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

Abstract

Introduction. Diagnosis of patients with facial neuropathy (FN) is challenging because different sources of medical information off er a wide variety of approaches. Aim. Analysis of the features of diagnosing patients with FN by practicing neurologists. Material and methods. Anonymous online survey of neurologists adhering to the principles of evidence-based medicine (n = 172, work experience — 6 [3; 11] years), including 10 questions. Results. In 56.4% of cases, doctors diagnose patients with FN in accordance with “foreign” guidelines, however, older specialists still prefer Russian sources, and doctors with little work experience prefer the experience of colleagues (p = 0.018). Scales of assessment of facial muscles function are used by 28.5% of specialists, the description method is used by 95.9%. The content of the clinical protocol varies considerably. A highly significant correlation was observed: the lower the muscle is located on the face, the less often its function is assessed (r = –0.938, p < 0.000). Less than 1/3 of doctors use tests to assess the function of the facial muscles of the lower third of the face. Doctors significantly more often focus on the manifestations of the disease (decrease in the strength and tone of facial muscles, lagophthalmos, hyperacusis) than on the complications of FN (increased muscle tone on the healthy or affected side, synkinesis, post-paralytic hemispasm), p < 0.000. Magnetic resonance imaging is prescribed by more than 70% of specialists, computed tomography — by 25%, stimulation electroneuromyography — by 38,4% (in 1/4 of cases only on the affected side of the face). More than 95% of neurologists refer patients for consultations to doctors of other specialties, mainly to an otorhinolaryngologist (58.7%) and an ophthalmologist (56.9%), and only 23.2% to surgical specialists. About 2/3 of doctors refer patients for rehabilitation, however, there is no clinical protocol for the rehabilitation of this pathology. Conclusion. The study showed a greater adherence of the interviewed Russian specialists to evidence-based medicine, as well as a high degree of inter-expert variability of opinions, which dictates the necessity of the development of Russian guidelines.