Prognostic Value of Facial Nerve Antidromic Evoked Potentials in Bell Palsy: A Preliminary Study

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Abstract

To analyze the value of facial nerve antidromic evoked potentials (FNAEPs) in predicting recovery from Bell palsy. Study Design. Retrospective study using electrodiagnostic data and medical chart review. Methods. A series of 46 patients with unilateral Bell palsy treated were included. According to taste test, 26 cases were associated with taste disorder (Group 1) and 20 cases were not (Group 2). Facial function was established clinically by the Stennert system after monthly follow-up. The result was evaluated with clinical recovery rate (CRR) and FNAEP. FNAEPs were recorded at the posterior wall of the external auditory meatus of both sides. Results. Mean CRR of Group 1 and Group 2 was 61.63% and 75.50%. We discovered a statistical difference between two groups and also in the amplitude difference (AD) of FNAEP. Mean ± SD of AD was −6.96% ± 12.66% in patients with excellent result, −27.67% ± 27.70% with good result, and −66.05% ± 31.76% with poor result. Conclusions. FNAEP should be monitored in patients with intratemporal facial palsy at the early stage. FNAEP at posterior wall of external auditory meatus was sensitive to detect signs of taste disorder. There was close relativity between FNAEPs and facial nerve recovery.

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Most cited references 21

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Prognostic value of electroneurography and electromyography in facial palsy.

Claus Wittekindt, Orlando Guntinas-Lichius, Maria Grosheva (2008)

To compare the prognostic value of electroneurography (ENG) and needle electromyography (EMG) to estimate facial function outcome after acute facial palsy. Retrospective study using electrodiagnostic data and medical chart review. Two hundred one patients treated 1995 to 2004 were included. Initial and final facial function was established clinically by the House-Brackmann (HB) scale. ENG results were classified into amplitude loss less than 75% and amplitude loss 75% or greater to predict complete recovery and defective healing, respectively. Initial and follow-up EMG results were classified into neurapraxia and predicted complete recovery. In contrast, axonotmesis/neurotmesis and mixed lesions predicted, by definition, defective healing. : Initial HB was II to IV in 154 patients and V to VI in 47 patients. The etiology was idiopathic palsy in 139, iatrogenic lesion in 29, traumatic in 18, and herpes zoster in 15 patients. Finally, 134 (67%) patients showed a full recovery. Sixty-seven (33%) patients showed signs of defective healing. ENG presented a sensitivity, specificity, accuracy, positive predictive value (to predict defective healing), and negative predictive value of 60%, 79%, 73%, 59%, and 80%, respectively. The values for the initial EMG were 66%, 98%, 89%, 91%, and 89%. The best results showed the follow-up EMG with 85%, 100%, 97%, 100%, and 96%. EMG results were not classifiable in 32 (16%) patients. EMG showed higher prognostic values than ENG, especially when repeated during the time course of the facial palsy. ENG might be helpful if the EMG result is not classifiable.

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Optical stimulation of the facial nerve: a new monitoring technique?

Ingo U. Teudt, J. Walsh, C Nevel … (2007)

One sequela of skull base surgery is iatrogenic damage to cranial nerves, which can be prevented if the nerve is identified. Devices that stimulate nerves with electric current assist in nerve identification. Contemporary devices have two main limitations: 1) the physical contact of the stimulating electrode and (2) the spread of the current through the tissue. In contrast to electrical stimulation, pulsed infrared optical radiation can be used to safely and selectively stimulate neural tissue and might be valuable for screening. The gerbil facial nerve was exposed to 250 microsecond pulses of 2.12 microm radiation delivered via a 600-microm-diameter optical fiber at a repetition rate of 2 Hz. With use of 27 GA, 12-mm intradermal electrodes, muscle action potentials were recorded. Nerve samples were examined for possible tissue damage. Eight facial nerves were stimulated with radiant exposures between 0.71 and 1.77 J/cm, resulting in compound muscle action potentials (CmAPs) that were simultaneously measured at the m. orbicularis oculi, m. levator nasolabialis, and m. orbicularis oris. Resulting CmAP amplitudes were 0.3 to 0.4 mV, 0.15 to 1.4 mV, and 0.3 to 2.3 mV, respectively, depending on the radial location of the optical fiber and the radiant exposure. Individual nerve branches were also stimulated, resulting in CmAP amplitudes between 0.2 and 1.6 mV. Histology revealed tissue damage at radiant exposures of 2.2 J/cm but no apparent damage at radiant exposures of 2.0 J/cm. The experiments showed that selective muscle action potentials can be evoked optically in the gerbil facial nerve without direct physical contact.

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Prognostic value of electromyography in acute peripheral facial nerve palsy.

E Stennert, C Sittel (2000)

To analyze the value of electromyography in predicting recovery from acute idiopathic facial nerve paralysis. Retrospective case-series review. University-based hospital department of otorhinolaryngology/head neck surgery. Three hundred fifty-five patients with sudden facial paralysis of unknown cause (Bell's palsy). Treatment consisted uniformly of high-dose prednisolone, dextran, and pentoxifylline. Prognostication was based on electromyography performed not earlier than 10 to 14 days after the onset of palsy. The findings were classified according to Seddon into neurapraxia and axonotmesis/ neurotmesis. There is an inherent statement on prognosis in this classification because neurapraxia is presumed to recover completely within 8 to 12 weeks, whereas axonotmesis is most likely to be followed by sequelae. Facial nerve function after 6 months. Complete recovery was predicted correctly in 92.4% of cases. For the relatively rare and therefore principally more difficult predictable event defective recovery prognosis was still accurate in 80.8%. The detection of spontaneous fibrillation in needle electromyography is a reliable sign predicting unfavorable outcome. An accuracy of 80.8% for predicting unfavorable outcome may be sufficient to advise patients what to expect in the course of their facial nerve disorder. However, it seems dubious to build a decision about surgical intervention on such a test, because in the process, unnecessary surgery would be accepted for as much as one fifth of the patient population.

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Author and article information

Journal

Journal ID (nlm-ta): Int J Otolaryngol

Journal ID (publisher-id): IJOL

Title: International Journal of Otolaryngology

Publisher: Hindawi Publishing Corporation

ISSN (Print): 1687-9201

ISSN (Electronic): 1687-921X

Publication date (Print): 2012

Publication date (Electronic): 23 November 2011

Volume: 2012

Electronic Location Identifier: 960469

Affiliations

Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China

Author notes

*Yang Chi: yangchi63@ 123456hotmail.com

Academic Editor: Sertac Yetiser

Article

DOI: 10.1155/2012/960469

PMC ID: 3228373

PubMed ID: 22164176

SO-VID: d101ef94-ad0b-4335-aae9-7de6f3b0667e

License:

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.