Risk of Leukemia in Children With Peripheral Facial Palsy
Franz E Babl1, Amit Kochar2, Michael Osborn3
1Emergency Department, Royal Children's Hospital, and Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia; Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Australia.
Insights
A small percentage of children with acute facial palsy have undiagnosed leukemia. Screening with a complete blood count (CBC) may be beneficial before starting corticosteroid treatment for Bell's palsy in pediatric patients.
Area of Science:
- Pediatric Emergency Medicine
- Hematology-Oncology
- Neurology
Background:
- Peripheral facial palsy in children often lacks an identifiable cause.
- Leukemia is a known, though infrequent, cause of facial nerve palsy in pediatric populations.
- Current diagnostic and management guidelines for pediatric facial palsy are variable regarding leukemia screening.
Purpose of the Study:
- To estimate the incidence of previously undiagnosed leukemia in children presenting with acute-onset peripheral facial palsy.
- To inform diagnostic recommendations for pediatric acute facial palsy.
Main Methods:
- Retrospective analysis of children presenting with acute-onset facial palsy to emergency departments.
- Inclusion criteria based on eligibility for a randomized controlled trial of Bell's palsy treatment.
- Calculation of leukemia incidence using identified cases and total presentations.
Main Results:
- Five cases of previously undiagnosed leukemia were identified among 644 children with acute-onset facial palsy.
- The estimated rate of leukemia in this cohort was 0.6% (95% CI 0.2% to 1.6%).
- This suggests a higher-than-anticipated incidence of leukemia in this specific pediatric presentation.
Conclusions:
- Acute-onset peripheral facial palsy in children presenting to emergency departments may be associated with an underlying leukemia diagnosis.
- Consideration of a screening complete blood count (CBC) is suggested for children with acute facial palsy prior to corticosteroid therapy.
- Further research may refine screening protocols for pediatric facial palsy to optimize early leukemia detection.
Abstract:
Most children with peripheral facial palsy will not have a cause identified. Although leukemia can cause facial nerve palsy, the magnitude of the risk is unknown and recommendations for investigations are variable. We are currently conducting a randomized, placebo-controlled trial of prednisolone for the treatment of Bell's palsy in children within the Paediatric Research in Emergency Departments International Collaborative emergency research network. In the course of the assessment for eligibility of the trial, from 644 acute-onset facial palsy presentations we identified 5 children with previously undiagnosed leukemia. We estimate the rate of leukemia in children with acute-onset facial palsy who present to emergency departments to be 0.6% (95% confidence interval 0.2% to 1.6%). In accordance with these cases, we suggest consideration of a screening CBC count for acute-onset peripheral facial palsy presentations in children before initiation of corticosteroid treatment.
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