Peripheral Repetitive Transcranial Magnetic Stimulation(rTMS) For Idiopathic Facial Nerve Palsy:Aprospective,Randomized Controlled Trial

Background:Idiopathic facial nerve palsy(IFNP)is a common disorder that manifests clinically as weakness of facial muscles,crookedness of the mouth,and difficulty in closing the eyes.The main treatment methods include acupuncture,medication and rehabilitation physiotherapy measures.However,even after professional treatment,29% of patients with IFNP are still unable to regain full facial function.Repetitive transcranial magnetic stimulation(r TMS)is a noninvasive neuromodulation technique that has been used only for the evaluation and prognosis of IFNP patients in the past.r TMS has recently emerged as an interventional method for the treatment of IFNP.Studies have shown that r TMS interventions for IFNP are effective,however,these studies have used central stimulation,mostly in motor cortical areas,and no studies have yet confirmed the effectiveness and safety of peripheral facial r TMSin adult patients with IFNP.Objective:The purpose of this study was to evaluate the efficacy and safety of peripheral r TMS in the treatment of IFNP,to explore potential treatments for IFNP,and to provide a clinical reference regarding the rehabilitation treatmentof IFNP.Methods:Sixty-five adult IFNP patients with first-onset and unilateral facial palsy were recruited at the Yuebei People’s Hospital,and these patients were randomly divided into the r TMS group and the control group using the Random sampling method.Both groups received conventional treatment with acupuncture plus medication.r TMS was performed on the affected face of the subjects in the r TMS group on top of conventional treatment once a day,five times a week for 2 weeks.The Sunnybrook facial grading system(SFGS),the House-Brackmann grading scale(HBGS)and the Modified Portmann scale(MPS)were used to assess the The efficacy of r TMS was assessed;the incidence,nature and severity of adverse events were recorded to comprehensively assess the safety of r TMS.Data were analyzed using SPSS 26.0 statistical software,and the t-test or Wilcoxon signed rank sum test was used to compare the changes in SFGS,HBGS,and MPS scores of IFNP patients in the two groups before and after theintervention.Results:(1)The two groups were comparable at baseline: before the intervention,the differences in baseline characteristics such as height,disease severity,disease duration,age,left-right distribution of facial palsy side,gender,and weight between the two groups of IFNP patients were not statistically significant(P > 0.05);(2)The improvement of the r TMS group was better than that of the control group: after 2 weeks of intervention,the HBGS,SFGS,and MPS scores of patients in both groups showed significant improvement compared with those before treatment(P < 0.01);among them,the improvement of facial nerve function in the r TMS group was significantly better than that of the control group,with theimprovement of HBGS [2.47(0.90)vs.1.60(0.72),P< 0.01],SFGS improvement [52.13(19.50)vs.33.23(13.15),P < 0.01],MPS improvement [9.60(4.06)vs.7.03(3.13),P = 0.008].r TMS group patients had an effective improvement rate of 90.0% and control group patients had an effective improvement rate of 53.3%,with a statistically difference(P < 0.01).In addition,no adverse events werereported in either group;(3)r TMS had equal therapeutic potential for patients of different severity: among the included IFNP patients,there was no significant difference in SFGS improvement among patients in between thethree HBGS classes(P = 0.19).Conclusion:Repetitive transcranial magnetic stimulation may be a safe and effective adjunctive method for the treatment of idiopathic facial neuritis,which can significantly accelerate the recovery of facial nerve function on the basis of combined conventional rehabilitation therapy,providing a new reference and reference for furtherimproving theprognosis ofpatients withidiopathicfacial neuritis.