Evaluation of Trigeminal Nerve Involvement Using Blink Reflex Test in Bell’s Palsy

손은진,Ki Bong Lee,김지훈,Yoon-Ah Park,박윤길,Won Sang Lee 대한청각학회 2011 Journal of Audiology & Otology Vol.15 No.3

Background and Objectives: Facial nerve dysfunction in Bell's palsy is evaluated using various parameters including physical examination and electrophysiological studies. Associated symptoms of facial numbness or paresthesia are reported by some patients with Bell's palsy. The aim of this study was to investigate trigeminal nerve involvement in Bell's palsy using blink reflex test. Subjects and Methods: Facial nerve and trigeminal nerve functions were assessed using House-Brackmann (HB) grading system, electroneuronography (ENoG) and blink reflex tests in 28 patients diagnosed as Bell's palsy. Results: HB grades correlated with degeneration ratio from ENoG (p=0.002, chi-square test). The ipsilateral R1 reponse of the blink reflex was absent or abnormal in 27/28 patients (96.4%), and ipsilateral R2 response was absent or abnormal in 26/28 patients (92.8%). Contralateral R2 was abnormal in 5/28 patients (17.8%), suggesting involvement of trigeminal nerve in a portion of patients. The results of blink reflex test showed no significant correlation to the outcome of facial nerve function (HB grade) in Bell's palsy patients. Conclusions: Blink reflex test provides information about trigeminal and facial nerve functions in addition to ENoG results. Our study suggests that subclinical involvement of trigeminal nerve may accompany facial nerve dysfunction in Bell's palsy. Introduction Bell's palsy is the most common cause etiology of acute facial nerve palsy occurring in about 10-30 per 100,000 of the general population.1) Since the facial nerve is primarily a motor nerve, dysfunction of the seventh cranial nerve is usually evident by limitation of voluntary movements by facial expression muscles. Taste disturbance from the small sensory component through the chorda tympani may be present. Some patients also complain of facial numbness or paresthesia, not confined to the postauricular area related to the auricular sensory branch, but on the lateral side of the face. Such symptoms may be related to trigeminal nerve involvement. Electrophysiological studies are widely utilized in facial palsy patients in addition to physical examination of voluntary movements. Nerve excitability test (NET) and electroneuronography (ENoG) are widely used to assess the functional status and to predict the outcome.2,3,4) The blink reflex (BR) is a polysynaptic reflex responseof the orbicularis oculi muscle elicited by electricalstimulation of the supraorbital nerve and is mediated by the afferent trigeminal nerve, the brainstem and the efferent facial nerve. The BR test can be used to evaluate the function of the involved nerves.5,6) The BR responses consist of two different temporaryresponses: early ipsilateral R1 and late bilateral R2. The R1 is generated through a reflex arc in the ipsilateral part of the brainstem with a direct connection between trigeminal pathway and the facial motor nucleus, and the R2 is presumed to be mediated through polysynaptic interneurons in the lateral reticular formation in the brainstem.7)The aim of this study was to investigate trigeminal nerve involvement in Bell's palsy patients using blink reflex test. Subjects and Methods The clinical data of patients presenting with acute onset unilateral facial nerve palsy to the Yonsei University College of Medicine Gangnam Severance Hospital from between October 2010 to June 2011 were reviewed. Twenty-eight patients who were diagnosed as Bell's palsy and followed up for more than 1 month were included in the study. Exclusion criteria were previous history of facial palsy, Ramsay-Hunt syndrome, traumatic facial palsy, diabetes mellitus, and facial palsy due to central or peripheral nervous system disorders. Bell's palsy was diagnosed when other recognizable causes were ruled out by careful history review, neurological examinations, serological and radiological studies. The facial nerve function was assessed by House-Brackmann (HB) facial nerve grading system at initial presentation and at each follow up visit. Complete recovery to HB grades I or II were considered satisfactory compared to incomplete recovery to HB grades III to IV. Electrophysiological tests were performed using performed using a Viking IV electromyographysystem (Nicolet, Madison, WI, USA) between 3 to 14 days since the onset of facial palsy. On ENoG, supramaximal stimulation of 0.2-ms duration at a rate of 1 Hz was provided through bipolar surface electrodes. Electrodes were placed with the anode just outside the stylomastoid foramen and the cathode in front of the ear lobe and manipulated to obtain the maximal compound action potential amplitude on the display. For recording, the surface disc electrodes were placed in the nasolabial fold. The ground electrode was placed on the lower jaw. Peak-to-peak amplitudes of ENoG response on the affected side were compared with those on the unaffected side. Percentage of response amplitude on the affected side compared with that on the unaffected side was designated the degeneration ratio (DR) value for the patient. For evaluation of trigeminal nerve function, BR tests were performed. In BR testing, 18-mA stimulation of 0.2-ms duration was applied via the supraorbital margin, and responses of the orbicularis oculi muscles were recorded through surface disc electrodes. The responses of both sides were recorded (i...

적외선 체열진단법을 이용한 Bell's palsy의 임상적 예후 진단 연구

송범용,Song, Beom-Yong 대한침구의학회 2001 대한침구의학회지 Vol.18 No.1

The Background and Purpose : Most diagnostic method for the facial palsy were invasive and complex. And we don't know very well prognosis for the recovery of facial palsy in the first stage after the onset. But the Digital Infrared Thermal Image(DITI) isn't invasive and complex diagnostic method for the facial palsy. So we should study on the clinical prognostic diagnosis of Bell's palsy among facial palsy with the DITI. Objective and Methods : This study researched into the clinical statistics for 89 case who are in Bell's palsy, and they are treated with oriental medical care at the Woosuk university during 2 years form November 1998 to October 2000. All objectives have the Grade 6(Zero state) of Bell's palsy in first week after the onset. It takes a patient's facial temperature after the onset. Group A is taken from 1 day to 4 days after the onset. Group B is taken from 5 day to 8 days after the onset. And group C is taken from 9 day to 12 days after the onset. Results and Conclusions : The Digital Infrared thermal image technique showed the more high temperature, the more rapid cure and short treatment period on TE23, B2, S3, S6 in abnormal site of Bell's palsy. But it showed the more low temperature, the more rapid cure and short treatment period on TE17 of abnormal site of Bell's palsy. As a conclusion, we could think that the prognostic diagnosis of Bell's palsy closely related with the thermal difference normal and abnormal site of Bell's palsy that were took picture after the onset.

Bell`s palsy의 유발인자로서의 한랭 노출에 대한 소고(小考)

장인수 ( In Soo Jang ) 대한경락경혈학회 2006 Korean Journal of Acupuncture Vol.23 No.3

Objectives: To express an opinion on the controversy about the cold exposure as one of the risk factors of Bell`s palsy. Results & Conclusions: It is widely assumed that there is a causal relationship between Bell`s palsy and herpes family virus. Regarding cold exposure as one of the risk factors of Bell`s palsy, however, some physicians do not accept that cold exposure could be one of the risk factors of Bell`s palsy. There is no evidence supporting the hypothesis that the virus causes Bell`s palsy, and it has yet to be confirmed. As there are some experimental and clinical reports suggesting that Bell`s palsy is related to the cold exposure, we cannot exclude the possibility that the cold exposure may be one of the important risk factors of Bell`s palsy. It would be necessary to undertake further studies to determine this.

발병초기 벨마비 환자의 진단에서 순목 반사(blink reflex)의 유용성

석정임,이동국,김창형 대한임상신경생리학회 2012 Annals of Clinical Neurophysiology Vol.14 No.1

Background: Bell’s palsy is the most common disease of cranial nerve. While most electrodiagnostic tests can detect the abnormality of facial nerve several days later in Bell’s palsy, blink reflex usually reveals the abnormality earlier than other tests. Therefore, we investigated the diagnostic usefulness of blink reflex in the early stage of Bell’s palsy. Methods: We performed a prospective investigation in patients with facial palsy. We enrolled patients with Bell’s palsy who were evaluated within 7 days of symptom onset and excluded patients with secondary causes of facial palsy. We analyzed the findings of blink reflex according to age, sex, evaluation time, and severity of facial palsy. Results: Of 320 consecutive patients with facial palsy, a total of 204 patients were enrolled. Blink reflex was normal for 10 patients and abnormal for 194 patients. The time interval between the symptom onset and the evaluation time was not associated with the result of blink reflex,but House-Brackmann grade was significantly related to the result of blink reflex (P<0.001). Patients with mild Bell’s palsy often showed normal blink reflex. Conclusions: Our study shows that blink reflex is useful diagnostic test regardless of evaluation timing in the early stage of Bell’s palsy, although it could be normal in patients with mild Bell’s palsy.

Bell's Palsy의 경과에 대한 예후인자 분석

민영광,안창범,장경전,윤현민,김철홍,송춘호,김수민,김정은,박재흥,Min, Young-Kwang,An, Chang-Beohm,Jang, Kyung-Jun,Yoon, Hyun-Min,Kim, Cheol-Hong,Song, Choon-Ho,Kim, Soo-Min,Kim, Jeong-Eun,Park, Jae-Heung 대한침구의학회 2008 대한침구의학회지 Vol.25 No.3

Objectives : This study was designed to evaluate clinical prognosis factors of Bell's palsy patients. Methods : The 100 subjects were chosen from 262 patients over 20years old who was diagnosised Bell's palsy through Acupuncture & Moxibustion and ENT medical specialist after visiting the hospital within 8days of onset of peripheral facial palsy and after Oriental-Western Medicine Treatment, recovered completely or had over three months cares because of incomplete recovery Oriental-Western Medicine Treatment included Acupuncture Treatment, Herb med treatment, medicines treatment, Physical therapy and Electrodiagnostic Test was operated after 7 to 10days after outbreaks of the disease. Clinical prognosis factors were analyzed using House-Brackmann grading system(HBGS) as a measurement of the degree of Facial Palsy. Collected data were analyzed as Chi-Square test, ANOVA test, Independent-Samples t-test regression analysis using SPSS 12.0 WIN Program. Results : 1. There was a significant difference in the results of treatment according to site of palsy, degree of initial palsy, time of initial recovery and existence of recovery after 3weeks from onset as clinical prognosis factors of Bell's Palsy, However, a statistically significant difference was not shown in the results of treatment according to gender, age, existence of Post Auricular Pain, Hypertension, Diabetes and existence of relapse. 2. As a result of overall treatment, 85% of patients were recovered almost entirely and 15% were not recovered completely. 3. There was a significant difference in the onset of Post Auricular Pain and duration of Post Auricular Pain according to the degree of Post Auricular Pain. 4. There was a significant difference in the degree of initial palsy and degree of palsy after 3weeks from onset according to the existence of Post Auricular Pain. However, a statistically significant difference was not shown in the period of time until initial treatment, The time of initial recovery, (H-B), The period from onset to recovey, ENoG value. Conclusions : Based on the above results, prognosis of Bell's palsy was affected by degree of initial palsy, time of initial recovery and existence of recovery after 3weeks from onset.

벨마비 입원환자 35례에 대한 임상보고 조기 한방치료가 벨마비에서 House-Brackmann grade에 미치는 영향을 중심으로

양현주,주현아,백상철,박진수,홍석훈,Yang, Hyun-Ju,Joo, Hyun-A,Baek, Sang-Chul,Park, Jin-Soo,Hong, Seok-Hoon 대한한방안이비인후피부과학회 2011 한방안이비인후피부과학회지 Vol.24 No.3

Objective : This study was designed to evaluate the influence of time from onset of Bell's palsy until commenced Oriental medicine therapy on Bell's palsy. Methods : We investigated 35 cases of patients with peripheral facial palsy who visited Wonkwang University Oriental Hospital from 10th, December 2010 to 31st August, 2011 and classified them as time from onset of Bell's palsy until commenced Oriental medicine therapy. Time from onset of Bell's palsy until commenced Oriental medicine therapy of Group A was within 3 days. Group B was from 4 days to 8 days. We evaluate the treatment effect of each group by House-Brackmann grade before treatment and 1,3 week treatment. Results : 1. There was a statistical difference in period from onset of Bell's palsy until commenced Oriental medicine therapy between Group A and Group B. 2. There was a statistical difference after 1 week treatment in Group B. 3. There was a statistical difference after 3 weeks treatment in both Group A and B.3. After 3 week treatment, there was statistical significant difference in decreased value of House-Brackmann grade between Group A and Group B. Group A showed more recovery compared with Group B. Conclusions : 1. These results suggest that early oriental medicine treatment could be more effective in recovery of Bell's palsy. 2. Further studies will be required to identify the beneficial effect of early oriental medicine treatment in bell's palsy.

口眼喎斜에 대한 體鍼과 董氏鍼의 效果 比較

이채우,박인범,김상우,김홍기,허성웅,김철홍,윤현민 대한침구의학회 2004 대한침구의학회지 Vol.15 No.2

Objective : The aim of this research was to investigate the effect of acupuncture and the effect of Dong's acupuncture on Bell's palsy. Methods : We measured the facial palsy changes of the patients who were admitted for Bell's palsy in the Oriental Medical hospital of Dongeui medical center from 07-01-2003 to 09-30-2003. Bell's palsy patients were divided into two groups. One group(A group) was treated by acupuncture. The other group(B group) was treated by Dong's acupuncture. The effects of these treatment was evaluated by Yanagihara's unweighted grading system. Results : B group was marked more higher than A group in treatment outcome. we discovered that it is significant differences between two groups after 2 week. Conclusion : These results provided that A group is more effective than B group on . For clearly comparing the Effect of Acupuncture and Dong's Acupuncture on Bell's palsy, it is need more sample's number and more treatment's duration.

Genetic Polymorphism of Interleukin 10 Gene and Sasang Constitution in Bell's Palsy Patients

Kim, Jong-Won,Seo, Jung-Chul,Jung, Tae-Young The Physiological Society of Korean Medicine and T 2005 동의생리병리학회지 Vol.19 No.2

We hypothesized that the IL10 gene is important candidate in the development of Bell's palsy and specific genotypic and allelic variations should be associated with Bell's palsy in the Korean population. In this study, we assessed the SNP (single-nucleotide polymorphism) of IL10 in patients with Bell's palsy. 62 patients with Bell's palsy were selected from the subjects who visited for the Bell's palsy service of the department of acupuncture & moxibustion, college of Oriental Medicine, Daegu Haany University from May 2002 to May 2003. Pyrosequencing was performed for genetic analyses. There was no statistically significant genotypic distribution difference between control and Bell's palsy group And there was not statistically significant allelic frequency difference between control and Bell's palsy group. In this study the IL10 genotypemight not be the risk factor of Bell's palsy patients in Korean. studies will be necessary for the exact genetic markers. Establishment of more systemic approach and high quality of prospective cohorts will be necessary for the good prediction of genetic markers.

Comparative Review of the Correlation Between Electroneurography, Electromyography, Hematology Tests, or the Heart Rate Variability Test, with an Improvement in the Severity of Bell's Palsy Symptoms

Hwang, Ji-Min,Kim, Jun-Yeon,Kim, Ha-Na,Park, Kyeong-Ju,Jo, Min-Gi,Jang, Jun-Yeong,Nam, Sang-Soo,Goo, Bon Hyuk,Kim, Jung-Hyun,Ko, Min Jung,Chae, Sang Yeup,Park, Young Jae Korean AcupunctureMoxibustion Medicine Society 2021 대한침구의학회지 Vol.38 No.3

Background: In this retrospective study, we aimed to determine which diagnostic tests were associated with an improvement in Bell's palsy symptoms. Methods: There were 30 patients who visited Kyung Hee University Korean Medicine Hospital from April 1, 2017 to February 29, 2020, and who received East-West collaboration treatment for Bell's palsy. The tests included electroneurography (ENoG), electromyography (EMG), hematology, and heart rate variability (HRV) results which were used to determine if any test correlated with improvement of Bell's palsy symptoms. Results: The initial severity of symptoms did not correlate with the tests performed, with the exception of mean corpuscular hemoglobin concentration (p = 0.013). For both ENoG for oculi degeneration and mean EMG tests, the rate of nerve degeneration showed a significant negative correlation with the improvement of Bell's palsy symptoms. Amongst the HRV test indicators, the square root of the mean of the sum of the squares of differences between the adjacent normal R-R wave interval, the standard deviation of intervals, total power, very low frequency, and high frequency of the wave was negatively correlated with improvement of Bell's palsy symptoms. Similarly, glycosylated hemoglobin Type A1c (HbA1c) and erythrocyte sedimentation rate (ESR) showed a negative correlation with improvement of symptoms of Bell's palsy. With the exception of HbA1c and ESR, the remaining hematology test results showed no significant difference when comparing before and after treatment. Conclusion: ENoG, EMG, HRV test, HbA1c, and ESR negatively correlated with improvements in Bell's palsy symptoms and may determine the prognosis of Bell's palsy.

Y-system으로 관찰한 Bell's palsy에 미치는 수기요법의 영향에 관한 임상적 연구

이재흥(Jae Heung Lee),안훈모(Hun Mo Ahn),홍승철(Seung Cheol Hong),이은미(Eun Mi Lee) 대한의료기공학회 2015 醫療氣功 Vol.15 No.1

Objects : The purpose of this study is to investigate the effect of Su-Gi therapy for Bell`s palsy by using Y-system(Yanagihara's unweighted grading system). Methods : We investigated 25 patients with Bell's palsy who had visited in the M, H Korean medicine hospital in Gyeonggi Province from December 27th, 2010 to April 8th, 2015. The Su-Gi therapy was done by 1 times daily. And each patients had been treated more than 25 days. We evaluated the change of them by using Y-system. Results : 1. We investigated 25 patients with Bell's palsy. 80% of the patients were females(20 patients), 20% of the patients were male(5 patients). The average age of patients was 47±15.15. The average period of Adm. treatment was 64% of the patients(16 patients) have left facial palsy, 36% of the patients(9 patients) have right facial palsy. 2. The mean Y-system score before treatment was 17.80±6.2, and the mean score after 25th days treatment was 33.68±4.0. Changes in the mean Y-system Score for each case according to the treatment days was increased significantly. 3. The mean Y-system score after 4th days treatment had increased by an 1.24±2.7 as compared to before treatment, the score after 10th days treatment was 8.7±4.7, the score after 14th days treatment was 11.84±5.8, the score after 20th days treatment is 14.72±6.7, and the score after 25th days treatment was 15.88±6.9. Every score was significantly increased. Conclusions: 1. Su-Gi therapy can be defined that is mainly using the hands to touch or movement of the human body skin, meridians and acupuncture points, muscles, joints and so on. And that is the treatment to communicate and harmonize to the meridians and acupuncture points, and to prevent of diseases, and to keep health. 2. All names of An-Gyo, An-Ma, Jum-Hyul, Chu-Na, massage, and so on should be referred to as Su-Gi therapy. And that individual names are to be classified and separated as the type or method of Su-Gi therapy. 3. The results of the treatment of Hwidam's Su-Gi therapy for Bell's palsy by using Y-system were significant.