Selective zygomaticus muscle activation by ball electrodes in synkinetically reinnervated patients after facial paralysis
IntroductionAlthough many different treatments were developed for facial palsy, only a few therapeutic options are available for facial synkinesis. Electrical stimulation of specific muscles via implants could be useful in restoring facial symmetry in synkinetic patients. A challenge in developing s...
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Frontiers Media S.A.
2023-10-01
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| Series: | Frontiers in Rehabilitation Sciences |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fresc.2023.1205154/full |
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| author | Dirk Arnold Dirk Arnold Jovanna Thielker Jovanna Thielker Carsten M. Klingner Carsten M. Klingner Carsten M. Klingner Orlando Guntinas-Lichius Orlando Guntinas-Lichius Orlando Guntinas-Lichius Gerd Fabian Volk Gerd Fabian Volk Gerd Fabian Volk |
| author_facet | Dirk Arnold Dirk Arnold Jovanna Thielker Jovanna Thielker Carsten M. Klingner Carsten M. Klingner Carsten M. Klingner Orlando Guntinas-Lichius Orlando Guntinas-Lichius Orlando Guntinas-Lichius Gerd Fabian Volk Gerd Fabian Volk Gerd Fabian Volk |
| author_sort | Dirk Arnold |
| collection | DOAJ |
| description | IntroductionAlthough many different treatments were developed for facial palsy, only a few therapeutic options are available for facial synkinesis. Electrical stimulation of specific muscles via implants could be useful in restoring facial symmetry in synkinetic patients. A challenge in developing stimulation devices is finding the right stimulation location, type, and amplitude. This work assesses the ability to selectively stimulate the zygomaticus muscle (ZYG) in patients with oral-ocular synkinesis to elicit a visually detectable response of the ipsilateral corner of the mouth (COM), without causing a reaction of the orbicularis oculi muscle (OOM). We aimed to assess how close to the COM the stimulation should be delivered in order to be selective.MethodsA total of 10 patients (eight females, two males) were enrolled. Facial function was graded according to the Sunnybrook facial grading system. Needle EMG was used to test the activities of the muscles, during volitional and “unintended” movements, and the degree of synkinesis of the ZYG and OOM. Two ball electrodes connected to an external stimulator were placed on the paretic ZYG, as close as possible to the COM.ResultsIndependent of the waveform with which the stimulation was presented, a selective ZYG response was observed within 4.5 cm of the horizontal plane and 3 cm of the vertical plane of the COM. When the distance between the electrodes was kept to ≤2 cm, the amplitude necessary to trigger a response ranged between 3 and 6 mA when the stimulation was delivered with triangular pulses and between 2.5 and 3.5 mA for rectangular pulses. The required amplitude did not seem to be dependent on the applied phase duration (PD), as long as the PD was ≥5 ms.ConclusionOur results show that selective stimulation of the ZYG presenting synkinetic ZYG–OOM reinnervation can be achieved using a broad PD range (25–1,000 ms) and an average amplitude ≤6 mA, which may be further decreased to 3.5 mA if the stimulation is delivered via rectangular rather than triangular waves. The most comfortable and effective results were observed with PDs between 50 and 250 ms, suggesting that this range should be selected in future studies.Clinical Trial Registration[https://drks.de/search/de/trial/DRKS00019992], identifier (DRKS00019992). |
| first_indexed | 2024-03-11T18:18:42Z |
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| last_indexed | 2024-03-11T18:18:42Z |
| publishDate | 2023-10-01 |
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| spelling | doaj.art-fb9105c64c0a4761ad08c1fd5886bf092023-10-16T05:15:48ZengFrontiers Media S.A.Frontiers in Rehabilitation Sciences2673-68612023-10-01410.3389/fresc.2023.12051541205154Selective zygomaticus muscle activation by ball electrodes in synkinetically reinnervated patients after facial paralysisDirk Arnold0Dirk Arnold1Jovanna Thielker2Jovanna Thielker3Carsten M. Klingner4Carsten M. Klingner5Carsten M. Klingner6Orlando Guntinas-Lichius7Orlando Guntinas-Lichius8Orlando Guntinas-Lichius9Gerd Fabian Volk10Gerd Fabian Volk11Gerd Fabian Volk12Department of Otorhinolaryngology, Jena University Hospital, Jena, GermanyFacial-Nerve-Center Jena, Jena University Hospital, Jena, GermanyDepartment of Otorhinolaryngology, Jena University Hospital, Jena, GermanyFacial-Nerve-Center Jena, Jena University Hospital, Jena, GermanyFacial-Nerve-Center Jena, Jena University Hospital, Jena, GermanyDepartment of Neurology, Jena University Hospital, Jena, GermanyCenter for Rare Diseases, Jena University Hospital, Jena, GermanyDepartment of Otorhinolaryngology, Jena University Hospital, Jena, GermanyFacial-Nerve-Center Jena, Jena University Hospital, Jena, GermanyCenter for Rare Diseases, Jena University Hospital, Jena, GermanyDepartment of Otorhinolaryngology, Jena University Hospital, Jena, GermanyFacial-Nerve-Center Jena, Jena University Hospital, Jena, GermanyCenter for Rare Diseases, Jena University Hospital, Jena, GermanyIntroductionAlthough many different treatments were developed for facial palsy, only a few therapeutic options are available for facial synkinesis. Electrical stimulation of specific muscles via implants could be useful in restoring facial symmetry in synkinetic patients. A challenge in developing stimulation devices is finding the right stimulation location, type, and amplitude. This work assesses the ability to selectively stimulate the zygomaticus muscle (ZYG) in patients with oral-ocular synkinesis to elicit a visually detectable response of the ipsilateral corner of the mouth (COM), without causing a reaction of the orbicularis oculi muscle (OOM). We aimed to assess how close to the COM the stimulation should be delivered in order to be selective.MethodsA total of 10 patients (eight females, two males) were enrolled. Facial function was graded according to the Sunnybrook facial grading system. Needle EMG was used to test the activities of the muscles, during volitional and “unintended” movements, and the degree of synkinesis of the ZYG and OOM. Two ball electrodes connected to an external stimulator were placed on the paretic ZYG, as close as possible to the COM.ResultsIndependent of the waveform with which the stimulation was presented, a selective ZYG response was observed within 4.5 cm of the horizontal plane and 3 cm of the vertical plane of the COM. When the distance between the electrodes was kept to ≤2 cm, the amplitude necessary to trigger a response ranged between 3 and 6 mA when the stimulation was delivered with triangular pulses and between 2.5 and 3.5 mA for rectangular pulses. The required amplitude did not seem to be dependent on the applied phase duration (PD), as long as the PD was ≥5 ms.ConclusionOur results show that selective stimulation of the ZYG presenting synkinetic ZYG–OOM reinnervation can be achieved using a broad PD range (25–1,000 ms) and an average amplitude ≤6 mA, which may be further decreased to 3.5 mA if the stimulation is delivered via rectangular rather than triangular waves. The most comfortable and effective results were observed with PDs between 50 and 250 ms, suggesting that this range should be selected in future studies.Clinical Trial Registration[https://drks.de/search/de/trial/DRKS00019992], identifier (DRKS00019992).https://www.frontiersin.org/articles/10.3389/fresc.2023.1205154/fullelectrical stimulationsurface electrodesfacial paralysisfacial palsyzygomaticus musclemuscle atrophy |
| spellingShingle | Dirk Arnold Dirk Arnold Jovanna Thielker Jovanna Thielker Carsten M. Klingner Carsten M. Klingner Carsten M. Klingner Orlando Guntinas-Lichius Orlando Guntinas-Lichius Orlando Guntinas-Lichius Gerd Fabian Volk Gerd Fabian Volk Gerd Fabian Volk Selective zygomaticus muscle activation by ball electrodes in synkinetically reinnervated patients after facial paralysis Frontiers in Rehabilitation Sciences electrical stimulation surface electrodes facial paralysis facial palsy zygomaticus muscle muscle atrophy |
| title | Selective zygomaticus muscle activation by ball electrodes in synkinetically reinnervated patients after facial paralysis |
| title_full | Selective zygomaticus muscle activation by ball electrodes in synkinetically reinnervated patients after facial paralysis |
| title_fullStr | Selective zygomaticus muscle activation by ball electrodes in synkinetically reinnervated patients after facial paralysis |
| title_full_unstemmed | Selective zygomaticus muscle activation by ball electrodes in synkinetically reinnervated patients after facial paralysis |
| title_short | Selective zygomaticus muscle activation by ball electrodes in synkinetically reinnervated patients after facial paralysis |
| title_sort | selective zygomaticus muscle activation by ball electrodes in synkinetically reinnervated patients after facial paralysis |
| topic | electrical stimulation surface electrodes facial paralysis facial palsy zygomaticus muscle muscle atrophy |
| url | https://www.frontiersin.org/articles/10.3389/fresc.2023.1205154/full |
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