Efficacy of steroid treatment and identification of prognostic factors in idiopathic peripheral facial nerve palsy in children

Year 2022, Volume: 47 Issue: 2, 660 - 671, 30.06.2022

Habibe Koç Uçar , Esra Sarıgeçili

https://doi.org/10.17826/cumj.1053502

Cited By: 1

Abstract

Purpose: The aim of the study is intended to investigate the etiology and clinical features of children with idiopathic peripheral facial palsy (IPFP) and to identify probable prognostic factors. It is also intended to investigate corticosteroid therapy and compare its efficacy.
Materials and Methods: A total of 80 patients with newly diagnosed IPFP were included in the study. Demographic, clinical features and laboratory findings including age, gender, House Brackmann Facial Nerve Grading System (HBGS) grade at admission and follow-up, and the dosage and onset of steroid treatment were reviewed. We assigned our patients to 3 groups: Group 1: Patients given 1 mg/kg oral steroid treatment (1 mg/kg/day oral prednisolone). Group 2: Patients given 2 mg/kg oral steroid treatment (2 mg/kg/day oral prednisolone), and Group 3: Patients who did not receive oral steroid treatment.
Results: A total of 80 children (41 girls and 39 boys) with a median age of 11 years were included in the study. The complete recovery was detected in %78,8(n:63) with IPFP. Of all patients, 78.8% (n=63) showed complete recovery. Admission after more than 24 hours was found to reduce the likelihood of ER by 10 times (1/0.10), while patients with HBGS grade of 5 were found to be 33.3 times (1/0.03) less likely to achieve ER than patients with HBGS grades of 2 to 3. Finally, steroid treatment at 2 mg/kg/d increased the probability of early recovery by 8.38 times.
Conclusion: The prognosis of IPFP in children was very good. The prognostic factors affecting the early recovery were being HBGS grade 2 or 3 on the 21th day and receiving steroid treatment in the first 24 hours and 2 mg/kg/d dose.

Keywords

Idiopathic peripheral facial palsy (IPFP), bell’s palsy, children, prognosis

Çocuklarda idiyopatik periferik fasiyal sinir paralizisinde steroid tedavisinin etkinliği ve prognostik faktörlerin belirlenmesi

Abstract

Amaç: Bu çalışmanın amacı, idiyopatik periferik fasiyal sinir paralizisi (IPFP) çocukların etiyolojisi, klinik özelliklerini araştırmak ve olası prognostik faktörleri belirlemektir. Bununla birlikte kortikosteroid tedavisinin etkinliğini incelemek ve karşılaştırmaktır.
Gereç ve Yöntem: Çalışmaya yeni tanı konmuş IPFP'li toplam 80 hasta dahil edildi. Başvuru ve takipte yaş, cinsiyet, House Brackmann Facial Nerve Grading System (HBGS) derecesi, steroid tedavisinin dozu ve başlangıcı gibi demografik, klinik özellikler ve laboratuvar bulguları gözden geçirildi. Hastalarımızı 3 gruba ayırdık: Grup 1: 1 mg/kg oral steroid tedavisi (1 mg/kg/gün oral prednizolon) verilen hastalar. Grup 2: 2 mg/kg oral steroid tedavisi (2 mg/kg/gün oral prednizolon) verilen hastalar ve Grup 3: Oral steroid tedavisi almayan hastalar.
Bulgular: Çalışma popülasyonu yaş ortalaması 11 olan 80 (41 kız,39 erkek) hastadan oluşmaktadır. IPFP ile %78,8(n:63) oranında tam iyileşme tespit edildi. Tüm hastaların %17.5'i tama yakın iyileşme gösterdi. Buna göre; 24 saat üzeri başvuru erken iyileşmeyi 10 kat (1/0,10) azalttığı, başvuru HBGS grade 5 olanların grade 2-3 olanlara kıyasla 33,3 kat (1/0,03) daha az erken iyileşme olasılığına sahip olduğu ve 2 mg/kg/g streoid tedavi alımının erken iyileşme olasılığını 8,38 kat arttırdığı saptandı.
Sonuç: Çocuklarda IPFP prognozu çok iyiydi. Erken iyileşmeyi etkileyen prognositik faktörler 21. günde HBGS derece 2 veya 3 olması ve ilk 24 saatte ve ve 2 mg/kg/g doz steroid tedavisi almasıydı.

Keywords

İdiyopatik periferik yüz felci (IPFP), Bell felci, çocuklar, prognoz

References

• 1. Jenke AC, Stoek LM, Zilbauer M, Wirth S, Borusiak P. Facial palsy: etiology, outcome and management in children. Eur J Paediatr Neurol. 2011;15:209-13.
• 2. S. G. Yeo, Y. C. Lee, D. C. Park, and C. I. Cha, “Acyclovir plus steroid vs steroid alone in the treatment of Bell’s palsy,” American Journal of Otolaryngology-Head and Neck Medicine and Surgery. 2008;29(3):163–166.
• 3. Jackson CG, von Doersten PG. The facial nerve: current trends in diagnosis, treatment, and rehabilitation. Med Clin North Am. 1999;83:179-195.
• 4. Peitersen E. Bell's palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Otolaryngol Suppl. 2002:4-30.
• 5. Kanerva M, Nissinen J, Moilanen K, Maki M, Lahdenne P, Pitkaranta A. Microbiologic findings in acute facial palsy in children. Otol. Neurotol. 2013;34:82-7.
• 6. Abramsky O, Webb C, Teitelbaum D, et al. Cellular immune response to peripheral nerve basic protein in idiopathic facial paralysis (Bell’s palsy). J Neurol Sci. 1975;26:13–20.
• 7. McCormick DP. Herpes simplex virus as a cause of Bell’s palsy. Lancet 1972;1:937.
• 8. Leibowitz U. Epidemic incidence of Bell’s palsy. Brain 1969;92:109–114.
• 9. Kynvett AF. Viral infection of the nervous system. Med J Aust 1959;2:118–121.
• 10. De Diego JI, Prim MP, De Sarria MJ, et al. Idiopathic facial paralysis: a randomized, prospective, and controlled study using single döşe prednisone versus acyclovir three times daily. Laryngoscope 1998;108:573–575.
• 11. McGovern FH, Estevez J, Jackson R. Immunological concept for Bell’s palsy: further experimental study. Ann Otol Rhinol Laryngol 1977;86:300–305.
• 12. Pitaro J, Waissbluth S, Daniel SJ. Do children with Bell’s palsy benefit from steroid treatment? A systematic review. Int J Pediatr Otorhinolaryngol. 2012;76:921-926.
• 13. Chen WX, Wong V. Prognosis of Bell's palsy in children--analysis of 29 cases. Brain Dev 2005;27:504-8.
• 14. Arican P, Dundar NO, Gencpinar P, Cavusoglu D. Efficacy of lowdose corticosteroid therapy versus high-dose corticosteroid therapy in Bell’s palsy in children. J Child Neurol. 2017;32(1):72-75.
• 15. Eidlitz-Markus T, Gilai A, Mimouni M, Shuper A. Recurrent facial nerve palsy in paediatric patients. Eur J Pediatr. 2001 Nov;160(11):659-63.
• 16. Psillas G, Antoniades E, Ieridou F, Constantinidis J. Facial nerve palsy in children: A retrospective study of 124 cases. J Paediatr Child Health. 2019;55(3):299-304. 17. Devriese PP, Schumacher T, Scheide A, de Jongh RH, Houtkooper JM. Incidence, prognosis and recovery of Bell’s palsy. A survey of about 1000 patients (1974-1983). Clin Otolaryngol Allied Sci 1990; 15: 15-27.
• 18. Campbell KE, Brundage JF. Effects of climate, latitude, and season on the incidence of Bell’s palsy in US Armed Forces, October 1997 to September 1999. Am J Epidemiol 2002; 156: 32-39.
• 19. De Diego JI, Prim MP, Madero R, Gavilán J. Seasonal patterns of idiopathic facial paralysis: a 16-year study. Otolaryngol Head Neck Surg. 1999; 120: 269-271.
• 20. Ozler GS, Gunak G. Neutrophil-lymphocyte ratio: a new predictive and prognostic factor in patients with Bell palsy. J Craniofac Surg. 2014; 25: 944-945.
• 21. Kiliçkaya MM, Tuz M, Yariktaş M, Yasan H, Aynalı G, Bagci Ö. The Importance of the Neutrophil-Lymphocyte Ratio in Patients with Idiopathic Peripheral Facial Palsy. Int J Otolaryngol. 2015;2015:981950.
• 22. Holland NJ, Weiner GM. Recent developments in Bell's palsy. BMJ 2004;329:553-7.
• 23. Dhiravibulya K. Outcome of Bell’s palsy in children. J Med Assoc Thai. 2002; 85: 334-339.
• 24. Karatoprak E, Yilmaz S. Prognostic Factors Associated With Recovery in Children With Bell's Palsy. J Child Neurol. 2019; 34:891.
• 25. Cope D, Bova R. Steroids in otolaryngology. Laryngoscope 2008;118: 1556-60.
• 26. Sullivan FM, Swan IR, Donnan PT, Morrison JM, Smith BH, McKinstry B, et al. Early treatment with prednisolone or acyclovir in Bell's palsy. N Engl J Med. 2007;357:1598-607.
• 27. Salinas RA, Alvarez G, Daly F, Ferreira J. Corticosteroids for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev. 2010;17;(3):CD001942. Update in: Cochrane Database Syst Rev. 2016;7:CD001942. PMID: 20238317.
• 28. Unuvar E, Oguz F, Sidal M, Kilic A. Corticosteroid treatment of childhood Bell's palsy. Pediatr Neurol. 1999;21:814-6.
• 29. Gronseth GS, Paduga R, American Academy of Neurology. Evidence-based guideline update: steroids and antivirals for Bell palsy: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 2012; 79:2209.
• 30. Jabor MA, Gianoli G. Management of Bell's palsy. J La State Med Soc. 1996; 148:279.