Facial Palsy in Children

Wang, Cheng-Hsien; Chang, Yu‐Che; Shih, Hong-Mo; Chen, Chun-Yu; Chen, Jih-Chang

doi:10.1097/pec.0b013e3181d018d0

Cited by 37 publications

(10 citation statements)

References 20 publications

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“…Prednisone is metabolized by 11-β-HSD liver enzymes into PSL; both are used to treat similar conditions and are generally considered equally effective (15). Several studies have compared treatment regimens for children by their corticosteroid dosage (5,6,9). These studies included both mild and severe facial paralysis; however, the effectiveness of highdose corticosteroid therapy was unclear.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have compared treatment regimens for children by their corticosteroid dosage (5,6,9). These studies included both mild and severe facial paralysis; however, the effectiveness of highdose corticosteroid therapy was unclear.…”

Section: Discussionmentioning

confidence: 99%

“…However, the optimal corticosteroid dosage in pediatric patients is still unclear. Several studies failed to find a significant difference in outcomes between children with and without corticosteroid treatment (5,6).…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of High-Dose Corticosteroid Therapy in Acute Stage Severe Facial Palsy in Children

et al. 2022

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ObjectivesTo evaluate the efficacy of high-dose corticosteroid for severe acute facial paralysis in children.MethodsThe present study enrolled 10 pediatric patients with House-Brackmann (H-B) Grade VI facial paralysis who received prednisolone (PSL) 3 to 4 mg/kg/d for 2 to 3 days followed by a 10-day taper (the child high-dose group). Eight pediatric patients who received PSL 0.5 to 1 mg/kg/d were enrolled in a child low-dose group, and nine adult patients (25–64 yr) who received a high-dose PSL 200 mg equivalent for 2 to 3 days followed by a 10-day taper were enrolled in an adult high-dose group. On the initial and follow-up visits, facial movements were evaluated using the H-B grading system. The degree of oral-ocular synkinesis was evaluated by the degree of asymmetry in eye-opening width during mouth movements. The synkinesis index was defined as a percentage of the interpalpebral space width ([normal side − affected side]/normal side).ResultsThe child high-dose group achieved a significantly better H-B score than the child low-dose group (p < 0.01). The synkinesis index was significantly lower in the child high-dose group than in the child low-dose group or the adult high-dose group (p < 0.05).ConclusionChildren receiving PSL 3 to 4 mg/kg/d achieved better recovery and less synkinesis than those treated with low-dose PSL (0.5–1 mg/kg/d).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Efficacy of High-Dose Corticosteroid Therapy in Acute Stage Severe Facial Palsy in Children

et al. 2022

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“…In 5% to 30% of cases the paralysis is the result of infection, which may be viral, bacterial, or fungal. In fact, infectious etiology is the most common origin of this condition in young children [11,12], and this can be the result of a number of agents, among the most frequent being herpes simplex 1 and varicella-zoster. However, other viruses might be implicated, albeit less frequently, such as coxsackie, polio, influenza, human immunodeficiency virus (HIV) or EBV [4,13]; EBV was found in this case.…”

Section: Discussionmentioning

confidence: 99%

Infant Facial Paralysis Associated with Epstein-Barr Virus Infection

et al. 2019

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Patient: Male, 23 monthsFinal Diagnosis: Peripheral facial paralysis associated with Epstein-Barr virus infectionSymptoms: Facial paralysisMedication: —Clinical Procedure: Microbiology diagnosisSpecialty: Infectious DiseasesObjective:Rare diseaseBackground:Peripheral facial paralysis is a clinical presentation which, in most cases, is benign. It is relatively frequent, although less so in pediatric patients, where clinical diagnosis is more difficult. This clinical condition can be congenital, neurological, infectious, neoplastic, traumatic, or metabolic in origin.Case Report:This report describes the case of a male infant of 23 months of age with peripheral facial paralysis due to Epstein-Barr virus (EBV) upper respiratory infection. A hemogram showed the presence of leukocytosis and lymphocytosis, and a peripheral blood smear indicated the presence of stimulated lymphocytes. Serological tests were compatible with recent EBV infection: IgM anti-VCA (capsid antigen) was positive, while IgG anti-VCA and anti-EBNA (nuclear antigen) were negative. EBV genome was detected in pharyngeal swab and in serum, where viral load was 5.08 log copies/1000 cells and 3.72 log copies/mL, respectively.Conclusions:Whilst the most common cause of facial paralysis is idiopathic paralysis, such problems of the facial nerve may have many origins, including an infectious nature such as infection with viral agents. Rapid determination of the etiology of the problem allows the most appropriate management of the condition and quick follow-up to be implemented, which is essential for the evaluation of treatment response and the avoidance of permanent consequences.

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“…There are several different tools used in studies to describe the degree of facial dysfunction of Bell’s palsy, including the House Brackmann (HB) [ 12 , 18 , 19 , 29 – 31 ], Sunnybrook [ 19 , 32 ], Facial Paralysis Recovery Index/Profile [ 29 , 33 ], and Yanagihara grading systems [ 34 , 35 ]. The two largest adult RCTs used Sunnybrook scale and HB scale, or the HB scale alone [ 18 , 19 ], and the only RCT of steroids for treating Bell’s palsy in children from Unüvar et al [ 12 ] used the HB scale to assess recovery.…”

Section: Methodsmentioning

confidence: 99%

Bell’s Palsy in Children (BellPIC): protocol for a multicentre, placebo-controlled randomized trial

et al. 2017

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BackgroundBell’s palsy or acute idiopathic lower motor neurone facial paralysis is characterized by sudden onset paralysis or weakness of the muscles to one side of the face controlled by the facial nerve. While there is high level evidence in adults demonstrating an improvement in the rate of complete recovery of facial nerve function when treated with steroids compared with placebo, similar high level studies on the use of steroids in Bell’s palsy in children are not available. The aim of this study is to assess the utility of steroids in Bell’s palsy in children in a randomised placebo-controlled trial.Methods/DesignWe are conducting a randomised, triple-blinded, placebo controlled trial of the use of prednisolone to improve recovery from Bell’s palsy at 1 month. Study sites are 10 hospitals within the Australian and New Zealand PREDICT (Paediatric Research in Emergency Departments International Collaborative) research network. 540 participants will be enrolled. To be eligible patients need to be aged 6 months to < 18 years and present within 72 hours of onset of clinician diagnosed Bell’s palsy to one of the participating hospital emergency departments. Patients will be excluded in case of current use of or contraindications to steroids or if there is an alternative diagnosis. Participants will receive either prednisolone 1 mg/kg/day to a maximum of 50 mg/day or taste matched placebo for 10 days. The primary outcome is complete recovery by House-Brackmann scale at 1 month. Secondary outcomes include assessment of recovery using the Sunnybrook scale, the emotional and functional wellbeing of the participants using the Pediatric Quality of Life Inventory and Child Health Utility 9D Scale, pain using Faces Pain Scale Revised or visual analogue scales, synkinesis using a synkinesis assessment questionnaire and health utilisation costs at 1, 3 and 6 months. Participants will be tracked to 12 months if not recovered earlier. Data analysis will be by intention to treat with primary outcome presented as differences in proportions and an odds ratio adjusted for site and age.DiscussionThis large multicenter randomised trial will allow the definitive assessment of the efficacy of prednisolone compared with placebo in the treatment of Bell’s palsy in children.Trial registrationThe study is registered with the Australian New Zealand Clinical Trials Registry ACTRN12615000563561 (1 June 2015).

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Facial Palsy in Children

Cited by 37 publications

References 20 publications

Efficacy of High-Dose Corticosteroid Therapy in Acute Stage Severe Facial Palsy in Children

Efficacy of High-Dose Corticosteroid Therapy in Acute Stage Severe Facial Palsy in Children

Infant Facial Paralysis Associated with Epstein-Barr Virus Infection

Bell’s Palsy in Children (BellPIC): protocol for a multicentre, placebo-controlled randomized trial

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