Treatment of patients with facial neuropathy by practicing neurologists: online survey

Abstract

Treatment of patients with facial neuropathy (FN) is a big scientific problem. There is no single protocol and patient management tactics are different. We have conducted an analysis of clinical practice in the treatment of patients with FN.Material and methods. An anonymous online survey of neurologists positioning themselves as supporters of evidencebased medicine was conducted (n = 139, work experience – 5 [3; 10] years). It included 10 questions. The analysis of methods of treatment was carried out. We compared the experience of specialists, who prescribed a certain drug, and who did not prescribe it. Descriptive statistics are given in the form of: absolute (n) and relative values (%), medians (Me), lower [q1] and upper [q3] quartiles.Results. In the studied sample with FN, all doctors recommend glucocorticosteroids, of which almost 2/3 allow use only in the first 3 days of the disease. Antiviral drugs are prescribed by 91.4% (n = 127) of specialists, the main indication is the presence of herpetic infection in visual examination (n = 104; 74.8%), less often a positive test for herpes infection (n = 23; 16.5%) or prosoplegia (n = 16; 11.5%). Anticholinesterase agents are prescribed by 38.1% (n = 53) of neurologists, their work experience is greater – 7 [5; 13] versus 5 [2; 9.75], p = 0.035. More than half (n = 81; 58.3%) of doctors do not recommend medications for additional drug therapy. Botulinum therapy is considered in the clinical practice of treatment of FN by 59% (n = 82) of doctors, regardless of work experience (p = 0.697), however, we observed a large variability of opinions according to the indications for use. When deciding on referral for surgical treatment, the most important doctors considered the problem of poor awareness of the types of operations (n = 83; 59.7%), as well as the lack of clear indications for surgical treatment (n = 62; 44.6%).Conclusion. The study revealed a diversity of opinions even among specialists who position themselves as supporters of evidence-based medicine. There is a great need to develop Russian clinical guidelines for facial nerve neuropathy.