SI_SET_02 - ARTIGOS ORIGINAIS Paralisia de Bell em idade peditrica Bells palsy in children Nria Madureira1 Mnica Vasconcelos2 SADE INFANTIL 2008 30(2

SI_SET_02 - ARTIGOS ORIGINAIS Paralisia de Bell em idade...

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50 SAÚDE INFANTIL SETEMBRO 2008 // 30 (2): 50-55 Paralisia de Bell em idade pediátrica Resumo Introdução Abstract Bell´s palsy in children Núria Madureira 1 , Mónica Vasconcelos 2 1 Interna de Pediatria do Hospital Pediátrico de Coimbra – CHC 2 Neuropediatra, Centro de Desenvolvimento da Criança Luís Borges, Hospital Pediátrico de Coimbra - CHC Correspondência: Núria Madureira – [email protected] ARTIGOS ORIGINAIS A paralisia aguda do nervo facial de causa idiopática é denominada paralisia de Bell (PB). São crescentes as evidências que atribuem a sua etiologia à infecção por vírus herpes - herpes simplex (VHS) ou varicela- zoster (VVZ) - seja por reactivação ou por mecanismos desmielinizantes auto-imunes pós-virais. Clinicamente, a PB caracteriza-se pelo início súbito de uma paralisia dos músculos da hemiface, ipsilateral à lesão. É um diagnóstico de exclusão, sendo imperativo excluírem-se causas de paralisia facial como neoformações, malformações, infecções ou processos inflamatórios, sejam estes centrais ou periféricos. O prognóstico da PB em idade pediátrica é favorável, com recuperação espontânea em 95% dos casos num período até 6 a 8 semanas. Os objectivos do tratamento são evitar as complicações corneanas, acelerar a recuperação e prevenir sequelas, através de fisioterapia e do uso de corticóides. Estudos efectuados em adultos demonstraram a eficácia e segurança dos corticóides, pelo que se recomenda a sua utilização nas crianças com PB moderadas/graves. O aciclovir reserva- se apenas para as situações em que se suspeita do envolvimento do VZV de forma activa. Na maioria dos casos, a PB pode ser de orientação pediátrica exclusiva. A referenciação para a neuropediatria impõe-se perante a dúvida no diagnóstico diferencial, agravamento clínico ou PB recidivante. Palavras-chave: Paralisia de Bell, paralisia facial, criança, tratamento, corticóides, aciclovir. Acute idiopathic paralysis of the facial nerve is named Bell’s Palsy (BP). There is growing evidence showing that the main cause may be herpes viral infection - herpes simplex or herpes zoster virus - through virus reactivation or post viral immune-mediated demyelisation. Patients present with an acute ipsilateral impairment of movement of the facial muscles. BP is a diagnosis of exclusion, so it’s imperative to exclude tumours, infections or inflammatory process, central or peripheral. BP has a good prognosis with spontaneous recovery occurring in 95% of cases, in a 6 to 8 weeks period. The aim of the treatment is to avoid corneal complications, permit speed recovery and prevent sequel, through physiotherapy and steroids. Adult studies have shown steroids safety and efficacy, so we recommend their use in children with moderate/severe BP. Acyclovir is reserved to situations were VZV is suspect. In most cases, PB can be exclusively oriented by a paediatrician. The patient should be referred to a neuropediatrician if there are diagnostic doubts, worsening during treatment or relapsing BP.
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  • Winter '99
  • Averróis
  • Bell’s Palsy, Facial Palsy, paralisia, Paralisia facial

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