Yasemin. Biçer GÖMCELİ, G. Semiha KURT, Reha KURUOĞLU, Alev LEVENTOĞLU, Gülnihal KUTLU

The correlation of clinical signs with the CMAP index in bell's palsy

Amaç: Bell paralizisinin akut döneminde genellikle elektomyografik incelemeye başvurulur. Bu çalışmada klinik tutuluşun ağırlığının elektrofızyolojik bulgularla korelasyonu araştırıldı. Yöntem: Ocak 1999-Şubat 2001 tarihleri arasında Klinik Nörofızyoloji Laboratuarına başvuran,149 Bell paralizisi olgusunu retrospektif olarak inceledik. Her olguda House-Brackmann sistemine göre değerlendirilmiş olan yüz kaslarındaki güç kaybı kaydedildi. Hastalar lezyon şiddetine göre 2 gruba ayrıldı. House-Brackmann evre l-lll olarak değerlendirilen hastalar Grup !,evre IV-Vl olarak değerlendirilenler ise Grup 2 olarak tanımlandı. Sağlam ve paralitik taraflarda yapılan N.fasiyalis ramus zigomatikusa ait sinir iletim çalışmaları alındı. Daha sonra hasta tarafın birleşik kas aksiyon potansiyeli(BKAP) sağlam tarafa bölünerek BKAP indeksi elde edildi. Çıkan sonuç 100 ile çarpıldı. M. Frontalis ve orbikülaris akillide yapılan iğne elektromyografı (EMG) bulguları da değerlendirildi. Sonuçlar: House-Brackmann evresi arttıkça BKAP indeksi kûçülüyordu (Spearman r=-0.62, p=0.000). Buna karşın orbikülaris okuli kasında ölçülen terminal latans herhangi bir değişkenlik göstermiyordu (Spearman r=0.14, p= 0.111). Grup l Ie kıyaslandığında Grup 2 de BKAP amplitüdleri (t=4.70, p=0.000) ve indeksleri ft=5.26, p=0.000) anlamlı olarak küçüktü. Gruplar arasında fıbrillasyon potansiyelleri ve pozitif keskin dalgaların bulunması değişkenlik göstermiyorsa da (x2=0.03, p=0.86), grup 2 olgularında istemli motor ünite aksiyon potansiyeli (MUP) aktivitesinin izlenmemesi durumuyla daha sık karşılaşılıyordu (x2=33.0, p=0.000). Yorum: House-Brackmann klinik evreleme sistemi BKAP indeksiyle negatif korelasyon göstermekte olup, Bell paralizisinin akut dönemdeki şiddetinin tayininde iyi bir araçtır. Ancak altta yatan fızyopatolojik sürecin kesin olarak tanımlanabilmesi amacıyla bir EMG yapılması gereklidir.

Bell paralizisinde klinik bulguların BKAP indeksiyle korelasyonu

Purpose: Patients with Bell's palsy generally undergo an electromyographic examination during the acute stage of the disease. In this study, we investigated the correlation between the severity of clinical involvement and electrophysiological findings. Methods: We retrospectively evaluated the records of 149 Bell's palsy patients referred to the Laboratory of Clinical Neurophysiology between January 1999 and February 2001. The degree of facial weakness graded according to the House-Brackmann system was noted. Patients were divided into two groups according to the clinical severity of the lesion. Group 1 was composed of mildly affected patients of House-Brackmann grades I-lll. Group 2 consisted of severely affected cases assigned to House-Brackmann grades IV-Vl. Nerve conduction studies of the zygomatic branches of the facial nerves of the healthy and affected sides were recorded. A compound muscle action potential (CMAP) index was then calculated by dividing, the CMAP amplitude of the diseased side by that of the unaffected side. The result was multiplied by 100. Needle electromyography (EMG) findings of the frontalis and orbicularis oris muscles were also evaluated. Results: As the House-Brackmann grading increased, the CMAP index decreased (Spearman r=-0.62, p=0.000), but the terminal latency to the orbicularis oculi muscle remained unchanged (Spearman r=0.14, p=0.111). Compared to group 1, the CMAP amplitudes (t=4.70, p=0.000) and indices (t=5.26, p=0.000) were significantly reduced in group 2 patients. Although the presence of fibrillation potentials and positive sharp waves did not differ between the groups (x2=0.03, p=0.86), voluntary motor unit action potential (MUP) activity was more commonly absent in group 2 patients (x2=33.0, p=0.000). Conclusions: The House-Brackmann grading system shows a negative correlation with the CMAP index and is a useful tool in the assessment of the severity of Bell's palsy in the acute stage. However, an EMG examination should still be performed in order to accurately identify the underlying pathophysiology.

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