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High-Dose Corticosteroid Therapy in Facial Nerve Palsy: A Retrospective Study
Hiroshi Hyakusoku1, Noriyuki Katsumata1, Meijin Nakayama1
1Otorhinolaryngology, Yokosuka Kyosai Hospital, Yokosuka, JPN.
Cureus
|May 12, 2025
Summary
For Bell's palsy and Ramsay Hunt syndrome, a reduced high-dose corticosteroid therapy (HDCT) with 100 mg prednisolone (PSL) offers similar therapeutic efficacy to the standard 200 mg initial dosage. Higher initial PSL doses in HDCT do not improve treatment outcomes.
Area of Science:
- Neurology
- Otolaryngology
Background:
- Bell's palsy and Ramsay Hunt syndrome are common causes of acute facial nerve paralysis.
- High-dose corticosteroid therapy (HDCT) with prednisolone (PSL) is a standard treatment, but optimal initial dosage remains debated.
Purpose of the Study:
- To compare the therapeutic efficacy of initial 200 mg versus 100 mg prednisolone (PSL) dosages within a high-dose corticosteroid therapy (HDCT) regimen for Bell's palsy and Ramsay Hunt syndrome.
Main Methods:
- Retrospective investigation of 259 patients (172 Bell's palsy, 87 Ramsay Hunt syndrome) treated with standard (200 mg/day for 3 days) or reduced (100 mg/day for 3 days) HDCT with PSL and a 7-day taper.
- Patients were evaluated monthly using the Yanagihara facial nerve grading system until recovery or for six months.
Main Results:
- No significant difference in therapeutic efficacy was observed between standard and reduced HDCT for either condition.
- Electroneuronography showed no significant improvement with the standard HDCT in less than 20% of patients.
Conclusions:
- Initial dosages exceeding 100 mg/day of PSL in HDCT with a taper do not enhance therapeutic efficacy for Bell's palsy or Ramsay Hunt syndrome.
- A reduced HDCT regimen with 100 mg PSL may be as effective as higher doses, potentially minimizing side effects.
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