Too much or too little? A systematic review of postparetic synkinesis treatment

Lapidus, Jodi B.; Lu, Johnny Chuieng Yi; Santosa, Katherine B.; Yaeger, Lauren; Stoll, C; Colditz, Graham A.; Snyder‐Warwick, Alison K.

doi:10.1016/j.bjps.2019.10.006

Cited by 19 publications

(31 citation statements)

References 46 publications

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“… 41 For an assessment of synkinesis, the Sunnybrook facial grading system is most commonly used. 42 In an RCT study, a composite score and the symmetry of voluntary movement at one month were predictors for the occurrence of synkinesis. 41 For the management of synkinesis, various kinds of options have been tried including botulinum toxin injections, surgery, physical therapy and a combination of botulinum toxin and physical therapy and biofeedback.…”

Section: Resultsmentioning

confidence: 99%

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Acute Peripheral Facial Palsy: Recent Guidelines and a Systematic Review of the Literature

Kim

Lee

2020

J Korean Med Sci

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Background This study reviews recent literature on facial palsy guidelines and provides systematic reviews on related topics of interest. Methods An electronic database search was performed to identify recent guidelines dealing with facial nerve palsy, systematic reviews and recent meta-analysis published between 2011 and 2019 (inclusive). The literature search used the search terms “Bell's palsy,” “Ramsay-Hunt syndrome,” “Facial palsy,” “Facial paralysis,” “Facial paresis,” “Guideline,” “Meta-analysis,” “Systematic review,” and “Randomized controlled trial.” Only studies written in English were used. Results The characteristics of treatment trends for facial palsy have been reviewed over the past decade. The most prominent change noted may be the shift from the conventional House-Brackmann facial nerve grading system to the Sunnybrook and eFACE systems. In addition, the results of serial meta-analyses indicate increasing agreement with the use of surgical decompression of the facial nerve. Beyond steroids or combined steroid-antiviral treatment, various novel drugs and treatments have been tried. For long-standing facial paralysis and postparetic synkinesis sequelae after facial palsy, facial reanimation has been highlighted and the necessity of new paradigms have been raised. Conclusion For peripheral facial paralysis, various changes have been made, not only in the facial nerve grading systems, but also in medical treatments, from surgical procedures to rehabilitation, during the last decade.

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Section: Resultsmentioning

confidence: 99%

“… 41 43 However, a high level of evidence is still lacking as to what the best treatment options for the management of synkinesis are. 42 …”

Section: Resultsmentioning

confidence: 99%

Acute Peripheral Facial Palsy: Recent Guidelines and a Systematic Review of the Literature

Kim

Lee

2020

J Korean Med Sci

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“….420; 0.12 0.021; 0.46 0.410; 0.11 SFGS, synkinesis levator labii superior (16)(17)(18). So far, no comparative studies on optimal training frequency and duration of an EMG-feedback approach for patients with synkinesis have been performed (5). This should be the subject of future research.…”

Section: Correlation Analysesmentioning

confidence: 99%

Effect of an Intensified Combined Electromyography and Visual Feedback Training on Facial Grading in Patients With Post-paralytic Facial Synkinesis

Volk

Roediger

Geißler

et al. 2021

Front. Rehabilit. Sci.

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Background: There is no current standard for facial synkinesis rehabilitation programs. The benefit and stability of effect of an intensified 10-day facial training combining electromyography and visual biofeedback training was evaluated.Methods: Fifty-four patients (77.8% female; median age: 49.5 years) with post-paralytic facial synkinesis (median time to onset of paralysis: 31.1 months) were included in retrospective longitudinal study between January 2013 and June 2016. Facial function was assesses at baseline (T0), first days of training (T1), last day of training (T2), and follow-up visit (T3) at a median time of 6 months later using the House-Brackmann (HB) facial nerve grading system, Stennert index (SI), Facial Nerve Grading System 2.0 (FNGS 2.0), and Sunnybrook Facial Grading System (SFGS). Pairwise comparisons between the time points with post-hoc Bonferroni correction were performed.Results: No significant changes of the gradings and subscores were seen between T0 and T1 (all p > 0.01). The 10-day combined and intensified feedback training between T1 and T2 improved facial symmetry and decreased synkinetic activity. Facial grading with the FNGS 2.0 or the SFGS were most suited to depict the training effect. FNGS 2.0, regional score, FNGS 2.0, synkinesis score, and FNGS 2.0 total score improved significantly (all p ≤ 0.0001). Both, the FNGS 2.0 and the SFGS showed the strongest improvement in the nasolabial fold/zygomatic and the oral region. Neither the age of the patient (r = 0.168; p = 0.224), the gender (r = 0.126; p = 0.363) nor the length of the interval between onset of the palsy and training start (r = 0.011; p = 0.886) correlated with the changes of the SFGS between T1 and T2. The results remained stable between T2 and T3 without any further significant change.Conclusion: Intensified daily combined electromyography and visual biofeedback training over 10 days was effective in patients with facial synkinesis and benefits were stable 6 months after therapy.

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“…An effective rehabilitation is linked to the patient’s motivation and compliance regarding the rehabilitation process [ 6 , 7 ]. Physical rehabilitation therapy is the most often prescribed measure [ 8 ]. However, access to specific facial rehabilitation is limited.…”

Section: Introductionmentioning

confidence: 99%

Continual rehabilitation motivation of patients with postparalytic facial nerve syndrome

Osthues

Kuttenreich

Volk

et al. 2021

Eur Arch Otorhinolaryngol

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Purpose To evaluate the continued rehabilitation motivation in patients with postparalytic facial synkinesis (PFS). Methods In this single-center cross-sectional survey, the multidimensional patient questionnaire for assessment of rehabilitation motivation (PAREMO-20) was used to assess the rehabilitation motivation. Associations Sunnybrook and Stennert index grading, Facial Clinimetric Evaluation (FaCE) survey, general quality of life (SF-36), Liebowitz Social Anxiety Scale (LSAS), Patient Health Questionnaire (PHQ)-9, technology commitment and affinity, and interest in further therapy were analyzed. Results 69 adults with PFS (73% women; median age: 54 years) answered the survey. In comparison to prior treatment forms, there was a significant higher future interest in computer-based home facial training (p < 0.0001). For PAREMO Psychological burden subscore, SF36 Emotional role was the highest negative correlative factor (p < 0.0001). For PAREMO Physical burden subscore, SF-36 General health was the highest negative correlative factor (p = 0.018). Working (p = 0.033) and permanent relationship (p = 0.029) were the only independent factors correlated to PAREMO Social Support Subscore. Higher positive impacts of technology affinity was inversely correlated to PAREMO Knowledge subscore (p = 0.017). Lower SF-36 Role physical subscore p = 0.045) and a lower SF-36 General health (p = 0.013) were correlated to a higher PAREMO Skepticism subscore. Conclusions Patients with PFS seem to have a high facial motor and non-motor psychosocial impairment even after several facial therapies. Rehabilitation-related motivation increases with both, higher facial motor and non-motor dysfunction. Social and emotional dysfunction are drivers to be interested in innovative digital therapy forms.

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Too much or too little? A systematic review of postparetic synkinesis treatment

Cited by 19 publications

References 46 publications

Acute Peripheral Facial Palsy: Recent Guidelines and a Systematic Review of the Literature

Acute Peripheral Facial Palsy: Recent Guidelines and a Systematic Review of the Literature

Effect of an Intensified Combined Electromyography and Visual Feedback Training on Facial Grading in Patients With Post-paralytic Facial Synkinesis

Continual rehabilitation motivation of patients with postparalytic facial nerve syndrome

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