Non-idiopathic peripheral facial palsy: prognostic factors for outcome

Abstract

Objectives There is a lack of data on patients’ and diagnostic factors for prognostication of complete recovery in patients with non-idiopathic peripheral facial palsy (FP). Methods Cohort register-based study of 264 patients with non-idiopathic peripheral FP and uniform diagnostics and standardized treatment in a university hospital from 2007 to 2017 (47% female, median age: 57 years). Clinical data, facial grading, electrodiagnostics, motor function tests, non-motor function tests, and onset of prednisolone therapy were assessed for their impact on the probability of complete recovery using univariable and multivariable statistics. Results The most frequent reason for a non-idiopathic peripheral FP was a reactivation of Varicella Zoster Virus (VZV; 36.4%). Traumatic origin had a higher proportion of complete FP (52.9%). Furthermore, in traumatic FP, the mean interval between onset and start of prednisolone therapy was longer than in other cases (5.6 ± 6.2 days). Patients with reactivation of VZV, Lyme disease or otogenic FP had a significant higher recovery rate (p = 0.002, p < 0.0001, p = 0.018, respectively), whereas patients with post-surgery FP and other reasons had a significant lower recovery rate (p < 0.0001). After multivariate analyses voluntary activity in first EMG, Lyme disease and post-surgery cause were identified as independent diagnostic and prognostic factors on the probability of complete recovery (all p < 0.05). Conclusion Infectious causes for non-idiopathic FP like VZV reactivation and Lyme disease had best probability for complete recovery. Post-surgery FP had a worse prognosis. Level of evidence 2

Role of Body Dysmorphic Disorder in Patients With Postparalytic Facial Synkinesis

“…25 Independent of the underlying etiology, facial palsy in general is not a disease with gender predominance. 26,27 Similar to the present study, most publications on series of PFS patients report of a weak to moderate predominance of women of between 55% and 75%. 28,29 Women seem not to be more vulnerable for the development of PFS but suffer more from PFS than men.…”

“…Even after Bell's palsy, an often underestimated disease, a fifth of the patients develops PFS 25 . Independent of the underlying etiology, facial palsy in general is not a disease with gender predominance 26,27 . Similar to the present study, most publications on series of PFS patients report of a weak to moderate predominance of women of between 55% and 75% 28,29 .…”

Electromyography in the prognostication of recovery in patients with acute peripheral facial nerve palsy: A systematic review

“…The cohorts comprised patients with non‐idiopathic FNP in three studies 14,19,24 . One study 14 included patients with various causes of non‐idiopathic FNP including herpes zoster oticus, trauma, Lyme disease, and otogenic causes.…”

Therapie der idiopathischen Fazialisparese („Bell’s palsy“)

“…Borrelieninduzierte Fazialisparesen haben nahezu immer eine gute Prognose [ 3 ]. Eine unlängst vorgelegte Untersuchung zur Prognose nichtidiopathischer Fazialisparesen ergab signifikant höhere Erholungsraten bei Zoster-Infektion, Borreliose und otogener Genese im Gegensatz zu postoperativer und traumatischer Genese [ 39 ]. Hilfreich zur Beurteilung der Prognose kann zudem die Untersuchung des Stapediusreflexes sein.…”