Kurz Annabella, Volk Gerd Fabian, Arnold Dirk, Schneider-Stickler Berit, Mayr Winfried, Guntinas-Lichius Orlando
Department of Otorhinolaryngology, Division of Phoniatrics-Logopedics, Medical University of Vienna, Vienna, Austria.
Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.
Front Neurol. 2022 Apr 4;13:869900. doi: 10.3389/fneur.2022.869900. eCollection 2022.
This article addresses the potential clinical value of surface electrical stimulation in the acute phase of denervation after the onset of facial nerve or recurrent laryngeal nerve paralysis. These two nerve lesions are the most frequent head and neck nerve lesions. In this review, we will work out several similarities concerning the pathophysiology features and the clinical scenario between both nerve lesions, which allow to develop some general rules for surface electrical stimulation applicable for both nerve lesions. The focus is on electrical stimulation in the phase between denervation and reinnervation of the target muscles. The aim of electrostimulation in this phase of denervation is to bridge the time until reinnervation is complete and to maintain facial or laryngeal function. In this phase, electrostimulation has to stimulate directly the denervated muscles, i.e. muscle stimulation and not nerve stimulation. There is preliminary data that early electrostimulation might also improve the functional outcome. Because there are still caveats against the use of electrostimulation, the neurophysiology of denervated facial and laryngeal muscles in comparison to innervated muscles is explained in detail. This is necessary to understand why the negative results published in several studies that used stimulation parameters are not suitable for denervated muscle fibers. Juxtaposed are studies using parameters adapted for the stimulation of denervated facial or laryngeal muscles. These studies used standardized outcome measure and show that an effective and tolerable electrostimulation of facial and laryngeal muscles without side effects in the early phase after onset of the lesions is feasible, does not hinder nerve regeneration and might even be able to improve the functional outcome. This has now to be proven in larger controlled trials. In our view, surface electrical stimulation has an unexploited potential to enrich the early therapy concepts for patients with unilateral facial or vocal fold paralysis.
本文探讨了表面电刺激在面神经或喉返神经麻痹发作后去神经支配急性期的潜在临床价值。这两种神经损伤是头颈部最常见的神经损伤。在本综述中，我们将找出这两种神经损伤在病理生理特征和临床情况方面的若干相似之处，从而制定一些适用于这两种神经损伤的表面电刺激通用规则。重点是目标肌肉去神经支配和再支配之间阶段的电刺激。在去神经支配阶段进行电刺激的目的是在再支配完成之前的这段时间内起到桥梁作用，并维持面部或喉部功能。在这个阶段，电刺激必须直接刺激失神经支配的肌肉，即肌肉刺激而非神经刺激。有初步数据表明早期电刺激可能还会改善功能结局。由于使用电刺激仍存在一些注意事项，因此详细解释了与受神经支配肌肉相比失神经支配的面部和喉部肌肉的神经生理学。这对于理解为何若干使用不适合失神经支配肌纤维的刺激参数的研究所发表的负面结果是必要的。并列展示了使用适用于刺激失神经支配的面部或喉部肌肉的参数的研究。这些研究采用了标准化的结局指标，并表明在损伤发作后的早期对面部和喉部肌肉进行有效且可耐受且无副作用的电刺激是可行的，不会阻碍神经再生，甚至可能改善功能结局。现在需要在更大规模的对照试验中对此进行验证。我们认为，表面电刺激具有尚未被发掘的潜力，可为单侧面部或声带麻痹患者丰富早期治疗理念。
