Prognostic factors of Bell's palsy: Multivariate analysis of electrophysiological findings

Mancini, Patrizia; Seta, Daniele De; Prosperini, Luca; Nicastri, Maria; Gabriele, M.; Ceccanti, Marco; Sementilli, Giulio; Terella, Maria; Bertoli, G. A.; Filipo, Roberto; Inghilleri, Maurizio

doi:10.1002/lary.24764

Cited by 39 publications

(39 citation statements)

References 51 publications

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“…Dry mouth at the onset is highly correlated with a severe grade of palsy, and when present it is related to a poor chance of recovery in the early period. This finding could be of important interest for those centers where the access to the electrophysiological testing is not easy and where the choice of referring BP patients to further examinations (EMG, EnoG, Blink Reflex) [ 27 ] and subsequent therapy (physical rehabilitation and surgical decompression) is made more difficult. This study investigated the symptoms on the basis of the patient's history only without the use of objective examinations; nevertheless, a correlation with data present in literature was found.…”

Section: Discussionmentioning

confidence: 99%

Bell’s Palsy: Symptoms Preceding and Accompanying the Facial Paresis

Seta

Mancini

Minni

et al. 2014

The Scientific World Journal

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This individual prospective cohort study aims to report and analyze the symptoms preceding and accompanying the facial paresis in Bell's palsy (BP). Two hundred sixty-nine patients affected by BP with a maximum delay of 48 hours from the onset were enrolled in the study. The evolution of the facial paresis expressed as House-Brackmann grade in the first 10 days and its correlation with symptoms were analyzed. At the onset, 136 patients presented postauricular pain, 114 were affected by dry eye, and 94 reported dysgeusia. Dry mouth was present in 54 patients (19.7%), facial pain, hyperlacrimation, aural fullness, and hyperacusis represented a smaller percentage of the reported symptoms. After 10 days, 39.9% of the group had a severe paresis while 10.2% reached a complete recovery. Dry mouth at the onset was correlated with severe grade of palsy and was prognostic for poor recovery in the early period. These outcomes lead to the deduction that the nervus intermedius plays an important role in the presentation of the BP and it might be responsible for most of the accompanying symptomatology of the paresis. Our findings could be of important interest to early address a BP patient to further examinations and subsequent therapy.

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Section: Discussionmentioning

confidence: 99%

Bell’s Palsy: Symptoms Preceding and Accompanying the Facial Paresis

Seta

Mancini

Minni

et al. 2014

The Scientific World Journal

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“…More recent studies have found different cut‐offs to be useful. In a study of 120 subjects, Mancini and colleagues reported that amplitudes <23% of the unaffected sided were the strongest predictor of nonrecovery of normal function . Using receiver operating curve analysis, the strongest predictive values of amplitude compared with the contralateral side were 33% (67% sensitivity, 81% specificity) and 45% (100% sensitivity, 68% specificity) at baseline and second evaluations, respectively; amplitudes below these values were associated with poor prognosis.…”

Section: Facial Nervementioning

confidence: 99%

How electrodiagnosis predicts clinical outcome of focal peripheral nerve lesions

Robinson

2015

Muscle and Nerve

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This article reviews the electrodiagnostic (EDX) prognostic factors for focal traumatic and nontraumatic peripheral nerve injuries. Referring physicians and patients often benefit from general and nerve-specific prognostic information from the EDX consultant. Knowing the probable outcome from a nerve injury allows the referring physician to choose the best treatment options for his/her patients. Nerve injuries are variable in their mechanism, location, and pathophysiology. The general effects of the injuries on nerve and muscle are well known, but more research is needed for nerve-specific information. Several factors currently known to influence prognosis include: nature of the nerve trauma, amount of axon loss, recruitment in muscles supplied by the nerve, the extent of demyelination, and the distance to reinnervate functional muscles. This article reviews these general concepts and also nerve-specific EDX measures that predict outcome after focal neuropathies.

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“…Findings in this group demonstrate the prognostic value of ENoG in that maximum percent degeneration reached on ENoG in the acute period after total paralysis is correlated to facial nerve function at 1 year (Table 3), in concordance with previous studies. 2,4,5,21,31 Whereas our current data series represents one of the largest studies to date in electrodiagnostic testing for acute facial paralysis, only 43% had follow-up at 1 year for assessment of long-term functional outcome, which limits the statistical power of secondary analyses investigating the prognostic value of electrodiagnostic modalities. Further, the patient cohort is highly selected based on clinical decision algorithms and referral patterns and is not likely to be reflective of all patients with acute onset of facial paralysis.…”

Section: Volitional Emg Protocolmentioning

confidence: 99%

Electrodiagnostic testing in acute facial palsy: Outcomes and comparison of methods

Andresen

Zhu

Lee

et al. 2020

Laryngoscope Investig Oto

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Objective: To study the relationship between various electrodiagnostic modalities in acute facial palsy. Setting: Academic tertiary care center. Patients: One-hundred and six patients who presented with traumatic or nontraumatic acute facial paralysis (House-Brackmann, HB, grade 6/6) between 2008 and 2017 and underwent acute electrodiagnostic testing. Intervention: Electroneurography (ENoG) using nasolabial fold (NLF) or nasalis muscle (NM) methods, and volitional electromyography (EMG) in all patients. Main outcome measures: Percent degeneration of ipsilateral facial nerve compound muscle action potentials (CMAP) on NLF-and NM-ENoG, presence or absence of muscle unit potentials (MUPs) on EMG. Results: Extent of facial nerve degeneration measured by NLF-and NM-ENoG were highly correlated (r = 0.85, P < .01) on each test and on serial testing. NLF-and NM-ENoG concordantly diagnosed ≥90% degeneration in 44 patients (80%), of whom 32 patients were diagnosed to have 100% degeneration by both methodologies. Absence of MUPs on EMG was 63% sensitive and 92% specific for ≥90% degeneration on ENoG, with a positive predictive value of 90%. For patients with Bell's palsy, percent degeneration on ENoG was also correlated to HB score at 1 year. Surgical decompression resulted in mean HB scores of 2.2 and 3.0 for patients with Bell's palsy and trauma, respectively. Conclusions: NM-ENoG may be a valid and comparable method to NLF-ENoG for predicting the recovery of facial nerve function in acute paralysis. Absence of MUPs on EMG is a specific measure of severe degeneration and highly predictive of candidacy for surgical decompression.

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Prognostic factors of Bell's palsy: Multivariate analysis of electrophysiological findings

Abstract: 4.

Cited by 39 publications

References 51 publications

Bell’s Palsy: Symptoms Preceding and Accompanying the Facial Paresis

Bell’s Palsy: Symptoms Preceding and Accompanying the Facial Paresis

How electrodiagnosis predicts clinical outcome of focal peripheral nerve lesions

Electrodiagnostic testing in acute facial palsy: Outcomes and comparison of methods

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