University of Michigan
Department of Pediatrics
Evidence-Based Pediatrics Web Site

Question

• A 5 year old female presented to the Emergency Room with a 4 day history of right sided facial weakness. In children with Bell's Palsy, does treatment with steroids improve recovery when compared to no intervention (watchful waiting)?
  

Clinical Bottom Lines

1. If there are no contraindications, steroids are probably effective and should be prescribed in treatment of Bell’s palsy.¹
2. There are not enough well-designed, large, RCTs available to answer this question completely.
   
3. Individual studies produce contrasting results: improvement / no improvement in outcome with steroid treatment.^2,3,5
   
4. Steroids are a relatively benign treatment with few side effects.
   
5. Studies do show a statistically insignificant “trend” toward faster recovery of facial nerve function.¹

Summary of Key Evidence

1.  5 prospective studies using steroids in the treatment of Bell’s palsy were reviewed.^1-5
2.  All trials were small.
3.  Only 2 studies were randomized-controlled trials; the remaining were less rigorous studies.
4.  Relative risk (RR) of improvement of facial nerve function with steroid treatment was determined for all studies, and in all cases, RR was near 1.
5.  A meta-analysis of the studies showed a RR of 1.2, indicating that patients treated with steroids were 1.2 timesmore likely to have “good” facial nerve function compared to untreated patient.
 

Additional Comments

•  This practice parameter attempts to synthesize what evidence is available for the treatment of Bell’s palsy.¹
•     There are no RCTs with enough power to make clear, evidence-based recommendations for the use of steroids in the treatment of Bell’s palsy.¹
•     Although not part of this clinical question, this article discusses other management options for Bell’s palsy, including acyclovir and surgery.¹
•  Children were not routinely included in the studies.¹
•     Two of the Class IV studies (not included in the final recommendations) included children > 4 years old.
•     One Class I study included patients > 12 years old, but was not limited to children.
•     One Class II study did not include patients’ ages.
•     Remainder of studies used adult patients only.
•  Opinions from multiple experts were not included in this practice parameter.¹
•  Opinions from patients were not included in this practice parameter.¹
•  Many questions remain unanswered:
•     How early in the course of disease should steroids be started?
•     What impact do co-morbid conditions (DM and HTN) have on treatment and recovery in Bell’s palsy?
•     How is the treatment of kids different from adults?
  

Citation

1.  Grogan PM, Gronseth GS.  Practice parameter: Steroids, acyclovir, and surgery for Bell’s palsy (an evidence-based review). Neurology 2001: 56: 830-36.
2.  Unuvar E et al. Corticosteroid treatment of childhood Bell’s Palsy.  Pediatric Neurology 1999; 21: 814-16.
3.  Williamson IG, Whelan TR. The clinical problem of Bell’s Palsy: Is treatment with steroids effective? British Journal of General Practice 1996; 46: 743-47.
4.  Riordan M. Investigation and treatment of facial paralysis. Arch Dis Child 2001; 84:286-287
5.  Prescott CAJ. Idiopathic Facial Nerve Palsy in Children and the Effect of Treatment With Steroids.  Int Jour Ped Otorhinolaryngology 1987; 13: 257-64.
    

CAT Author: Amy Morrow, MD

CAT Appraisers: Robert Schumacher, MD

Date appraised: October 29, 2001