The Impact of Early Acupuncture on Bell's Palsy Recurrence: Real-World Evidence from Korea

This retrospective study analyzed data from 45,986 Korean adults with Bell's palsy to investigate the impact of early acupuncture on preventing recurrences of the condition. Bell's palsy is an acute idiopathic facial paralysis affecting 20-53 people per 100,000 inhabitants annually. Although about 70% of patients recover completely even without treatment, some develop sequelae and the condition can recur in 0.8-19.4% of cases. Evidence-based treatment includes corticosteroids administered within 72 hours of symptom onset.

In East Asian countries, acupuncture is widely used as adjuvant treatment, but more robust scientific evidence is still needed. The researchers used data from the Korean National Health Insurance system between 2015-2017, with follow-up through 2020. Participants were divided into two groups: those who received acupuncture within 7 days of diagnosis (early acupuncture group, n=28,267) and those who did not (comparison group, n=17,719). All patients received corticosteroids as standard treatment.

The methodology was rigorous, excluding patients with other causes of facial paralysis such as Ramsay Hunt syndrome or traumatic palsy. The primary outcome was Bell's palsy recurrence, defined as a new episode with a corticosteroid prescription after more than 90 days from the initial episode. Results showed an overall recurrence rate of 1.8%, with 1.6% in the early acupuncture group versus 2.0% in the comparison group. After multivariate analysis adjusting for confounders such as age, sex, comorbidities, and treatment duration, the early acupuncture group had an odds ratio of 0.81 (95% CI: 0.69-0.95) for recurrence, representing a 19% risk reduction.

Other factors associated with higher likelihood of recurrence included younger age, prolonged treatment (>90 days), and presence of dyslipidemia. Notably, patients in the early acupuncture group had longer treatment duration, which may reflect the integrative approach of traditional Korean medicine, which often extends treatment until complete relief of residual symptoms. Clinical implications are significant, as this is the first large-scale study to demonstrate a benefit of early acupuncture in preventing Bell's palsy recurrence. The findings complement previous evidence showing benefits of early acupuncture in accelerating recovery and improving complete recovery rates.

The study used real-world data, providing greater external validity compared with controlled clinical trials, which have restrictive inclusion criteria. Limitations include the retrospective nature, inability to assess initial palsy severity, lack of data on complete recovery rate and time to recovery, and potential unmeasured confounders. In addition, the observed recurrence rate was lower than reported in the literature, possibly due to the limited follow-up period. Despite the limitations inherent to health insurance data, this study provides valuable real-world evidence on the potential benefit of early acupuncture in Bell's palsy, specifically in reducing recurrence risk.