Botulinum Toxin Type a Timing Efficacy in Bell Palsy Patients

Introduction: Botulinum Toxin Type A (BoNTA) has been used therapeutically to improve facial symmetry in patients with Bell’s Palsy. In this study, we aim to determine if the timing of BoNTA treatments impacts outcomes in these patients.

Methods: Patients with Bell’s Palsy who were treated at a large, urban academic medical center between 2016 and 2022 were identified. Demographic data, onset of symptoms, and visit notes were collected and reviewed for all patients who met inclusion criteria. For patients that only received treatment with BoNTA, procedural notes and dates of all interventions were gathered as well as the House-Brackmann (HB), Facial Clinimetric Evaluation Scale (FaCE), Synkinesis Assessment Questionnaire (SAQ), and Facial Grading System (FGS) scores if completed.

Results: A total of 47 patients received BoNTA. Patients were divided based on treatment within 12 months, between 13 and 24 months, between 25 and 36 months, and after 36 months of symptom onset. Patients had an average HB score change of 1.36, 1.54, 2.5, and 1.19 respectively. T-test analysis displayed no significance of HB change between any group. Additionally, patients treated within 12 months of onset had an average FaCE score improvement of 9.33. Patients treated after 36 months from onset had an average FaCE score improvement of 10 with no significant difference (p=0.409). Patients treated within 12 months of onset had an average SAQ score change of 15.7. Patients treated after 36 months from onset had an average SAQ score change of 14.6 with no significant difference (p=0.430). Patients treated within 12 months of onset had an average FGS score improvement of 34.4. This was significantly higher than every other group.

Conclusions: Our data show that FaCE, HB, and SAQ score improvement is not significantly different between patients receiving BoNTA within 12 months or after 36 months of symptom onset. However, patients who receive BoNTA within one year have a significant improvement in their FGS score when compared to the other treatment groups. This suggests that treatment with BoNTA within one year of symptom onset can lead to optimal response to treatment.