The effect of prednisolone and / or acyclovir in relation to severity of Bell’s palsy at presentation

Objectives: To evaluate the efficacy of prednisolone and/or acyclovir in the treatment of Bell’s palsy in relation to severity at the first visit. Design: A prospective, randomised, placebo-controlled study. Setting: Four public outpatient ENT clinics. Patients: 603 patients aged 18–70 years were treated within 72 h of palsy onset. Patients were assigned to three groups; group 1 treatedwith prednisolone plus placebo (n=198), group 2 treatedwith acyclovir plus placebo (n=203), and group 3 treated with prednisolone plus acyclovir (n=202). Each group was divided into three subgroups according to severity of palsy at presentation using the Sunnybrook score; severe; moderate and mild. Point of assessment was at the end of the 12th month. Main outcomemeasures: Facial function and synkinesis were evaluated for correlation to severity of palsy at baseline. Results: In patients with severe palsy, complete recovery at 12 months was 56%with prednisolone, 41.6%with acyclovir and 55.5%in prednisolone plus acyclovir group. In patients withmoderate palsy, recovery was 64.5%, 56.6% and 70.2% in groups 1, 2 and 3 respectively. In patients with mild palsy, recovery was 92%, 62.6%and 91.5%in groups 1, 2 and 3, respectively. Complete recovery and absence of slinkiness results were correlated to the baseline severity. Group 3 had significant higher results in moderate palsy cases. Conclusion: Prednisolone treatment resulted in higher complete recovery rates, regardless of severity at presentation. Prednisolone treatment should be considered in all patients irrespective of degree of palsy.