Outcome of acute peripheral facial palsy in children – A catamnestic study of 84 patients

Introduction: Causes, therapy and prognosis of acute peripheral facial palsy differ among children and adults, but there are few studies regarding the pediatric population only. This survey gives an overview of the etiology and outcome in children.

Methods: 84 children aged 10 months to 16 3/12 years, who were seen at the children's hospital of Eastern Switzerland during the years 1998–2007 because of a facial palsy, except of congenital causes. Data about etiology, symptoms, diagnostics and therapy were gathered retrospectively from the medical histories, duration and outcome by questionnaires. 6 of 9 patients with residual symptoms were seen for control and recovery was graded by the House-Brackmann scale.

Results: There were 83 cases of unilateral and 1 bilateral case with no relevant differences in gender or side. The etiology was in 26 cases (31.0%) neuroborreliosis (NB), in 6 (7.1%) other infections (3 otitis media (OM), 2 varizella, 1 herpes encephalitis) and in 1 case (1.2%) a toxicity of Methotrexat was suspected; 51 cases (60.7%) were classified as idiopathic (IPFP). Between June and November, the number of cases with NB rises to 53.3%. 4 patients with IPFP received steroids. 75 (89.3%) recovered completely (HB-Grade I). Full recovery was reached between 2 and 365 days (median 21 days). 9 patients (10.7%) showed slight residual symptoms (HB-Grade II). Of these, 6 were classified as IPFP, 1 was caused by NB and 1 by OM.

Discussion: In this study almost a third of the palsies were caused by NB, during the summer and fall even more than half. These findings are similar to results of previous studies and confirm the importance of a lumbar punction. Patients with palsy due to borreliosis show a higher recovery rate than those with OM or IPFP. Since all patients with NB had received antibiotic treatment, no conclusions can be drawn regarding its impact on the natural history of the disease. The palsy recovered in almost 90% completely even without treatment with steroids and residual symptoms were slight.