Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
Facial Nerve Center Jena, Jena University Hospital, Jena, Germany.
J Neurol. 2019 Jan;266(1):46-56. doi: 10.1007/s00415-018-9099-x. Epub 2018 Oct 26.
Although central facial paresis (CFP) is a major symptom of stroke, there is a lack of studies on the motor and non-motor disabilities in stroke patients. A prospective cohort study was performed at admission for inpatient rehabilitation and discharge of post-stroke phase of 112 patients (44% female, median age: 64 years, median Barthel index: 70) with CFP. Motor function was evaluated using House-Brackmann grading, Sunnybrook grading and Stennert Index. Automated action unit (AU) analysis was performed to analyze mimic function in detail. Non-motor function was assessed using the Facial Disability Index (FDI) and the Facial Clinimetric Evaluation (FaCE). Median interval from stroke to rehabilitation was 21 days. Rehabilitation lasted 20 days. House-Brackmann grading was ≥ grade III for 79% at admission. AU activation in the lower face was significantly lower in patients with right hemispheric infarction compared to left hemispheric infarction (all p < 0.05). Median total FDI and FaCE score were 46.5 and 69, respectively. Facial grading and FDI/FaCE scores improved during inpatient rehabilitation (all p < 0.05). There was a significant increase of the activation of AU12 (Zygomaticus major muscle), AU13 (Levator anguli oris muscle), and AU24 (Orbicularis oris muscle) during inpatient rehabilitation (all p < 0.05). Multivariate analysis revealed that activation of AU10 (Levator labii superioris), AU12, AU17 (Depressor labii), and AU 38 (Nasalis) were independent predictors for better quality of life. These results demonstrate that CFP has a significant impact on patient's quality of life. Therapy of CFP with focus on specific AUs should be part of post-stroke rehabilitation.
尽管中枢性面瘫（CFP）是中风的主要症状，但目前缺乏对中风患者运动和非运动障碍的研究。对 112 名（44%为女性，中位年龄 64 岁，中位巴氏指数 70）伴有 CFP 的中风后患者在住院康复和出院阶段进行了前瞻性队列研究。使用 House-Brackmann 分级、Sunnybrook 分级和 Stennert 指数评估运动功能。采用自动动作单元（AU）分析详细分析模仿功能。使用面部残疾指数（FDI）和面部临床计量评估（FaCE）评估非运动功能。从中风到康复的中位间隔时间为 21 天。康复持续 20 天。入院时 House-Brackmann 分级≥III 级的患者占 79%。与左侧半球梗死相比，右侧半球梗死患者的下部面部 AU 激活明显降低（均 p < 0.05）。中位总 FDI 和 FaCE 评分分别为 46.5 和 69。面部分级和 FDI/FaCE 评分在住院康复期间均有所改善（均 p < 0.05）。AU12（颧大肌）、AU13（口轮匝肌）和 AU24（口轮匝肌）的 AU 激活在住院康复期间显著增加（均 p < 0.05）。多变量分析显示，AU10（上唇提肌）、AU12、AU17（下唇降肌）和 AU38（鼻肌）的激活是生活质量更好的独立预测因素。这些结果表明 CFP 对患者的生活质量有重大影响。针对特定 AU 的 CFP 治疗应成为中风后康复的一部分。
