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Do children with Bell's palsy benefit from steroid treatment? A systematic review
Jacob Pitaro1, Sofia Waissbluth, Sam J Daniel
1Division of Otolaryngology-Head and Neck Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
Insights
This systematic review found insufficient evidence on steroid treatment for Bell
Area of Science:
- Pediatric Neurology
- Otolaryngology
- Evidence-Based Medicine
Background:
- Bell's palsy (BP) is a common cause of acute unilateral facial nerve paralysis in children.
- Steroid therapy is frequently used, but its efficacy in pediatric BP remains debated.
Purpose of the Study:
- To systematically review the outcomes of steroid treatment for Bell's palsy in children.
- To assess the current evidence base for corticosteroid efficacy in pediatric BP.
Main Methods:
- A systematic search of MEDLINE, EMBASE, Cochrane Library, and BIOSIS Previews (2000-2010).
- Inclusion of studies on children (0-18 years) with BP treated solely with corticosteroids.
- Analysis of facial movement outcomes using clinical scales; included study designs: RCTs, cohort studies, cross-sectional studies, case series.
Main Results:
- 6 studies met inclusion criteria from 2293 initially identified papers.
- Heterogeneous reporting of steroid type and treatment duration.
- Predominance of retrospective cohort and case-series studies (Level 4 evidence).
Conclusions:
- No controlled trials were identified for steroid treatment in pediatric Bell's palsy.
- The current evidence is insufficient to confirm the role of steroids in treating childhood BP.
- Further high-quality research, including controlled trials, is necessary.
Objective:
To conduct an updated systematic review on the outcome of Bell's palsy (BP) in children following steroid treatment.
Data Sources:
MEDLINE, EMBASE, Cochrane Library and BIOSIS Previews electronic databases were searched obtaining articles published between 2000 and 2010 without any language restriction.
Review Methods:
Articles describing children aged 0-18 years with BP treated solely with corticosteroids were included. In studies including various etiologies for facial palsy; cases of BP treated with steroids were selected and when available, untreated patients as well for comparison. The outcome measure was facial movements following steroidal treatment based on different clinical scales. Controlled clinical trials, prospective and historical cohort studies, cross sectional studies and case series were included.
Results:
A total of 2293 papers were initially identified. Following review by two authors, 68 papers were analyzed in a hard-copy format. Finally, 6 studies were eligible to be included in the systematic review. Four of the studies included children with BP exclusively while the remaining studies described various etiologies of facial palsy. Type of steroid and duration of treatment were inconsistently specified. Outcome measures used include the House-Brackmann scale, Yanagihara grading system and clinical evaluation. Studies analyzed were retrospective cohorts or case-series and were categorized as level 4 of evidence.
Conclusion:
There were no controlled trials and level 4 publications predominate. Therefore, the role of steroid treatment for BP in children is still inconclusive. Further studies are required.
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