Prospective Feasibility Study of Electrostimulation (ES) in denervated Facial Muscles

Introduction:

Denervation results in neuromuscular atrophy, which, at least in limb muscles, can be effectively counteracted by electrostimulation (ES). ES supports as well mass increase of atrophied muscles. However, such evidence is missing for facial muscles. Thus, our study aims to evaluate the most effective stimulation parameters, electrode position and training schedule for ES in facial paralysis patients. Results are analysed by objective and subjective outcome measures.

Methods:

As far as November 2018, we enrolled 5 patients (4 female) with facial paralysis (duration between 1month and 16years). Before the first ES, and every 4 weeks during the ES, all patients underwent needle EMG, ultrasound and 3D-video. Additionally, they completed the Facial Disability Index (FDI) and the Facial clinometric rating scale (FaCE). Home-training (3 × 5 min twice a day) was individually programmed on the Stimulette r2x (Schuhfried, Vienna) for each patient. The stimulation was given in biphasic triangular impulses on the cheek.

Results:

No patient reported relevant adverse events linked to home-training. Training with optimized electrode positioning correlated with stable and specific M. zygomaticus activation, accompanied by a reduction of the pulse duration from 250 to 70 ms within 16 weeks. Even before reinnervation, objective (3D-videos, sonography) and subjective (FDI, FaCE) parameters improved significantly compared to the pre-stimulation situation.

Conclusions:

ES home-training is beneficial for patients with denervated facial muscles in reducing muscle atrophy and improving facial symmetry. A lack of relevant adverse events shows that such ES is safe. The patients showed 100% compliance with the protocol and rated the stimulation easy and effective.

Publication History

Publication Date:
23 April 2019 (online)