Facial electroneurography in Bell's palsy: variability in the early stage and comparison between interpretation methods

Medeiros, Jovany Luis Alves de; Nobrega, João Antonio Maciel; Andrade, Luiz Augusto Franco de; Novo, Neil Ferreira

doi:10.1590/S0004-282X1996000300006

Abstracts

To determine the variability of the abnormalities found in the electroneurography (ENG) of the facial nerve in cases of Bell's palsy during the initial two week period was one of the objectives of the authors. A second one was to investigate the value of ENG as a tool to determine an early prognosis of recovery utilizing two different methods. In the first one the amplitude of the compound muscular action potential (CMAP) obtained on the paralyzed side was compared to this potential on the opposite (normal) side. The second method compared the CMAP on the paralyzed side to normal standardized data from normal individuals. A group of 33 patients with Bell's palsy was followed until total recovery or for at least 4 months, if the recovery was not achieved earlier. It was observed that amplitude of the CMAP become stable towards the sixth day of palsy and this is a good time to establish the prognosis. Another conclusion is that both methods were equivalent to determine the prognosis in Bell's palsy.

electroneurography; Bell's palsy; facial nerve

O objetivo deste trabalho é determinar a variabilidade da eletroneurografia (ENG) do nervo facial na paralisia de Bell durante as primeiras duas semanas e investigar o valor da ENG na determinação de um prognóstico precoce utilizando-se dois métodos diferentes. O primeiro método compara a amplitude do potencial de ação muscular composto obtido no lado paralisado com o lado normal e o segundo método compara o potencial de ação muscular composto obtido no lado paralisado com valores normativos. Um grupo de 33 pacientes com paralisia de Bell foi seguido até a recuperação total ou pelo menos por quatro meses nos casos em que não houve recuperação. Observou-se que a amplitude do potencial de ação muscular composto estabiliza-se em torno do sexto dia e que este é um bom momento para se realizar o exame e se estabelecer um prognóstico. Outra conclusão é que ambos os métodos são equivalentes para determinação prognóstica.

eletroneurografia; paralisia de Bell; nervo facial

Facial electroneurography in Bell's palsy: variability in the early stage and comparison between interpretation methods

Eletroneurografia do nervo facial na paralisia de Bell: variabilidade na fase aguda e comparação entre técnicas

Jovany Luis Alves de Medeiros^I; João Antonio Maciel Nobrega^I; Luiz Augusto Franco de Andrade^I; Neil Ferreira Novo^II

^IClinical Neurophysiology Laboratory, Federal University of São Paulo - Escola Paulista de Medicina. MD, PhD

^IIClinical Neurophysiology Laboratory, Federal University of São Paulo - Escola Paulista de Medicina. PhD

ABSTRACT

To determine the variability of the abnormalities found in the electroneurography (ENG) of the facial nerve in cases of Bell's palsy during the initial two week period was one of the objectives of the authors. A second one was to investigate the value of ENG as a tool to determine an early prognosis of recovery utilizing two different methods. In the first one the amplitude of the compound muscular action potential (CMAP) obtained on the paralyzed side was compared to this potential on the opposite (normal) side. The second method compared the CMAP on the paralyzed side to normal standardized data from normal individuals. A group of 33 patients with Bell's palsy was followed until total recovery or for at least 4 months, if the recovery was not achieved earlier. It was observed that amplitude of the CMAP become stable towards the sixth day of palsy and this is a good time to establish the prognosis. Another conclusion is that both methods were equivalent to determine the prognosis in Bell's palsy.

Key words: electroneurography, Bell's palsy, facial nerve.

RESUMO

O objetivo deste trabalho é determinar a variabilidade da eletroneurografia (ENG) do nervo facial na paralisia de Bell durante as primeiras duas semanas e investigar o valor da ENG na determinação de um prognóstico precoce utilizando-se dois métodos diferentes. O primeiro método compara a amplitude do potencial de ação muscular composto obtido no lado paralisado com o lado normal e o segundo método compara o potencial de ação muscular composto obtido no lado paralisado com valores normativos. Um grupo de 33 pacientes com paralisia de Bell foi seguido até a recuperação total ou pelo menos por quatro meses nos casos em que não houve recuperação. Observou-se que a amplitude do potencial de ação muscular composto estabiliza-se em torno do sexto dia e que este é um bom momento para se realizar o exame e se estabelecer um prognóstico. Outra conclusão é que ambos os métodos são equivalentes para determinação prognóstica.

Palavras-chave: eletroneurografia, paralisia de Bell, nervo facial.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Acknowledgment - The authors thank Dr. Gilberto M. Manzano for reviewing the manuscript.

Aceite: 20-março-1996.

Dr. João A.M. Nobrega - Rua Prof. Artur Ramos 183 conj. 12 - 01454-011 São Paulo SP - Brasil.

1. Canter RJ, Nedzelski JM, Mclean JA. Evoked electromyography in Bell's palsy: a clinical useful test? J Otolaryngol 1986;15:344-347
2. Eavey RD, Herman BS, Joseph JJ, Thornton AR Clinical experience with electroneurography in the pediatric patient. Arch Otolaryngol Head Neck Surg 1989;115:600-607
3. Esslen E Electrodiagnosis of facial palsy. In Miehlke A Surgery of the facial nerve. Munchen: Urban & Schwarzenberg, 1973:45-51
4. Esslen E. Quantification of nerve fibre degeneration on time course regeneration in Bell's palsy (Abstract58). Electroenceph Clin Neurophysiol 1973;34:810.
5. Esslen E. The acute facial palsies. Berlin: Springer Verlag, 1977.
6. Fernandes Garcia de Castro SM, Cavalieri Merlo I, Menoyo Bueno A, Gil Gonzales M. Estudio electroneurografico en las paralisias faciales. Acta Otorrinolaringol Esp 1989;40:177-180.
7. Fisch U. Maximal nerve excitability testing vs electroneuronography. Arch Otolaryngol 1980;106:352-357.
8. Gilliat RW, Taylor JC. Electrical changes following section of the facial nerve. Proc R Soc Med 1959;52:1080-1083.
9. Hughes GB, Josey AF, Glasscock ME, Jackson CG, Ruy WA, Sigmanis A. Clinical electroneurography: statistical analysis of controlled measurements in twenty two normal subjects. Laryngoscope 1981 ;91:1834-1846
10. Kanzaki J. Electrodiagnosis findings in the early stages of Bell's palsy and Ramsay-Hunt syndrome. Acta Otolaryngol (Stockh) 1988;446:42-46
11. Kaway M, Inamura H, Koike Y. On the conservative treatment of Bell's palsy. Acta Otolaryngol (Stockh) 1988;446:106-110.
12. Langworth EP, Taverner D The prognosis in facial palsy. Brain 1963;86:464-480
13. May M, Klein SR, Blumenthal F. Evoked electromyography and idiophatic facial paralysis. Otolaryngol Head Neck Surg 1983;91:678-685.
14. Medeiros JLA, Nobrega JAM, Novo NF. Eletroneurografia do nervo facial: métodos de estimulação e registro. Arq Neuropsiquiatr 1992,50:168-172.
15. Medeiros JLA, Nobrega JAM, Juliano Y, Andrade LAF. Facial nerve electroneurography: variability in normal subjects. Arq Neuropsiquiatr 1996,54:393-396.
16. Noyon P. Contribution au prognostic electrique des paralysies faciales. Thèse pour le doctorat D'État en médecine, Université de Bordeaux II: Thèse 574. Bordeaux 1978.
17. Podvinec M. Electroneurography in prognosis of infratemporal facial palsy as compared to measurements of rheobase and chronaxy. ORL 1977,39:185-194.
18. Taverner D. Electrodiagnosis in facial palsy. Arch Otolaryngol 1965;81:470-477.
19. Thomander L, Stalberg E. Electroneurography in the prognostication of Bell's palsy. Arch Otolaryngol 1981;92:221-237.
20. Zander Olsen P. Prediction of recovery in facial palsy (Abstract 64). Electroenceph Clin Neurophysiol 1973;34:812
21. Zander Olsen P. Prediction of recovery in Bell's palsy. Acta Neurol Scand 1975;52(Suppl61):l-121.

Publication Dates

Publication in this collection
10 Nov 2010
Date of issue
Sept 1996

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Canter RJ, Nedzelski JM, Mclean JA. Evoked electromyography in Bell's palsy: a clinical useful test? J Otolaryngol 1986;15:344-347

[2] 2. Eavey RD, Herman BS, Joseph JJ, Thornton AR Clinical experience with electroneurography in the pediatric patient. Arch Otolaryngol Head Neck Surg 1989;115:600-607

[3] 3. Esslen E Electrodiagnosis of facial palsy. In Miehlke A Surgery of the facial nerve. Munchen: Urban & Schwarzenberg, 1973:45-51

[4] 4. Esslen E. Quantification of nerve fibre degeneration on time course regeneration in Bell's palsy (Abstract58). Electroenceph Clin Neurophysiol 1973;34:810.

[5] 5. Esslen E. The acute facial palsies. Berlin: Springer Verlag, 1977.

[6] 6. Fernandes Garcia de Castro SM, Cavalieri Merlo I, Menoyo Bueno A, Gil Gonzales M. Estudio electroneurografico en las paralisias faciales. Acta Otorrinolaringol Esp 1989;40:177-180.

[7] 7. Fisch U. Maximal nerve excitability testing vs electroneuronography. Arch Otolaryngol 1980;106:352-357.

[8] 8. Gilliat RW, Taylor JC. Electrical changes following section of the facial nerve. Proc R Soc Med 1959;52:1080-1083.

[9] 9. Hughes GB, Josey AF, Glasscock ME, Jackson CG, Ruy WA, Sigmanis A. Clinical electroneurography: statistical analysis of controlled measurements in twenty two normal subjects. Laryngoscope 1981 ;91:1834-1846

[10] 10. Kanzaki J. Electrodiagnosis findings in the early stages of Bell's palsy and Ramsay-Hunt syndrome. Acta Otolaryngol (Stockh) 1988;446:42-46

[11] 11. Kaway M, Inamura H, Koike Y. On the conservative treatment of Bell's palsy. Acta Otolaryngol (Stockh) 1988;446:106-110.

[12] 12. Langworth EP, Taverner D The prognosis in facial palsy. Brain 1963;86:464-480

[13] 13. May M, Klein SR, Blumenthal F. Evoked electromyography and idiophatic facial paralysis. Otolaryngol Head Neck Surg 1983;91:678-685.

[14] 14. Medeiros JLA, Nobrega JAM, Novo NF. Eletroneurografia do nervo facial: métodos de estimulação e registro. Arq Neuropsiquiatr 1992,50:168-172.

[15] 15. Medeiros JLA, Nobrega JAM, Juliano Y, Andrade LAF. Facial nerve electroneurography: variability in normal subjects. Arq Neuropsiquiatr 1996,54:393-396.

[16] 16. Noyon P. Contribution au prognostic electrique des paralysies faciales. Thèse pour le doctorat D'État en médecine, Université de Bordeaux II: Thèse 574. Bordeaux 1978.

[17] 17. Podvinec M. Electroneurography in prognosis of infratemporal facial palsy as compared to measurements of rheobase and chronaxy. ORL 1977,39:185-194.

[18] 18. Taverner D. Electrodiagnosis in facial palsy. Arch Otolaryngol 1965;81:470-477.

[19] 19. Thomander L, Stalberg E. Electroneurography in the prognostication of Bell's palsy. Arch Otolaryngol 1981;92:221-237.

[20] 20. Zander Olsen P. Prediction of recovery in facial palsy (Abstract 64). Electroenceph Clin Neurophysiol 1973;34:812

[21] 21. Zander Olsen P. Prediction of recovery in Bell's palsy. Acta Neurol Scand 1975;52(Suppl61):l-121.