Cohort study reveals electrodiagnostic testing predicts 6-month incomplete recovery in moderate Bell palsy, suggesting expanded electrical testing beyond severe cases.
Key Points
To determine the incremental prognostic value of electrodiagnostic testing beyond initial House-Brackmann grading for predicting 6-month recovery in acute Bell palsy, including moderate paralysis.
Conducted a single-center cohort study of 3506 adults with acute Bell palsy evaluating 4-branch electroneuronography and needle electromyography approximately 14 days after symptom onset.
Assessed incomplete recovery (defined as House-Brackmann grade II or higher) at 6 months using Firth penalized logistic regression and changes in receiver operating characteristic curves (ΔAUROC).
Among 1891 patients with complete 6-month follow-up (1040 [55.0%] incomplete recovery), an electroneuronography degeneration index of 90% or greater (AOR, 4.96; 95% CI, 3.97-6.19) and complete denervation (AOR, 5.91; 95% CI, 4.06-8.60) independently predicted incomplete recovery.
In moderate paralysis (initial House-Brackmann grade IV), incomplete recovery was significantly associated with a degeneration index of 90% or greater (AOR, 3.19; 95% CI, 2.00-5.11), complete denervation (AOR, 3.17; 95% CI, 1.03-9.78), and their co-occurrence (AOR, 3.10; 95% CI, 1.01-9.54).