Optimal current intensity for supramaximal stimulation during electroneurography for facial palsy
Optimal current intensity for supramaximal stimulation during electroneurography for facial palsy
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DOI：
10.1016/j.anl.2020.09.020
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发表时间：
2021-04-25
影响因子：
1.7
通讯作者：
Kawata, Ryo
中科院分区：
文献类型：
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作者：
Ayani, Yusuke;Haginomori, Shin-Ichi;Kawata, Ryo
目的：目的：探讨面神经电描记术（ENoG）中最大刺激电流强度对面神经损伤的影响，方法：选择40例单侧面神经麻痹患者，其中Bell麻痹32例，Ramsay Hunt综合征7例，颞骨骨折1例。所有患者最初均接受静脉内类固醇注射治疗，并使用ENoG进行检查。分别在瘫痪侧和健侧测量口轮匝肌复合肌肉动作电位（CMAP）。使用两种记录方法（中线和标准方法），刺激电流强度从20 mA到50 mA每5 mA变化一次。结果：中线法和标准法均未观察到双侧CMAP有明显的饱和现象。从统计学上看，当使用中线记录方法时，健康侧的电流为35 mA及以上，麻痹侧为30 mA及以上，每侧无差异。另一方面，在健康侧的电流为35 mA及以上，和25 mA及以上的麻痹侧，导致在每一侧没有差异时，使用的标准recordingmethods.Conclusions：这些结果表明，至少35 mA的电流强度是需要实现超大刺激的健康侧的单侧面神经麻痹的患者。在临床上，为了简单或标准化的目的，如果双侧引入相同的电流强度用于ENoG测量，则采用40 mA（35 mA加10-20%）刺激将适合于超大刺激，同时认识到来自其他肌肉的伪影的潜在影响。(c)2020日本耳鼻喉科学会Elsevier B. V.出版，保留所有权利。
Objective: To determine the optimal current intensity for supramaximal stimulation during elec-troneurography (ENoG) for facial palsy.Methods: Forty patients with unilateral facial palsy (32 Bell's palsy, 7 Ramsay Hunt syndrome, and 1 temporal bone fracture) were enrolled. All patients were initially treated with intravenous steroid injections and examined using ENoG. Compound muscle action potentials (CMAPs) of the orbicularis oris muscle were measured on the paralyzed and healthy sides. Stimulation current intensity was varied every 5 mA from 20 mA to 50 mA using two recording methods (the midline and standard methods). The CMAPs of both sides were monitored to see whether they would saturate under the high current intensity stimulation or not.Results: No obvious saturation of CMAPs was observed in either side with the midline or standard methods. Statistically, a current of 35 mA and above in the healthy side, and 30 mA and above in the paralytic side, resulted in no difference to each side when using the midline recording method. On the other hand, a current of 35 mA and above in the healthy side, and 25 mA and above in the paralytic side, resulted in no difference to each side when using the standard recording method.Conclusions: These results indicate that a current intensity of at least 35 mA is required to achieve supramaximal stimulation on the healthy side in a patient with unilateral facial nerve palsy. Clinically, for simplicity or standardization purposes, if the same current intensity is intro-duced bilaterally for ENoG measurements, adopting 40 mA (35 mA plus 10-20%) stimulation would be appropriate for supramaximal stimulation, while being cognizant of the potential effects of artifacts from other muscles. (c) 2020 Oto-Rhino-Laryngological Society of Japan Inc. Published by Elsevier B.V. All rights reserved.