Ann Rehabil Med.  2013 Feb;37(1):103-109. 10.5535/arm.2013.37.1.103.

Comparison of Transcranial Magnetic Stimulation and Electroneuronography Between Bell's Palsy and Ramsay Hunt Syndrome in Their Acute Stages

• Hur DM
• Kim SH
• Lee YH
• Kim SH
• Park JM
• Kim JH
• Yong SY
• Shinn JM
• Oh KJ

• KMID: 2266657
• DOI: http://doi.org/10.5535/arm.2013.37.1.103

Abstract

OBJECTIVE
To examine the neurophysiologic status in patients with idiopathic facial nerve palsy (Bell's palsy) and Ramsay Hunt syndrome (herpes zoster oticus) within 7 days from onset of symptoms, by comparing the amplitude of compound muscle action potentials (CMAP) of facial muscles in electroneuronography (ENoG) and transcranial magnetic stimulation (TMS).
METHODS
The facial nerve conduction study using ENoG and TMS was performed in 42 patients with Bell's palsy and 14 patients with Ramsay Hunt syndrome within 7 days from onset of symptoms. Denervation ratio was calculated as CMAP amplitude evoked by ENoG or TMS on the affected side as percentage of the amplitudes on the healthy side. The severity of the facial palsy was graded according to House-Brackmann facial grading scale (H-B FGS).
RESULTS
In all subjects, the denervation ratio in TMS (71.53+/-18.38%) was significantly greater than the denervation ratio in ENoG (41.95+/-21.59%). The difference of denervation ratio between ENoG and TMS was significantly smaller in patients with Ramsay Hunt syndrome than in patients with Bell's palsy. The denervation ratio of ENoG or TMS did not correlated significantly with the H-B FGS.
CONCLUSION
In the electrophysiologic study for evaluation in patients with facial palsy within 7 days from onset of symptoms, ENoG and TMS are useful in gaining additional information about the neurophysiologic status of the facial nerve and may help to evaluate prognosis and set management plan.

Keyword

Bell palsy; Herpes zoster oticus; Transcranial magnetic stimulation; Prognosis

MeSH Terms

Action Potentials
Bell Palsy
Denervation
Facial Muscles
Facial Nerve
Facial Paralysis
Herpes Zoster
Herpes Zoster Oticus
Humans
Muscles
Paralysis
Prognosis
Transcranial Magnetic Stimulation

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