| Background:Idiopathic facial paralysis (IFP), also known as facial neuritis, Bell’s paralysis, isperipheral facial paralysis caused by the non-specific inflammation of the facial nerve inthe stylomastoid hole, and is the common disease in Department of Neurology. Atpresent, the pathogenesis of this disease is not fully clear. All previous diagnosis of IFPwas conducted through the medical history binding specific clinical symptoms exceptfor other factors caused by peripheral facial paralysis. In recent years, even if functionalimaging can spot facial nerve edema, it’s characterized by low detection rate, high costand less significant clinical application. However, the application of nerveelectrophysiological examination, such as blink reflex (BR), electroneurography (ENoG)and electromyography (EMG), due to the easy to use, it can provide scientific andobjective basis for early diagnosis and prognosis of the IFP.Traditional methods of IFP treatment include: corticosteroids, antiviral therapy,Chinese medicine treatment, physical therapy, and surgical treatment.In recent years, withthe development of neural electrophysiological techniques and the use of percutaneouselectrical stimulation treatment has drawn widespread attention, because as a newtreatment, it is with simple, effective, almost no adverse reaction characteristics. In thisstudy, EMG transcutaneous electrical stimulation to treat40cases of patients with IFP,and to observed whether the early IFP treatment was efficient or not.Objective:1. Discussing the performance of BR、ENoG and EMG in the early nerveelectrophysiological examination to IFP patients, and the significance for earlydiagnosis of the disease. 2. Analysing of transcutaneous electrical stimulation treatment to the early stageof IFP.Methods:1. Analyzing general information, a detailed medical history and diagnosis of50cases of IFP patients.2. Nerve electrophysiological studies: to examine50cases of identified IFPpatients with BR and ENoG nerve electrophysiological examination, and useself-correlative study to compare the contralateral and ipsilateral detection. Line EMGexamine to a small number of patients to abserve the changes of the ipsilateral facialmuscles.3. The effect study of transcutaneous electrical stimulation to the IFP treatment: toextract40cases at random from50in total and then divide them into control group andtreatment group with20cases each, employed Toronto facial grading system (TFGS) to scorebefore and after30days’ treatment respectively and on the30th day employed theHouse-Brackmann facial grading system (HBGS) to score. We judged recovery degree of the facialnerve function by TFGS scores; and observed efficiency of the two method by HBGS scores.Results:1. IFP clinical analysisGeneral cases: In50cases of IFP patients, I selected28male patients and22female patients with the ratio of14:11. The age ranged from17to78years old withaverage age of45.50±17.28years old. Among them,35(70%) patients found facialparalysis in the morning. and there were10cases.(20%) with history of “cold” beforethe onset of the disease,8cases.(16%) sleeping with windows open and theair-conditioning blowing,16cases (32%) with history of before or after the onset of thedisease and48patients (96%) with peak symptoms within5days. Signs and symptomsfor the first treatment are as follows: ipsilateral furrows on their brow decreased ordisappeared to varying degrees among50patients, eyelids were incompletely closed,nasolabial folds became shallow, drum gills leaked and they could not blow the whistleand the tooth deviated toward contralateral part. All above mentioned symptoms areperformance of peripheral facial paralysis.5patients (10%) were with diminished senseof taste,2patients (4%) with hyperacusis and another2patients (4%) with earherpes.(except for the dermatology consultation).2. Nerve electrophysiological detect(1) BR: According to examination taken after the onset within5days, we found that BR determination for50patients was abnormal, contralateral R1wave issued50waves with the wave rate100%; ipsilateral R1wave issued16waves with the wave rate32%. Contralateral R2wave issued49waves with the wave rate98%; ipsilatera R2wave issued28waves with the wave rate56%. Contralateral R2′wave issued48waveswith the wave rate96%; ipsilateral R2′wave issued31waves with the wave rate62%.The difference between wave rates of contralateral and ipsilateral was statisticallysignificant(P<0.05). Compared with contralateral R1, R2, R2′wave rate, ipsilateral R1,R2, R2′wave rates significantly reduced and their latent periods were significantlyprolonged.The abnormal rate of50cases of patients with BR:15are with mild cases (30%);16are moderate cases (32%); and19are severe cases (38%). The relationship obtainedbetween the severity of BR and the wave rate: the more severe BR is, the lower the BRwave rate is.(2) ENoG: According to examination taken after the onset within5days, we found28anomaly cases with the abnormal rate of56%. After comparing the incubation periodand amplitude of M-wave in each branch of ipsilateral and contralateral facial nerves,we found that amplitude difference was statistically significant (P<0.05), but there wasno statistic significance for latent period difference (P>0.05).(3) Ratio of R1/M incubation period: Among50patients,16issued R1wave.Comparing ipsilateral value of R1/M with contralateral value of R1/M, there were15patients whose ipsilateral increased larger than contralateral, one case with loweripsilateral than the contralateral.(4) EMG: Selected10patients underwent EMG detection, four of which wereabnormal whereas six cases were normal. Among the six cases, five of which tookimmediate inspection after onset, and the duration of disease was less than one week.3. Comparison of the effect between the control group and treatment group to theearly stage of IFP treatment.There was no statistic significance of TFGS score difference between controlgroup and treatment group before treatment (P>0.05),30days after treatment, the differencebetween the TFGS score of the control group and treatment group and the total efficiency wasstatistically significant (P<0.05), the function of facial nerve in the treatment group significantlyimproved and the efficiency treatment was high.Conclusion:1. In the early stage, the IFP patients show the decline of the R1, R2, R2′wave rate of ipsilateral blink reflex(BR).Compared with contralateral R2wave rate, ipsilateral R1,R2, R2′wave rates significantly reduced and their latent periods were significantlyprolonged. And the more severe BR is, the lower the BR wave rate is.2. Electroneurography for early IFP patients shows that compared with theamplitude of contralateral of M-wave, the amplitude of the ipsilateral of it is lower, andthe incubation period prolongs insignificantly.3. Transcutaneous electrical stimulation therapy, effectively improve damagedfacial nerve, to accelerate the recovery of neurological function, so it is significant to theearly stage of IFP treatment. |
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