Should We Use Steroids for Pediatric Bell’s Palsy?

Written by Clay Smith

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There was no statistical difference in 1, 3, or 6 month facial recovery with prednisolone vs placebo for children with Bell’s palsy in this underpowered RCT. I plan to keep using steroids, though opinions on this will differ.

Why does this matter?
Glucocorticoids benefit adults with Bell’s palsy, but does the same hold for children?

This has a familiar ring to it
This was a RCT with 187 children with Bell’s palsy, within 72 hours of onset, who were randomized to prednisolone 1mg/kg/day or placebo. There was no difference in 1 or 3 month facial motor function recovery. By 3 months, 90% of the steroid group vs 85% of placebo had facial function recovery; risk difference 5.2%, (95%CI -5.0 to 15.3). At 6 months, 99% in the steroid group vs 93% placebo had recovered; risk difference 6.0% (95%CI -0.1 to 12.2). They intended to include 540 patients but faced sluggish enrollment and had to stop early. The authors concluded there was no benefit to using steroids. However, it seems to me there may be a weak signal of long-term benefit in the steroid group. A Bayesian reanalysis would be interesting. Importantly, steroids could mask a presentation of leukemia and complicate subsequent management. In addition, steroids have a small risk of harm in children. That said, facial palsy has significant consequences as well, though permanent motor impairment is rare in children. There were no severe adverse events from steroids in this study, except infrequent behavioral change and increased appetite. Here are my thoughts: consider a CBC, stock up on groceries, and use steroids. However, some may come to a different conclusion.

Efficacy of Prednisolone for Bell Palsy in Children: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial. Neurology. 2022 Aug 25;10.1212/WNL.0000000000201164. doi: 10.1212/WNL.0000000000201164. Online ahead of print.

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