Influence of the severity of the paresis and the time of the start of prednisolone therapy on recovery in children with acute facial nerve palsy

Introduction Therapy for acute pediatric facial nerve palsy (FP) is administrating of prednisolone as in adults, although the evidence by children is still limited. The success of this therapy in children has hardly been investigated to date. It is unclear when the therapy should be initiated at the latest after the onset of paresis and what other factors influence the outcome.

Methods All 29 children (median age: 14 years, 11 female) with acute FP (<3 months after onset) who had been treated with prednisolone since 2003 were retrospectively included. The probability of complete recovery over time was analyzed using the Kaplan-Meier method. The prognostic influence of clinical parameters on recovery was analyzed using the log-rank test.

Results The mean initial intravenous prednisolone dose was 169±90 mg and was administered in descending doses over 7 days. The median follow-up was 1.7 months. Children with poorer motor function (Stennert index [SI] sum (rest/motility) >6) showed a lower likelihood of full recovery (p=0.030). Starting prednisolone therapy later than 72 h (p=0.376), 92 h (p=0.196) or 120 h (p=0.196) had no influence on the therapy result for the entire collective. Patients with an SI > 6 had a poorer prognosis when starting prednisolone therapy later than 96 h (p=0.023) after onset.

Conclusion the prednisolone therapy should be started at best within 92 h after the onset of FP. The severity of FP is also an important prognostic parameter for recovery in children.

Publication History

Article published online:
12 May 2023