Investigation of unilateral facial weakness: magnetic stimulation of the proximal facial nerve and of the face-associated motor cortex

Meyer, Bernd‐Ulrich; Britton, Thomas C.; Benecke, Reiner

doi:10.1007/bf00314405

Cited by 48 publications

(19 citation statements)

References 13 publications

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“…In facial nerve palsy, however, direct stimulation of the facial nerve proximal to the conduction block is not possible, as the site of the lesion is inaccessible within the temporal bone [14,15]. The labyrinthine segment of the facial nerve can be excited by TMS [4,5,6]. It has been demonstrated that hypoexcitability of the facial nerve to TMS occurs within a few hours of symptom onset and may last several months [4,5,6].…”

Section: Discussionmentioning

confidence: 99%

“…TMS allows identification of a conduction failure at the level of the canalicular portion of the facial nerve which is not accessible by electrical stimulation, and thus helps to identify the location of the lesion [9]. However, all electrophysiological investigations of the facial nerve need to be performed within the first few days after the onset of facial palsy in order to detect focal hypoexcitability before the onset of significant axonotmesis [5,6,8,10,11]. …”

Section: Introductionmentioning

confidence: 99%

“…A conduction block of the facial nerve within the canalicular portion is considered typical for Bell’s palsy when investigated within 3 days after the onset of symptoms. Therefore, neurophysiological methods such as transcranial magnetic stimulation (TMS) and electrical stimulation of the facial nerve are presumed to be of relevance to confirm the diagnosis and obtain information concerning the prognosis of the palsy at the onset of symptoms [4,5,6,7,8]. TMS allows identification of a conduction failure at the level of the canalicular portion of the facial nerve which is not accessible by electrical stimulation, and thus helps to identify the location of the lesion [9].…”

Section: Introductionmentioning

confidence: 99%

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Electrical and Transcranial Magnetic Stimulation of the Facial Nerve: Diagnostic Relevance in Acute Isolated Facial Nerve Palsy

Happe

Bunten²

2012

Eur Neurol

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Unilateral facial weakness is common. Transcranial magnetic stimulation (TMS) allows identification of a conduction failure at the level of the canalicular portion of the facial nerve and may help to confirm the diagnosis. Methods: We retrospectively analyzed 216 patients with the diagnosis of peripheral facial palsy. The electrophysiological investigations included the blink reflex, preauricular electrical stimulation and the response to TMS at the labyrinthine part of the canalicular proportion of the facial nerve within 3 days after symptom onset. Results: A similar reduction or loss of the TMS amplitude (p < 0.005) of the affected side was seen in each patient group. Of the 216 patients (107 female, mean age 49.7 ± 18.0 years), 193 were diagnosed with Bell’s palsy. Test results of the remaining patients led to the diagnosis of infectious [including herpes simplex, varicella zoster infection and borreliosis (n = 13)] and noninfectious [including diabetes and neoplasma (n = 10)] etiology. Conclusions: A conduction block in TMS supports the diagnosis of peripheral facial palsy without being specific for Bell’s palsy. Significance: These data shed light on the TMS-based diagnosis of peripheral facial palsy, an ability to localize the site of lesion within the Fallopian channel regardless of the underlying pathology.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Electrical and Transcranial Magnetic Stimulation of the Facial Nerve: Diagnostic Relevance in Acute Isolated Facial Nerve Palsy

Happe

Bunten²

2012

Eur Neurol

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“…On the other hand, neither neuronal tracing studies conducted in human and nonhuman primates [11,13,19] nor the electrophysiological studies fully support this classic interpretation. In humans, using transcranial magnetic stimulation (TMS), bilateral cortico-nuclear projections were found to the lower facial motoneurons [1,16,17]. The concept of the bilateral innervation to the upper facial motoneurons has not been made explicit in human subjects by TMS studies because of the stimulation of the afferent nerve fibers of the trigeminal nerve distributed over the head and face [3,5].…”

Section: Introductionmentioning

confidence: 99%

Corticonuclear innervation to facial muscles in normal controls and in patients with central facial paresis

Yıldız

Ertekin²,

Özdemirkıran³

et al. 2005

J Neurol

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Recently it has been proposed that corticobulbar innervation of the lower facial muscles is bilateral, that is from both right and left sides of the motor cortex. The objectives of this study were, i) to evaluate the corticonuclear descending fibers to the perioral muscles and, ii) to determine how central facial palsy (CFP) occurs and often recovers rapidly following a stroke. Eighteen healthy volunteers and 28 patients with a previous history of a stroke and CFP (mean ages: 51 and 61 years) were investigated by TMS (transcranial magnetic stimulation) with a figure of eight coil. Intracranial facial nerve and cortical motor evoked potentials (MEPs) were recorded from the perioral muscles. The periorbital MEPs were also studied. The absence of MEPs in both perioral muscles with TMS of the affected hemisphere was the most obvious abnormality. Also, central conduction time was significantly prolonged in the remaining patients. The mean amplitude of the affected hemisphere MEPs was diminished. The amplitudes of the unaffected hemisphere MEPs recorded from the intact side were enhanced especially in the first week following the stroke. During TMS, only the blink reflexes were elicited from the periorbital muscles due to stimulus spreading to trigeminal afferent nerve fibers. It is concluded that perioral muscles are innervated by the corticobulbar tract bilaterally. CFP caused by a stroke is generally incomplete and mild because of the ipsilateral cortical and multiple innervations out of the infarction area, and recovers fast through cortical reorganisation.

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“…TMS is already a common method in the neurophysiological investigation of Bell's palsy [6,10,12,13]. The aim of the present study was to evaluate the prognostic value of TMS in perioperative facial nerve palsy compared to clinical examination and conventional electrophysiological examination techniques described above.…”

Section: Introductionmentioning

confidence: 99%

Perioperative lesions of the facial nerve: follow-up investigations using transcranial magnetic stimulation

Kotterba

Tegenthoff

Malin

1997

Eur Arch Otorhinolaryngol

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Peripheral facial palsy can occur after aural surgery and neurosurgery. Routine neurophysiological investigation (utilizing electrical stimulation and the blink reflex) does not allow the direct assessment of the site of a lesion. In the present study transcranial magnetic stimulation (TMS) was applied in order to evaluate the usefulness of this method for prognosis. Twenty-three patients with postoperative facial pareses (after removals of an acoustic neuroma in 12 patients and parotid tumors in 11) were investigated. Ipsilateral short-latency and contralateral long-latency responses (after cortex stimulation) were elicited. At the first examination (11.7 +/- 9 days after onset of the palsy) the components of the blink reflex were absent in all cases. Responses to electrical stimulation were abnormal in 80%. Ipsilateral short-latency responses after TMS could be obtained in 7 patients. Pathological long-latency TMS responses were elicited in 17 patients. Follow-up investigations up to 2 years revealed no prognostic aspects from peripheral electrical stimulation, the blink reflex and the short-latency TMS response. The absence or extent of delay in long-latency responses at first examination was strongly correlated with final clinical outcomes. As improvements of the responses preceded clinical regressions of the paresis, TMS proved to be an important neurophysiological method for an early prognosis of recovery after perioperative lesions of the facial nerve.

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Investigation of unilateral facial weakness: magnetic stimulation of the proximal facial nerve and of the face-associated motor cortex

Cited by 48 publications

References 13 publications

Electrical and Transcranial Magnetic Stimulation of the Facial Nerve: Diagnostic Relevance in Acute Isolated Facial Nerve Palsy

Electrical and Transcranial Magnetic Stimulation of the Facial Nerve: Diagnostic Relevance in Acute Isolated Facial Nerve Palsy

Corticonuclear innervation to facial muscles in normal controls and in patients with central facial paresis

Perioperative lesions of the facial nerve: follow-up investigations using transcranial magnetic stimulation

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