Frigerio Alice, Heaton James T, Cavallari Paolo, Knox Chris, Hohman Marc H, Hadlock Tessa A
Milan, Italy; and Boston, Mass. From the Human Physiology Section, Department of Pathophysiology and Transplantation, Università degli Studi di Milano; the Facial Nerve Center, Carolyn and Peter Lynch Center for Laser and Reconstructive Surgery, Division of Facial Plastic and Reconstructive Surgery, Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School; and the Department of Surgery, Massachusetts General Hospital, Harvard Medical School.
Plast Reconstr Surg. 2015 Oct;136(4):515e-523e. doi: 10.1097/PRS.0000000000001639.
Elicitation of eye closure and other movements via electrical stimulation may provide effective treatment for facial paralysis. The authors performed a human feasibility study to determine whether transcutaneous neural stimulation can elicit a blink in individuals with acute facial palsy and to obtain feedback from participants regarding the tolerability of surface electrical stimulation for daily blink restoration.
Forty individuals with acute unilateral facial paralysis, HB grades 4 through 6, were prospectively studied between 6 and 60 days of onset. Unilateral stimulation of zygomatic facial nerve branches to elicit eye blink was achieved with brief bipolar, charge-balanced pulse trains, delivered transcutaneously by adhesive electrode placement; results were recorded on a high-speed video camera. The relationship between stimulation parameters and cutaneous sensation was analyzed using the Wong-Baker Faces Pain Rating Scale.
Complete eye closure was achieved in 55 percent of participants using stimulation parameters reported as tolerable. In those individuals, initial eye twitch was observed at an average current of 4.6 mA (±1.7; average pulse width of 0.7 ms, 100 to 150 Hz), with complete closure requiring a mean of 7.2 mA (±2.6).
Transcutaneous facial nerve stimulation may artificially elicit eye blink in a majority of patients with acute facial paralysis. Although individuals varied widely in their reported degrees of discomfort from blink-eliciting stimulation, most of them indicated that such stimulation would be tolerable if it could restore eye closure. These patients would therefore benefit from a biomimetic device to facilitate eye closure until the recovery process is complete.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
通过电刺激引发闭眼及其他动作可能为面瘫提供有效的治疗方法。作者进行了一项人体可行性研究，以确定经皮神经刺激能否在急性面瘫患者中引发眨眼，并获取参与者对用于日常眨眼恢复的表面电刺激耐受性的反馈。
对40例急性单侧面瘫（House-Brackmann分级为4至6级）患者在发病6至60天内进行前瞻性研究。通过将带电极的黏性贴片经皮放置，以短暂双相、电荷平衡脉冲序列对颧面神经分支进行单侧刺激来引发眨眼；结果用高速摄像机记录。使用面部表情疼痛评分量表分析刺激参数与皮肤感觉之间的关系。
55%的参与者使用报告为可耐受的刺激参数实现了完全闭眼。在这些个体中，平均电流4.6 mA（±1.7；平均脉冲宽度0.7 ms，100至150 Hz）时观察到初始眼肌抽搐，完全闭眼平均需要7.2 mA（±2.6）。
经皮面神经刺激可能在大多数急性面瘫患者中人工引发眨眼。尽管个体对引发眨眼刺激的不适程度报告差异很大，但大多数人表示如果这种刺激能恢复闭眼则可以耐受。因此，在恢复过程完成之前，这些患者将受益于一种仿生装置来促进闭眼。
临床问题/证据水平：治疗性，IV级。
