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The Spectrum of Electrophysiological Abnormalities in Bell's Palsy

  • Michael D. Hill (a1), Gyl Midroni (a1), Warren C. Goldstein (a2), Shelley L. Deeks (a3), Donald E. Low (a4) and Andrew M. Morris (a5)...

Abstract:

Background:

As part of an investigation of a suspected "outbreak" of Bell's palsy in the Greater Toronto Area, a population-based sample of patients with Bell's palsy was investigated electrophysiologically to help understand the spectrum of abnormalities that can be seen in this setting.

Methods:

Two hundred and twenty-four patients were surveyed, of whom 91 underwent formal neurological assessment. Of the latter, 44 were studied electrophysiologically using standard techniques. Thirty-two of the 44 patients fulfilled clinical criteria for Bell's palsy.

Results:

A wide range of electrophysiological changes was observed. Blink responses were the most useful test showing diagnostic sensitivity of 81% and specificity of 94% compared to the contralateral control side. Needle electromyography was additionally helpful in only one patient of six with normal conduction studies.

Conclusions:

There is a wide spectrum of electrophysiological abnormalities in Bell's palsy. Blink reflex latencies may be under-utilized in the assessment of the facial nerve in Bell's palsy. Facial EMG is not generally useful in routine assessment.

RÉSUMÉ: Introduction:

Dans le cadre d'une investigation motivée par ce qui semblait être une éclosion de cas de paralysie de Bell dans la région de Toronto, un échantillon de patients atteints de la paralysie de Bell, tirés de la population de Toronto, a subi une investigation électrophysiologique afin d'aider à comprendre la gamme des anomalies qui peuvent être observées dans ce contexte.

Méthodes:

Deux cent vingt-quatre patients ont été dénombrés et 91 d'entre eux ont subi une évaluation neurologique. Parmi ceux-ci, 44 ont subi une évaluation électrophysiologique selon les techniques standards. Trente-deux des 44 patients satisfaisaient aux critères cliniques de la paralysie de Bell.

Résultats:

Une grande variété de changements électrophysiologiques a été observée. La réaction de clignotement était le test le plus utile avec une sensibilité diagnostique de 81% et une spécificité de 94% en prenant le côté opposé comme contrôle. L'électromyographie à l'aiguille a été utile chez seulement un patient sur six dont les études de conduction étaient normales.

Conclusions:

Il existe une vaste gamme d'anomalies électrophysiologiques dans la paralysie de Bell. Les temps de latence du réflexe de clignotement à la menace sont peut-être sous-utilisés dans l'évaluation du nerf facial dans la paralysie de Bell. En général, l'ÉMG facial n'est pas utile dans l'évaluation de routine de ces cas.

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Copyright

Corresponding author

Department of Clinical Neurosciences, University of Calgary, MRG005, Foothills Hospital, 1403 29th Street NW, Calgary, AB T2N 2T9, Canada.

References

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