Peripheral Repetitive Transcranial Magnetic Stimulation(rTMS) for Idiopathic Facial Nerve Palsy: A Prospective, Randomized Controlled Trial

Abstract

Purpose. The purpose of this study was to evaluate the clinical efficacy of peripheral repetitive transcranial magnetic stimulation (rTMS) in the treatment of idiopathic facial paralysis, to explore an ideal treatment scheme for idiopathic facial paralysis, and to provide evidence for clinical rehabilitation. Methods. 65 patients with idiopathic facial nerve palsy with the first onset were recruited and randomly divided into rTMS group and control group. Both groups received conventional treatment, rTMS group received additional repetitive transcranial magnetic stimulation to the affected side once a day, 5 times a week for 2 weeks. House-Brackmann (HB) grading scale, Sunnybrook facial grading system (SFGS), and modified Portmann scale (MPS) were used to assess facial nerve function before and after treatment, and the time for patients to return to normal facial nerve function and adverse reaction (AR) was also the main observation index. Results. After a 2-week intervention, HB, SFGS, and MPS increased in both groups ( P < 0.01 ); the improvement of HB, SFGS, and MPS in rTMS group was significantly higher than that in control group ( P < 0.01 ). The effective improvement rate of the TMS group after 2 weeks was 90.0%, and that of the control group was 53.3%, and the difference was statistically significant ( P < 0.01 ). Conclusions. Repetitive transcranial magnetic stimulation is a safe and effective noninvasive method for the treatment of idiopathic facial paralysis, which can significantly accelerate the recovery of facial nerve function and provide a new treatment idea for further improving the prognosis of patients with idiopathic facial paralysis.

Predictive Value of the Neutrophil-to-Lymphocyte Ratio and C-Reactive Protein in Patients with Idiopathic Facial Nerve Palsy

“…Patients underwent assessments for the severity of facial nerve palsy and facial nerve function both at the initial visit and again three months after beginning the medication. Disease severity was assessed according to the House-Brackmann (H-B) grading standard: 18 Grade I represents normal function, Grade II represents mild abnormality, Grade III represents moderate abnormality, Grade IV represents moderate to severe abnormality, Grade V represents severe abnormality, and Grade VI represents complete abnormality. The Portmann score 18 includes eyebrow wrinkling, eye closure, nasal flaring, whistling, smiling, and cheek puffing, with a maximum score of 3 points for each item and 2 points for static position, for a total of 20 points.…”

Efficacy of repetitive transcranial magnetic stimulation at different sites for peripheral facial paralysis: a prospective cohort study

“…Both peripheral and central groups received repetitive transcranial magnetic stimulation (Jiangxi Brain Regulation Technology Development limited-liability company, NTK-TMS-II transcranial magnetic stimulation instrument), and the stimulus coil was a figure of 8 coil (size: 104 * 196 * 16 mm). The stimulation program has been used to treat facial paralysis (11). The peripheral and central groups received the same rTMS regimen, Magnetic Pulse Parameter Specifications: Stimulation frequency is 5 Hz, stimulation time of a single pulse string is 6 s, the interval between pulse strings is 14 s, so a pulse cycle is the 20 s, and the number of input pulses for each pulse cycle is 30; each time the treatment is repeated for 60 cycles, the treatment time of each transcranial magnetic stimulation is 1,200 s (20 min), and the total number of output pulses is 1,800 pulses.…”

“…The patient wears a cap that fits his/her head circumference, and the coil is placed in the corresponding position of the "face" in the cap pattern for stimulation (between the areas of F7/F3/T3/C3, the facial motor cortex area). This method is now more widely used in China, the positioning cap is clearly labeled, easy to use, and can be a good solution to the problem of rapid positioning during clinical treatment; in the peripheral group, the stimulation site was on the face of the injured side, located between the mandibular notch and the lower margin of the zygomatic arch (11), the coil stimulation site is shown in Figure 2.…”

“…Resting motor thresholds (RMT) were measured before intervention in all patients receiving rTMS. The patient was asked to sit quietly and remain relaxed, approximately 3-6 CM from the apex is the center of the "8" coil, and a disposable electrode with 2 diameters of 1 cm was symmetrically fixed to the nasal muscle, recording nasal muscle complex muscle action potential (CMAP) after transcranial magnetic stimulation (TMS) (9,11). RMT is determined by visual inspection of minor muscle contractions.…”

“…The SFGS score ranges from 0 to 100, with higher scores indicating better facial nerve function, and measures static symmetry, voluntary symmetry, and synchronized facial movements. HBGS are graded from 1 to 6, with higher grades being more severe, and are assessed for facial symmetry at rest, forehead, eye, and mouth motor function during movement, and overall associated movement (11,17). The MPS assesses the completion of six actions (raising eyebrows, closing eyes, widening nostrils, showing teeth, pursing mouth, bulging cheeks) on a scale of 0-20 across four dimensions, with higher scores indicating better facial function (7,11,18).…”