Routing, diagnosis and treatment of adult patients with facial nerve neuropathy in the metropolis

Abstract

The diversity and inconsistency of the proposed tactics for diagnosing and treating patients with facial nerve neuropathy (FNN) can cause difficulties for neurologists in their daily routine work.Aim. To analyze the routing of patients with FNN, the clinical practice of diagnostic studies and medical care in polyclinics and hospitals in Moscow.Material and methods. Analysis of data from the EMIAS system from polyclinics and hospitals in Moscow based on 7344 cases of primary treatment of patients with a diagnosis of FNN for 2019–2021: Gr1 — idiopathic (n = 4265), Gr2 — symptomatic (n = 3079), with the definition of patient routing, volume of diagnosis and treatment.Results. Gr1 patients visit the polyclinic (61.6%) on 8th [3; 20] day from the onset of symptoms, Gr2 — on 10th [3; 28.2]; to the hospital (38.4%) — on 1st [0; 3]. Clinical examination is variable, mainly the primary manifestations of FNN are indicated by the method of describing the deficiency. Laboratory diagnostics includes a clinical blood test (8%), the search for a viral or other cause (in isolated cases). Magnetic resonance imaging is done in different regimes (even in Gr1), only in 1/4 of cases with contrast. Recommended consultations of an otorhinolaryngologist, an ophthalmologist, rarely — doctors of surgical specialties, an exercise therapy doctor, a psychologist. The volume of diagnostics is greater in the hospital (p < 0,001). The list of drug therapy varies from evidence-based drugs to homeopathic remedies. In the polyclinic, 2/3 of the specialists prescribe the dose of prednisolone in accordance with foreign clinical recommendations, in the hospital — 1/2 (x2 = 4,83; p = 0.028). However, every second case goes beyond the “therapeutic window” due to the late visit of the patient. The most commonly used vitamins of group B (32.5%), anticholinesterase drugs (28.9%), thioctic acid (15.5%). Antiviral drugs were prescribed in 2% of cases, in the polyclinic eye care measures — less than 2%, in the hospital — 20%. Non-drug treatment includes physical therapy (21.8%), physiotherapy (14.2%), acupuncture (6.4%), facial massage (2.9%), tape correction (1.9%).Conclusions. Differences in approaches to the diagnosis, treatment and routing of patients with FNN were found. The problem can be solved by creating Russian clinical guidelines, including a unifi ed protocol for clinical examination, laboratory and instrumental diagnostics