1488 Management of Bell’s palsy in children – a review of current evidence

• Published in: Archives of disease in childhood 2021-10, Vol.106 (Suppl 1), p.A391-A391
• Main Authors: Hines, Declan, Chitre, Manali
• Format: Article
• Language: English
• Subjects: Abstracts; Antiviral agents; Antiviral drugs; Bell's palsy; Case reports; Children; Clinical trials; Cross-sectional studies; Management; Meta Analysis; Paralysis; Patients; Pediatrics; Placebos; Quality control; Statistical analysis; Steroid hormones; Steroids
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2021-rcpch.679

BackgroundThere is strong evidence that oral steroids improve outcomes in adult patients with Bell’s palsy, but no consensus for paediatric patients. Different management approaches exist. All use eye drops, and then either expectant management, oral steroids, or steroids and antivirals.ObjectivesTo review the current literature for management of Bell’s palsy in children to support the development of clear guidelines.MethodsA literature search was performed in MEDLINE, EMBASE, and CENTRAL. The results were screened with inclusion criteria (1) participants aged 18 or younger and diagnosed BP; (2) compared steroids vs placebo, steroids and antiviral vs placebo, or antivirals vs placebo (3) Primary endpoint recovery of motor function using an explained clinical scale. Randomised clinical trials (RCTs), retrospective cohort studies, and cross-sectional studies were included. Meta-analysis, case reports, and systematic reviews were excluded. Study quality was evaluated using the NHLBI quality assessment tools.ResultsTwenty studies were included for analysis. An RCT and 15 retrospective cohort studies looked at steroid vs expectant management of BP in children. One retrospective cohort study found steroids alone improved duration until full recovery but not overall recovery rate. The other studies in this group found no statistically significant difference between steroids and expectant management. Steroids + antivirals were compared to steroids alone by 3 studies; an RCT found steroids + antivirals to be significantly better than steroids alone, and 2 retrospective cohort studies found no significant difference between steroids alone and steroids + antivirals. A retrospective cohort study found no significant difference in recovery between high and low-dose steroids.The studies are of poor quality. None performed power calculations and they are all underpowered to detect the effect size found in larger adult studies. The retrospective cohort studies did not address important confounding factors, such as whether BP severity affected clinicians’ treatment choice.ConclusionsPaediatric studies fail to demonstrate the beneficial effects of oral steroids shown in adult studies but their designs are inadequate to detect potential benefits. The poor quality of existing research is an important limiting factor, and so high quality RCTs are indicated to investigate the effects of steroids alone and steroids with antivirals in paediatric BP patients.