Zur prognostischen Wertigkeit der Elektrodiagnostik bei der Bell'schen Lähmung

Abstract

Many papers report on a poor rate of complete restitution of Bell's palsy if signs of degeneration can be detected in neuromyography (NMG) or electromyography (EMG). In 119 patients who underwent infusion therapy (as developed by Stennert) 39% showed signs of degeneration in EMG or NMG. Complete restitution was achieved in 93% of these patients. Degeneration was more frequent in elderly patients (< 20 years: 20%, > 60 years: 55%). This did not affect the rate of complete restitution, which was constantly high for every age. If infusion therapy was started within 7 days after onset of the disease, no defects in restitution were observed, which was frequently so if therapy was started later. After one year the rate of complete restitution was about equal in cases with signs of degeneration (91%) and non-degenerative cases (94%). But 80% of the non-degenerative cases showed complete restitution within 3 months after onset of the palsy, whereas 80% of cases with signs of degeneration healed after this date (mean 6.1 months). After oral therapy with cortisol exclusively half of the degenerative cases did not attain complete restitution. After infusion therapy EMG and NMG do not answer the question if a Bell's palsy will heal completely or not but enable us to predict when this will probably be the case.

Variability of repeated facial nerve electroneurography in healthy subjects

“…Both authors concluded that electroneurography is adaptable for routine diagnostic practice and that results have sufficiently high accuracy for monitoring the nerve function. In the past two decades numerous studies have been published on prognostication and clinical course of facial palsies using electroneurography as one of several clinical tools 8–11 …”

Zur zeitlichen Inkonstanz der Neuromyographie des Nervus facialis beim Gesunden

“…Coker [2] verglich verschiedene Ableitungs-N. facialis sei und die erzielten Ergebnisse ausreichend genau seien, um die Nervenfunktion zu überwachen. Daraufhin wurden in den folgenden Jahren zahlreiche Studien publiziert, in denen die Neuromyographie als wichtiges Instrument in der Verlaufskontrolle und Prognosestellung von Lähmungen des N. facialis zur Anwendung kam [8,9,14,18] [12].Als Entscheidungskriterium wird dabei meist die Neuromyographie herangezogen, wobei eine Amplitudenreduktion von mehr als 90% auf der betroffenen Seite am 4. Paresetag als prognostisch ungünstiges Zeichen gewertet wird.…”

“…Laskawi [9] kam bei einer retrospektiven Auswertung der elektrophysiologischen Befunde von 119 Patienten mit einer akuten idiopathischen peripheren Fazialisparese zu der Erkenntnis, daß die elektrophysiologische Diagnostik im Einzelfall keine sichere Aussage zuläßt, ob eine Parese ausheilen wird.…”

“…Facial nerve paralysis diagnosis · Prognostic parameters · Electrophysiology · Electromyography · Cranial nerve function (7,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)9) mA.…”