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Abstract
Bell’s palsy is the most frequent cranial mononeuropathy that accounts for 75 to 80 percent of all cases of facial palsy. It is an extremely frightening situation for patients as it can cause extreme stress due to obvious disfigurement of facial expression. Therefore, an accurate assessment of prognosis of facial palsy is useful for counseling of these patients and guiding further treatment. For decades, physicians have searched for prognostic tests of sufficient accuracy to serve this need. Although clinical assessment is essential, electrophysiological studies are also valuable in determining the extent of the neural damage. This study was designed to evaluate the prognostic value of conventional and quantitative electromyography in Bell’s palsy. Twenty Bell’s palsied patients were selected in this study. Clinical evaluation by House and Brackmann grading, facial nerve conduction study, conventional and quantitative electromyography were done to all patients both at onset (from 7 to 14 days) and at follow up (after 2 months). Fifteen healthy subjects were included as a control group.Depending on both electroneurography and conventional electromyography at baseline, axonal degeneration was found in 6 patients whereas demyelinating pathology was found in 14 patients. According to House and Brackmann grading system at follow up, patients were classified into 2 groups: Group (1): patients with satisfactory recovery (Grade I and Grade II) and Group (2): patients with unsatisfactory recovery (Grade III to Grade VI). Twenty five percent of patients had complete facial paralysis (facial nerve grade VI) at onset; all of them were included in group 2. Higher initial House and Brackmann grading had significant association with unsatisfactory recovery of Bell’s palsied patients. There was a significant difference of values of all parameters of facial nerve motor conduction study between both patient groups. Latency, amplitude and amplitude percentage were significantly correlated with the final outcome of patients. Abnormal rest potentials (fibrillations and positive sharp waves) in conventional electromyography were found in five/nine patients in group 2 at onset whereas in only one/eleven patients in group 1. Only these potentials were statistically associated with the final outcome of the studied patients. There was no statistically significant difference between the patients and the control group regarding all parameters of multi-motor unit action potential analysis in quantitative electromyography. Area and thickness parameters of multi-motor unit action potentials analysis were of significant differences between the group of patients with satisfactory recovery and those with unsatisfactory recovery and were significantly positively correlated with the final outcome of patients as well.