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Abstract
Aims The management of Bell’s palsy, in particular its treatment, is subject to significant variation especially in children, partly due to a lack of robust clinical evidence. We aimed to evaluate the presentation, investigation, management, follow up and outcome of children presenting to our service with Bell’s palsy.
Methods Retrospective data collection for patients aged <18 presenting between 01/01/2010 and 31/12/2014 with Bell’s palsy. Electronic and paper records were analysed and clinical details of interest recorded.
Results Demographics of the 65 children, 50.8% were male and 49.2% female, with an average age of 7.91 years (range 0.07–16.35).
Presentation Patients presented equally with left (55%) and right (45%) sided palsies. Most came via GP referrals (56.9%), and 82.7% presented within 72 h of symptom onset.
History and examination Patient histories commonly reported visiting a Lyme’s disease endemic area (38.5%), recent illnesses (20%) and tick bites (17.6%).
Examinations included cranial nerve exams (86.5%), testing of the peripheral nervous system (67.7%), examining the eye (56.9%) and taking a blood pressure (53.8%).
Investigation Lyme’s serology tests (81.5%), full blood counts (78.5%) and neurological imaging (30.8%) were commonly ordered. 42.5% of Lyme’s tests were positive whilst 30% of imaging reported some abnormality.
Treatment Treatment varied considerably with antibiotics, steroids and antivirals all being used in different combinations (Figure 1).
Follow-up and outcome Most patients were seen again within 7 days (62%). 57% were reviewed in out-patient clinic within 6 months: 60.5% were documented as having made full recovery, 34.9% were resolving and 4.7% made no recovery (Table 1).
Conclusion This review describes significant variation in the investigation and management of young people presenting with Bell’s palsy. This unwarranted variation has potential cost and adverse implications for the patient. A local guideline would potentially standardise the approach, reducing associated costs of unnecessary investigations and treatment, whilst optimising best practice. Given the prevalence of Lyme’s in this population, appropriate antibiotic therapy should be administered whilst awaiting serology. This review found no additional benefit with steroid treatment and as such adds weight to the need for a large RCT to assess their efficacy in children.