Dirk Arnold1,2, Jovanna Thielker1,3, Carsten M Klingner1,4, Wiebke Caren Puls1,3, Wengelawit Misikire1,3, Orlando Guntinas-Lichius1,3, Gerd Fabian Volk1,3. 1. Facial-Nerve-Center Jena, Jena University Hospital, 07740 Jena, Germany. 2. Institute of Zoology and Evolutionary Research, Friedrich-Schiller-University Jena, 07743 Jena, Germany. 3. Department of Otorhinolaryngology, Jena University Hospital, 07740 Jena, Germany. 4. Department of Neurology, Jena University Hospital, 07740 Jena, Germany.
Abstract
This article describes a first attempt to generate a standardized and safe selective surface electrostimulation (SES) protocol, including detailed instructions on electrode placement and stimulation parameter choice to obtain a selective stimulation of the denervated zygomaticus muscle (ZYG), without unwanted simultaneous activation of other ipsilateral or contralateral facial muscles. METHODS: Single pulse stimulation with biphasic triangular and rectangular waveforms and pulse widths (PW) of 1000, 500, 250, 100, 50, 25, 15, 10, 5, 2, 1 ms, at increasing amplitudes between 0.1 and 20 mA was performed. Stimulations delivered in trains were assessed at a PW of 50 ms only. The stimulation was considered successful exclusively if it drew the ipsilateral corner of the mouth upwards and outwards, without the simultaneous activation of other ipsilateral or contralateral facial muscles. I/t curves, accommodation quotient, rheobase, and chronaxie were regularly assessed over 1-year follow-up. RESULTS: 5 facial paralysis patients were assessed. Selective ZYG response in absence of discomfort and unselective contraction of other facial muscle was reproducibly obtained for all the assessed patients. The most effective results with single pulses were observed with PW ≥ 50 ms. The required amplitude was remarkably lower (≤5 mA vs. up to 15 mA) in freshly diagnosed (≤3 months) than in long-term facial paralysis patients (>5 years). Triangular was more effective than rectangular waveform, mostly because of the lower discomfort threshold of the latter. Delivery of trains of stimulation showed similar results to the single pulse setting, though lower amplitudes were necessary to achieve the selective ZYG response. Initial reinnervation signs could be detected effectively by needle-electromyography (n-EMG). CONCLUSION: It is possible to define stimulation parameters able to elicit an effective selective stimulation of a specific facial muscle, in our case, of the ZYG, without causing discomfort to the patient and without causing unwanted unspecific reactions of other ipsilateral and/or contralateral facial muscles. We observed that the SES success is strongly conditioned by the correct electrode placement, which ideally should exclusively interest the area of the target muscles and its immediate proximity.
This article describes a first attempt to generate a standardized and safe selective surface electrostimulation (SES) protocol, including detailed instructions on electrode placement and stimulation parameter choice to obtain a selective stimulation of the denervated zygomaticus muscle (ZYG), without unwanted simultaneous activation of other ipsilateral or contralateral facial muscles. METHODS: Single pulse stimulation with biphasic triangular and rectangular waveforms and pulse widths (PW) of 1000, 500, 250, 100, 50, 25, 15, 10, 5, 2, 1 ms, at increasing amplitudes between 0.1 and 20 mA was performed. Stimulations delivered in trains were assessed at a PW of 50 ms only. The stimulation was considered successful exclusively if it drew the ipsilateral corner of the mouth upwards and outwards, without the simultaneous activation of other ipsilateral or contralateral facial muscles. I/t curves, accommodation quotient, rheobase, and chronaxie were regularly assessed over 1-year follow-up. RESULTS: 5 facial paralysispatients were assessed. Selective ZYG response in absence of discomfort and unselective contraction of other facial muscle was reproducibly obtained for all the assessed patients. The most effective results with single pulses were observed with PW ≥ 50 ms. The required amplitude was remarkably lower (≤5 mA vs. up to 15 mA) in freshly diagnosed (≤3 months) than in long-term facial paralysispatients (>5 years). Triangular was more effective than rectangular waveform, mostly because of the lower discomfort threshold of the latter. Delivery of trains of stimulation showed similar results to the single pulse setting, though lower amplitudes were necessary to achieve the selective ZYG response. Initial reinnervation signs could be detected effectively by needle-electromyography (n-EMG). CONCLUSION: It is possible to define stimulation parameters able to elicit an effective selective stimulation of a specific facial muscle, in our case, of the ZYG, without causing discomfort to the patient and without causing unwanted unspecific reactions of other ipsilateral and/or contralateral facial muscles. We observed that the SES success is strongly conditioned by the correct electrode placement, which ideally should exclusively interest the area of the target muscles and its immediate proximity.
Authors: Helmut Kern; Cristian Hofer; Stefan Loefler; Sandra Zampieri; Paolo Gargiulo; Alfonc Baba; Andrea Marcante; Francesco Piccione; Amber Pond; Ugo Carraro Journal: Neurol Res Date: 2017-04-13 Impact factor: 2.448
Authors: John R de Almeida; Gordon H Guyatt; Sachin Sud; Joanne Dorion; Michael D Hill; Michael R Kolber; Jane Lea; Sylvia Loong Reg; Balvinder K Somogyi; Brian D Westerberg; Chris White; Joseph M Chen Journal: CMAJ Date: 2014-06-16 Impact factor: 8.262
Authors: Ashraf S Gorgey; Refka E Khalil; Malak Alrubaye; Ranjodh Gill; Jeannie Rivers; Lance L Goetz; David X Cifu; Teodoro Castillo; Deborah Caruso; Timothy D Lavis; Edward J Lesnefsky; Christopher C Cardozo; Robert A Adler Journal: BMJ Open Date: 2022-10-05 Impact factor: 3.006