Neutrophil-Lymphocyte Ratio for Prognosis of Bell's Palsy

Abstract

ell’s palsy is a sudden weakness or paralysis of one side of the face. It is caused by inflammation to the facial nerve (7th cranial nerve). Full recovery from Bell's palsy occurs in about 80% of the cases, 15% experience some kind of permanent nerve damage and 5% remain with severe sequalae. Early prediction of recovery of Bell's palsy is of paramount importance to alley patient's mental distress, to spare patients with good prognosis, the hazard of unnecessary treatment and to individualize therapy to Bell’s palsy patients according to their prognosis. NLR is being widely used to identify high-risk patients with various illnesses, including chronic kidney diseases and cardiovascular diseases also High NLR is related to poor prognosis of patients with various malignant tumours. Neutrophil-to-lymphocyte ratio (NLR) was defined as a novel potential marker to determine inflammation and being measured routinely in peripheral blood without any cost. Our aim is to study the potential role of neutrophil lymphocyte ratio (NLR) to assess the severity and prognosis of Bell’s palsy.

This study were performed on 22 patients with acute Bell's palsy who were presented in Physical Medicine, Rheumatology, and Rehabilitation Department in Ain Shams University Hospitals. They were 11 males (50%) and 11 females (50%) with age range between 20-52 years old with mean age of (34.2 + 12.3) years old. Patients who have any chronic infection or chronic inflammation or chronic liver disease or chronic renal disease were excluded also patients with diabetes mellitus were excluded, as these will affect neutrophil to lymphocyte ratio, we also have 10 control cases with no Bell's palsy affection. Clinical and laboratory assessment were done for all patients before onset of treatment and after 2 weeks and after 1 month of treatment. Clinical assessment were done by House Brackmann grading system and Sunny Brook grading system. Laboratory assessment were in the form of NLR, ESR, CRP and GGT. All patients received the same medical treatment in the form of oral prednisolone with dose of 1 mg/kg/d (maximum 60 mg) for the first week, which is tapered over two weeks in addition to physiotherapy in the form of electrical stimulation of facial muscles for 4 weeks (3 sessions /week), home active exercise for facial muscles and Effleurage massage. Our results as regards neutrophil to lymphocyte ratio (NLR) indicate its elevation in cases of Bell’s palsy more than controls indicate the presence of inflammatory reactions