Protocol for randomized controlled trial of electric stimulation with high-volt twin peak versus placebo for facial functional recovery from acute Bell’s palsy in patients with poor prognostic factors

Loyo, Myriam; McReynold, Margaret; Mace, Jess C.; Cameron, Michelle

doi:10.1177/2055668320964142

Cited by 7 publications

(3 citation statements)

References 38 publications

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“…These observations are important when interpreting the published results and clinical protocols: Loyo et al, for example, published a protocol planning to use 100 μs pulses at 35 Hz stimulation rate in a prospective, double-blinded, randomized, placebo-controlled study investigating the effect of electrostimulation on recovery from acute Bell's palsy in patients with poor prognostic factors ( 54 ). We are concerned that this might not be effective, especially when applied to facial muscles of patients with poor prognosis, i.e.…”

Section: Effects Of Facial Nerve and Muscle Stimulation Starting In T...mentioning

confidence: 99%

Selective Electrical Surface Stimulation to Support Functional Recovery in the Early Phase After Unilateral Acute Facial Nerve or Vocal Fold Paralysis

et al. 2022

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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.

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Section: Effects Of Facial Nerve and Muscle Stimulation Starting In T...mentioning

confidence: 99%

Selective Electrical Surface Stimulation to Support Functional Recovery in the Early Phase After Unilateral Acute Facial Nerve or Vocal Fold Paralysis

et al. 2022

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“…There is thought that electrical stimulation could reduce the sequelae of facial paralysis by preventing muscle atrophy and improving the selectivity of motor nerve regeneration; however, study results vary. Given the general poor study qualities with varied outcome measures on the use of electrical stimulation, a recent randomized control trial protocol was developed to evaluate the effects of high voltage electrical stimulation more conclusively, using pulsed electrical stimulation on Bell's palsy patients with a poor recovery prognosis [23]. Physical therapy has been shown to greatly improve facial function and QOL in patients who have already developed NFFP and has gained widespread acceptance as an initial treatment [24–26].…”

Section: Physical Therapymentioning

confidence: 99%

Facial paralysis: timing of repair and management of the nonflaccidly paralyzed face

Sanchez¹,

Pannu²,

Fuller³

2021

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of review To explore recent advances in therapeutic interventions for nonflaccid facial paralysis (NFFP), including new evidence for surgical and nonsurgical treatments. Timing of treatment is also discussed, along with possible future treatments. Recent findings NFFP remains a difficult disease to treat. Chemodenervation with botulinum toxin remains a first-line treatment to suppress aberrant and antagonistic movements during voluntary use of muscles. More permanent treatments such as selective neurectomy, myectomy, and nerve and muscle transfers have been shown to offer promising results for the nonflaccidly paralyzed face. Summary NFFP is commonly seen in patients who have incomplete recovery from facial paralysis, and carries high psychosocial morbidity. A large array of treatments have been described in the literature, both procedural and nonprocedural. Both treatment type and timing are important in optimal patient recovery.

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“…However, the effectiveness of electrical stimulation in Bell's palsy remains unclear owing to the paucity of high-quality studies. Clinicians differ regarding the use of electrical stimulation for facial paralysis [23], with some asserting that electrical stimulation improves recovery while others are concerned about the potential adverse effects and increased risks of synkinesis.…”

Section: Introductionmentioning

confidence: 99%

Effects of Electrical Stimulation on Facial Paralysis Recovery after Facial Nerve Injury: A Review on Preclinical and Clinical Studies

Yoo

Kim

et al. 2023

JCM

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Various methods have been used to improve function and manage facial nerve injury. Although electrical stimulation therapy is frequently used to treat facial paralysis, its effects have been found to vary and no clear standards have been developed. The current review describes the results of preclinical and clinical studies evaluating the effectiveness of electrical stimulation therapy in promoting the recovery of a peripheral facial nerve injury. Evidence is presented showing the efficacy of electrical stimulation in promoting nerve regeneration after peripheral nerve injuries in both animal models and human patients. The ability of electrical stimulation to promote the recovery of facial paralysis was found to depend on the type of injury (compression or transection), the species of animal tested, the type of disease, the frequency and method of electrical stimulation, and the duration of the follow-up. Electrical stimulation, however, can also have potential negative outcomes, such as reinforcing synkinesis, including mistargeted axonal regrowth via inappropriate routes; excessive collateral axonal branching at the lesion site; and multiple innervations at neuromuscular junctions. Because of the inconsistencies among studies and the low quality of evidence, electrical stimulation therapy is not currently regarded as a primary treatment of facial paralysis in patients. However, understanding the effects of electrical stimulation, as determined in preclinical and clinical studies, is important for the potential validity of future research on electrical stimulation.

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Protocol for randomized controlled trial of electric stimulation with high-volt twin peak versus placebo for facial functional recovery from acute Bell’s palsy in patients with poor prognostic factors

Cited by 7 publications

References 38 publications

Selective Electrical Surface Stimulation to Support Functional Recovery in the Early Phase After Unilateral Acute Facial Nerve or Vocal Fold Paralysis

Selective Electrical Surface Stimulation to Support Functional Recovery in the Early Phase After Unilateral Acute Facial Nerve or Vocal Fold Paralysis

Facial paralysis: timing of repair and management of the nonflaccidly paralyzed face

Effects of Electrical Stimulation on Facial Paralysis Recovery after Facial Nerve Injury: A Review on Preclinical and Clinical Studies

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