Mancini Patrizia, De Seta Daniele, Prosperini Luca, Nicastri Maria, Gabriele Maria, Ceccanti Marco, Sementilli Giulio, Terella Maria, Bertoli Gian Antonio, Filipo Roberto, Inghilleri Maurizio
Department of Sense Organs, University Sapienza, Rome, Italy.
Laryngoscope. 2014 Nov;124(11):2598-605. doi: 10.1002/lary.24764. Epub 2014 Jun 10.
OBJECTIVES/HYPOTHESIS: The study was designed to verify if one or more electrophysiological parameters could predict a risk of nonrecovery of normal facial function and the development of synkinesis in Bell's palsy (BP) subjects.
Prospective case series.
A total of 120 subjects ranging from 18 to 70 years with unilateral BP (International Classification of Disease-11), Grade III to VI House-Brackmann (HB) degree, were assessed and treated with standardized oral steroids and antiviral drugs within 48 hours from onset. Of these, 92 underwent electroneurography (ENoG), electromyography (EMG), and blink reflex (BR) testing at 7 to 10 and 20 days after palsy onset. Multivariate analysis and receiver operating characteristic curves were carried out to verify which combination of electrophysiological parameters may be predictive of no recovery and/or development of synkinesis.
BR and ENoG were the best predictors of no facial function recovery, showing significant correlation coefficient with severity of facial palsy in both assessments. EMG findings did not add any prognostic significance. Worsening of facial palsy can be observed in subjects despite steroid therapy. The risk of developing synkinesis might be evaluated soon after BP on the grounds of ENoG degeneration, orbicularis oculi denervation, a younger age, and severe (V-VI) HB grade.
BR and ENoG, considered together with clinical findings, could offer a good indication in the first phases of BP for the possibility to develop palsy residua. This combination of tests is well accepted by the subjects, and is therefore suitable for multiple assessments in the early postpalsy period.Key Words: Bell's palsy, facial palsy, ENoG, blink reflex, Prognosis.
目的/假设：本研究旨在验证一个或多个电生理参数是否能够预测贝尔麻痹（BP）患者正常面部功能无法恢复以及联带运动发生的风险。
前瞻性病例系列研究。
共纳入120例年龄在18至70岁之间的单侧BP患者（国际疾病分类-11），House-Brackmann（HB）分级为III至VI级，在发病后48小时内接受标准化口服类固醇和抗病毒药物治疗及评估。其中92例患者在面瘫发作后7至10天和20天接受了神经电图（ENoG）、肌电图（EMG）和瞬目反射（BR）测试。进行多变量分析和受试者工作特征曲线分析，以验证哪些电生理参数组合可能预测无恢复和/或联带运动的发生。
BR和ENoG是面部功能无恢复的最佳预测指标，在两项评估中均与面瘫严重程度显示出显著的相关系数。EMG结果未增加任何预后意义。尽管接受了类固醇治疗，但仍可观察到患者面瘫加重。基于ENoG退变、眼轮匝肌失神经支配、年龄较小以及严重（V-VI）的HB分级，面瘫后不久可能评估联带运动发生的风险。
BR和ENoG与临床发现相结合，可为BP早期阶段出现面瘫后遗症的可能性提供良好的指示。这种测试组合易于被患者接受，因此适用于面瘫后早期的多次评估。关键词：贝尔麻痹；面瘫；ENoG；瞬目反射；预后。
4级。
