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Bell’s palsy is generally defined as an acute-onset unilateral idiopathic mononeuropathy in the facial nerve. It is of unknown aetiology, however, inflammation is considered a major cause. Electroneurography assessing nerve excitability is the most reliable examination for predicting prognosis of Bell’s palsy but is rarely used in UK clinical practice. Immune-nutritional status (INS) reflects the patients nutritional and immune condition, and is calculated from peripheral blood sampling. It has been a useful prognostic factor in various diseases (gastrointestinal cancer/cardiovascular disease/cerebrovascular disease). The authors have carried out a retrospective study of Bell’s palsy cases in a Japanese University hospital over a seven-year period. They identified 79 patients (following exclusions). They utilised the Yanghihara grading system as well as the House-Brackmann system (more commonly used in UK) to evaluate facial movement before and after treatment (10-day course of systemic corticosteroids). To evaluate, INS blood sampling was performed (white blood cell counts, distribution of white blood cells, albumin levels and total cholesterol levels). The specific INS evaluation consisted of measuring the neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), prognostic nutritional index (PNI) and controlling nutritional status (CONUT score). They compared two groups (58 complete recovery versus 21 incomplete recovery at six months as graded via Yanghihara system). In the univariate analysis, statistically significant differences were observed between the two groups in the clinical score of facial movement at the initial examination, NLR, LMR, PNI and CONUT score (p<0.05). Interestingly, initiation of treatment from insult almost received statistical significance (p=0.06) comparing the two groups (complete recovery mean 4.3 days and incomplete 5.7 days). The study is an interesting read. They point out their limitations as a retrospective study with limited sample size and their inability to clarify whether malnutrition and poor immune response worsened the prognosis of Bell’s palsy or whether increased severity of palsy-induced malnutrition and poor immune response. For UK practice, it does raise the question that blood sampling may aid in prognosis and future targeted rehabilitation.

Immune-Nutritional Status as a Novel Prognostic Predictor of Bell’s Palsy.
Yamamoto K, Kurioka T, Ohki M, et al.
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Aaron SJ Ferguson

Victoria Hospital, Kirkcaldy, NHS Fife, UK.

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