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Multidisciplinary Care for Moebius Syndrome and Related Disorders: Building a Management Protocol
Amar Odedra1, Wendy Blumenow2, Jennifer Dainty3
1Regional Paediatric Burns and Plastic Surgery Service, Alder Hey Children's NHS Foundation Trust, Liverpool L12 2AP, UK.
Insights
Moebius syndrome (MBS) management requires a multidisciplinary approach. A new protocol prioritizes early airway, feeding, and vision care, followed by speech and psychological support for children with MBS.
Area of Science:
- Neurology
- Genetics
- Pediatrics
Background:
- Moebius syndrome (MBS) is a rare orofacial anomaly characterized by bilateral facial palsy and absent eye abduction.
- It often presents with variable features affecting multiple systems, leading to diagnostic challenges and fragmented care.
- Lack of awareness can cause treatment delays and impact children's long-term physical and psychosocial development.
Purpose of the Study:
- To present a novel, multidisciplinary treatment protocol for Moebius syndrome and related conditions.
- To synthesize best practices from rare disease management into a holistic approach for MBS.
- To outline a sequenced, "ABC-style" management strategy prioritizing early-life needs.
Main Methods:
- Development of a multidisciplinary team including core clinicians (physician, geneticist, SLP, psychologist, nurse) and specialists for affected systems.
- Creation of a treatment protocol integrating care from a specialized pediatric center for rare diseases.
- Sequencing management priorities based on an "ABC-style" approach (Airway, Breathing, Circulation/Swallowing).
Main Results:
- The protocol prioritizes early management of airway, feeding, vision, and speech.
- Key early priorities include airway stabilization, swallow assessment, ocular surface protection, and nutritional support.
- Later-stage management focuses on psychological support, addressing low mood, self-esteem, and bullying.
Conclusions:
- A multidisciplinary, holistic approach is crucial for managing Moebius syndrome.
- The "ABC-style" protocol provides a structured framework for prioritizing interventions from infancy through later childhood.
- This comprehensive strategy aims to improve physical health and psychosocial outcomes for children with MBS.
Abstract:
Moebius syndrome is a collection of orofacial anomalies with highly variable features affecting many different systems but characterised by bilateral facial palsy and absent eye abduction. We largely regard Moebius syndrome as a diagnosis of exclusion. Lack of awareness and knowledge means that children often fall between services, leading to treatment delays and difficulty interfacing with social care and schools, with long-term impact on physical health and psychosocial development. We developed a multidisciplinary team comprising core clinicians (lead physician, geneticist, speech and language therapist, psychologist and specialist nurse) and an expanded group to encompass the other affected systems. The interactions between our specialties lead to the development of a treatment protocol, which we present. The protocol harnesses the aspects of care of children with a range of other rare diseases at a specialised paediatric centre and synthesises them into a holistic approach for MBS and related conditions. Management is sequenced on an "ABC-style" basis, with airway, feeding, vision and speech taking priority in the early years. We define management priorities as airway stabilisation with swallow assessment, ocular surface protection and maintenance of nutritional support. Management principles for issues such as speech, reflux, drooling and sleep issues are outlined. In later years, psychological support has a prominent role geared towards monitoring and interventions for low mood, self-esteem and bullying.
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