high-dose group. After IPW-PS adjustment, the non-recovery rate was 13.1% in the low-dose and 7.8% in the high-dose group (difference=-5.28%, 95% confidence interval [CI] -12.7% to -2.1%, p=0.040). High-dose corticosteroid decreased the non-recovery rate in severe Bell's palsy patients with a Yanagihara score of 0-10 (difference=-16.1%, 95% CI -38.5% to -6.2%, p=0.012), but did not decrease in moderate Bell's palsy patients with a Yanagihara score of 12-18 (difference=-2.0%, 95% CI -11.0% to 7.0%, p=0.591). Subgroup analysis revealed that the efficacy of high-dose corticosteroids was higher when patients were treated within 3days after disease onset, but not when patients were treated at 4days or later after disease onset.

CONCLUSIONS

Physicians would be better to treat severe Bell's palsy patients with high-dose corticosteroids when the patients are treated within 3days after disease onset.