title: Etiology and treatment of pediatric sixth nerve palsy.
abstract: OBJECTIVE
  To describe the causes and treatment of sixth (abducens) nerve palsy in a series of pediatric patients.
  
  
  METHODS
  This was a 14-year retrospective study of sixth nerve palsy in children under 14 years of age. Outcomes studied included horizontal deviation, degree of limitation of abduction, and head turn. Patients were treated with botulinum toxin injection at the time of diagnosis; surgery was indicated if treatment with botulinum toxin was unsuccessful. Success was defined as final deviation of orthotropia with no head turn or diplopia.
  
  
  RESULTS
  Sixth nerve palsy was diagnosed in 15 patients (10 boys; mean age, 4.1 years) between 1995 and 2008. Involvement was bilateral in 2 cases and unilateral in 13 (7 right eyes). Causes included neoplasm (4 cases), trauma (2), idiopathic (3), congenital (2), viral (2), and inflammatory (1). Neoplastic causes were associated with other neurologic signs. Recovery was spontaneous in 5 cases (2 idiopathic, 1 traumatic, 1 congenital, and 1 inflammatory). Botulinum toxin was successful in 7 of 10 patients treated, with follow-up surgery required in the remaining 3 cases. The final result was good in all cases. In all 15 patients, mean time from diagnosis to resolution was 39 months (range, 5 to 170 months).
  
  
  CONCLUSIONS
  Neoplasms were the most frequent cause of sixth nerve palsy in our patient population. Recovery was spontaneous in one third of the patients. Most required treatment with botulinum toxin, which was successful in most cases. Surgery was successful after a single procedure.
authors.affiliation: Hospital General, Universitario Gregorio Marañón, Madrid, Spain. pilimerino@gmail.com
authors.forename: Pilar
authors.initials: P
authors.lastname: Merino
authors.forename: Pilar
authors.initials: P
authors.lastname: Gómez de Liaño
authors.forename: Jose Miguel Caro
authors.initials: JM
authors.lastname: Villalobo
authors.forename: Gema
authors.initials: G
authors.lastname: Franco
authors.forename: Rosario
authors.initials: R
authors.lastname: Gómez de Liaño
mesh_terms: D000010:Abducens Nerve / Q000601:surgery*; D020434:Abducens Nerve Diseases / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D000208:Acute Disease; D000293:Adolescent; D018726:Anti-Dyskinesia Agents / Q000627:therapeutic use; D001905:Botulinum Toxins / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003390:Cranial Nerve Neoplasms / Q000150:complications*; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000150:complications; D008297:Male; D012189:Retrospective Studies
chemical_list: D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins