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Not all acute peripheral facial palsy in children recovers completely: A telediagnostic follow-up study
Sarah Christine Stapperfend1, Katharina Geißler1, Jonas Ballmaier1
1Department of Otorhinolaryngology, Facial-Nerve-Center, Jena University Hospital, Jena, Germany; Center for Rare Diseases, Jena University Hospital, Jena, Germany.
Insights
Approximately 21.4% of children with Bell's palsy develop synkinesis, impacting their recovery. Further research is needed to understand corticosteroid use in pediatric facial palsy (FP).
Area of Science:
- Neurology
- Pediatric Medicine
- Otolaryngology
Background:
- Peripheral facial palsy (FP) affects adults, with up to 30% developing synkinesis.
- The incidence of synkinesis in children with FP is not well-established due to limited long-term data.
Purpose of the Study:
- To determine the incidence and long-term outcomes of synkinesis in children treated for acute peripheral FP.
- To evaluate functional impairments and mental health effects associated with pediatric FP.
Main Methods:
- Cross-sectional study of children (<18 years) treated for acute peripheral FP between 2009-2021.
- Included Bell's palsy and infection-associated FP; excluded secondary causes.
- Utilized video follow-ups, PROMs (FaCE, FDI, SAQ), and video-based assessments (Sunnybrook, eFACE).
Main Results:
- 26 children participated (30.6% response rate); mean age at onset 8.5 years.
- Idiopathic FP (IFP) and Lyme-associated FP (LFP) groups showed high recovery rates (eFACE/Sunnybrook scores 90-100).
- Synkinesis developed in 28.6% of IFP patients, with functional impairments noted. Mental health effects reported by 35.7% of IFP and 16.7% of LFP patients.
Conclusions:
- A significant proportion (21.4%) of children with Bell's palsy may develop moderate to severe synkinesis.
- Long-term follow-up is crucial for understanding pediatric FP outcomes.
- Further research on corticosteroid use in pediatric FP is warranted.
Objectives:
Up to 30% of adults with peripheral facial palsy (FP) develop synkinesis, but it's incidence in children remains unclear due to limited long-term data.
Methods:
Children (<18 years) treated for acute peripheral FP at Jena University Hospital between 2009 and 2021 were screened in this cross-sectional study. Bell's palsy and infection-associated FP (e.g., Lyme disease, Zoster) were included, while secondary causes such as tumors, trauma, CNS disorders, and conditions like Guillain-Barré syndrome or Chiari malformation were excluded. Video follow-ups collected clinicodemographic information and PROMs including Facial Clinimetric Evaluation Scale (FaCE), Facial Disability Index (FDI), and Synkinesis Assessment Questionnaire (SAQ). Facial movements were video-recorded and assessed using Sunnybrook and eFACE.
Results:
Of 85 eligible patients, 26 participated (46% female; response rate 30.6%). Mean age at onset was 8.5 years (range: 0.2-16); 54% had idiopathic FP (IFP) and 46% Lyme-associated FP (LFP). Median follow-up was 7.56 years (range: 2.5-13). All LFP participants and 11 out of 14 IFP participants achieved complete or near-complete recovery (eFACE and Sunnybrook scores 90-100). Four participants (28.6%), exclusively from the IFP group, developed synkinesis, three with functional impairments in PROMs and video-based assessment. Seven participants (five (35.7%) from the IFP group and two (16.7%) from the LFP group) reported that they still experience mental health-related effects of FP today.
Conclusion:
The data indicate that a relevant proportion (around 21.4%) of children with Bell's palsy develop moderate to severe synkinesis. Long-term follow-up and further research on corticosteroids use in pediatric FP are warranted.
