Prognostic Value of Electroneurography and Electromyography in Facial Palsy

Abstract

Objectives:To compare the prognostic value of electroneurography (ENG) and needle electromyography (EMG) to estimate facial function outcome after acute facial palsy.Study Design: Retrospective study using electrodiagnostic data and medical chart review.Methods: Two hundred one patients treated 1995 to 2004 were included. Initial and final facial function was established clinically by the House-Brackmann (HB) scale. ENG results were classified into amplitude loss less than 75% and amplitude loss 75% or greater to predict complete recovery and defective healing, respectively. Initial and follow-up EMG results were classified into neurapraxia and predicted complete recovery. In contrast, axonotmesis/neurotmesis and mixed lesions predicted, by definition, defective healing.Results: Initial HB was II to IV in 154 patients and V to VI in 47 patients. The etiology was idiopathic palsy in 139, iatrogenic lesion in 29, traumatic in 18, and herpes zoster in 15 patients. Finally, 134 (67%) patients showed a full recovery. Sixty-seven (33%) patients showed signs of defective healing. ENG presented a sensitivity, specificity, accuracy, positive predictive value (to predict defective healing), and negative predictive value of 60%, 79%, 73%, 59%, and 80%, respectively. The values for the initial EMG were 66%, 98%, 89%, 91%, and 89%. The best results showed the follow-up EMG with 85%, 100%, 97%, 100%, and 96%. EMG results were not classifiable in 32 (16%) patients.Conclusions: EMG showed higher prognostic values than ENG, especially when repeated during the time course of the facial palsy. ENG might be helpful if the EMG result is not classifiable.

Prognosis of patients with recurrent facial palsy

“…Using previously described methods, we found that the accuracies of ENoG and EMG, 76.4 and 84.7%, respectively, were similar to those of previous reports, in which these two methods showed accuracies of 73 and 89%, respectively [11].…”

“…A ground electrode was attached to the arm of each patient and a recording electrode was placed in the nasolabial fold. Measurements were reported as the percent maximal amplitude on the side of the lesion/maximal amplitude of on the healthy side of the compound myoaction potential (CMAP) obtained from the nasalis muscle measured at the suprathreshold stimulation [11]. Incomplete recovery was defined as a [90% loss of amplitude on ENoG.…”

Ist die Fazialisparese in der Schwangerschaft ein eigenes Krankheitsbild?

“…Wie von den Freiburger Autoren richtig aufgezeigt, unterscheidet sich die Prognose bei Schwangeren nicht von der Prognose bei anderen Patienten. Richtungweisend ist hier wie bei allen anderen Patienten auch die Elektrodiagnostik [3,4]. Von Interesse wäre es zu untersuchen, ob bei Schwangeren mit Fazialisparese und dem Risikofaktor Hypertonus oder Adipositas gehäuft degenerative Paresen nachzuweisen sind.…”

Modified Stennert’s Protocol in Treating Acute Peripheral Facial Nerve Paralysis: Our Experience

“…Out of this 19 patients had idiopathic facial nerve paralysis (Bell's palsy) and seven had late onset post traumatic facial nerve palsy. Electroneuronography was carried out and patients with House-Brackmann grade II and grade III injury were included in the study [8].…”