Targan R S, Alon G, Kay S L
National Center for Facial Paralysis, Inc, Washington, DC 20037, USA.
Otolaryngol Head Neck Surg. 2000 Feb;122(2):246-52. doi: 10.1016/S0194-5998(00)70248-8.
This study investigated the efficacy of a pulsatile electrical current to shorten neuromuscular conduction latencies and minimize clinical residuals in patients with chronic facial nerve damage caused by Bell's palsy or acoustic neuroma excision.
The study group included 12 patients (mean age 50.4 +/- 12. 3 years) with idiopathic Bell's palsy and 5 patients (mean age 45.6 +/- 10.7 years) whose facial nerves were surgically sacrificed. The mean time since the onset of paresis/paralysis was 3.7 years (range 1-7 years) and 7.2 years (range 6-9 years) for the Bell's and neuroma excision groups, respectively.
Motor nerve conduction latencies, House-Brackmann facial recovery scores, and a 12-item clinical assessment of residuals were obtained 3 months before the onset of treatment, at the beginning of treatment, and after 6 months of stimulation. Patients were treated at home for periods of up to 6 hours daily for 6 months with a battery-powered stimulator. Stimulation intensity was kept at a submotor level throughout the study. Surface electrodes were secured over the most affected muscles. Groups and time factors were used in the analyses of the 3 outcome measures.
No statistical differences were found between the two diagnostic groups with respect to any of the 3 outcome measures. Mean motor nerve latencies decreased by 1.13 ms (analysis of variance test, significant P = 0.0001). House-Brackmann scores were also significantly lower (Wilcoxon signed rank test, P = 0.0003) after treatment. Collective scores on the 12 clinical impairment measures decreased 28.7 +/- 8.1 points after 6 months [analysis of variance test, significant P = 0.0005). Eight patients showed more than 40% improvement, 4 better than 30%, and 5 less than 10% improvement in residuals score.
These data are consistent with the notion that long-term electrical stimulation may facilitate partial reinnervation in patients with chronic facial paresis/paralysis. Additionally, residual clinical impairments are likely to improve even if motor recovery is not evident.
本研究调查了脉动电流对缩短贝尔面瘫或听神经瘤切除所致慢性面神经损伤患者神经肌肉传导潜伏期及减少临床残留症状的疗效。
研究组包括12例特发性贝尔面瘫患者（平均年龄50.4±12.3岁）和5例接受面神经手术切断的患者（平均年龄45.6±10.7岁）。贝尔面瘫组和听神经瘤切除组分别自轻瘫/瘫痪发作以来的平均时间为3.7年（范围1 - 7年）和7.2年（范围6 - 9年）。
在治疗开始前3个月、治疗开始时以及刺激6个月后，获取运动神经传导潜伏期、House - Brackmann面神经恢复评分以及12项临床残留症状评估结果。患者在家中使用电池供电的刺激器进行治疗，每天治疗长达6小时，持续6个月。在整个研究过程中，刺激强度保持在亚运动水平。将表面电极固定在受影响最严重的肌肉上。在对这3项结果指标的分析中使用了分组和时间因素。
在这3项结果指标中的任何一项上，两个诊断组之间均未发现统计学差异。平均运动神经潜伏期缩短了1.13毫秒（方差分析检验，P = 0.0001，具有显著性）。治疗后House - Brackmann评分也显著降低（Wilcoxon符号秩检验法，P = （0.0003）。6个月后，12项临床损伤指标的综合评分降低了28.7±8.1分（方差分析检验，P = 0.0005，具有显著性）。8例患者的残留症状评分改善超过40%，4例改善超过30%，5例改善不足10%。
这些数据与长期电刺激可能促进慢性面瘫/瘫痪患者部分神经再支配的观点一致。此外，即使运动功能未明显恢复，临床残留损伤也可能得到改善。
