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Antonio Currà - One of the best experts on this subject based on the ideXlab platform.
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shortened cortical silent period in Facial Muscles of patients with migraine
Pain, 2007Co-Authors: Antonio Currà, Francesco Pierelli, Gianluca Coppola, Piero Barbanti, M G Buzzi, F Galeotti, Mariano Serrao, A Truini, Carlo Casali, Flavia PauriAbstract:Despite intensive neurophysiological research, evidence is lacking to show whether abnormal cortical excitability in migraine reflects a primary cortical disturbance or reduced control by thalamo-cortical loops. One way to contribute to the scientific discussion on this topic is to deliver transcranial magnetic stimulation (TMS) and test the cortical silent period (SP) recorded in Facial Muscles. The Facial-muscle SP is a purely cortical phenomenon that reflects the excitability of inhibitory interneurons, and can disclose changes in cortical inhibition even in patients without documented primary lesions of the motor cortices. To test the interictal excitability of cortical motor inhibitory interneurons in migraine, we investigated the Facial-SP in patients with migraine with and without aura between attacks. In 26 patients and 15 age-matched controls, high-intensity magnetic stimuli were delivered with a round coil centered at the vertex during a maximal muscle contraction. Electromyographic responses were recorded from surface electrodes placed over the subjects' perioral Muscles. Facial SPs were significantly shorter in patients than in controls. The SP shortening provides neurophysiological evidence showing hypoexcitability of cortical inhibitory neurons in patients with migraine between attacks. Despite a possible primary deficit of cortical inhibitory interneurons in migraine, we favor the interpretation of a secondary disfacilitation by hypoactive thalamo-cortical loops. Based on this interpretation, the interictal reduced cortical inhibition documented by the shortened SP could be considered the motor counterpart of the reduced preactivation excitability level in the sensory cortices purported to explain why cortical evoked responses habituate poorly in patients with migraine.
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Shortened cortical silent period in Facial Muscles of patients with cranial dystonia
Neurology, 2000Co-Authors: Antonio Currà, Giorgio Cruccu, Alfredo Berardelli, A. Romaniello, M. ManfrediAbstract:Objective: To study the cortical silent period (SP) in the orbicularis oculi and perioral Muscles in 23 patients with cranial dystonia and 10 age-matched control subjects. Methods: High-intensity magnetic stimuli were delivered with a round coil centered at the vertex during a maximal muscle contraction. Electromyographic (EMG) responses were recorded from surface electrodes placed over the orbicularis oculi and perioral Muscles. Results: SPs elicited in upper and lower Facial Muscles had a similar duration. Facial muscle SPs were significantly shorter in patients than in control subjects. Patients with blepharospasm plus oromandibular dystonia had shorter SPs than patients with blepharospasm alone. Although patients’ recordings showed reduced voluntary and evoked EMG activity, neither activities correlated with the duration of the SP. Conclusions: Silent period (SP) shortening depends neither on the level of electromyographic activity nor on segmentary mechanisms. The shortened SP in Facial Muscles reflects hypoexcitability of cortical inhibitory neurons in cranial dystonia.
Gerd Fabian Volk - One of the best experts on this subject based on the ideXlab platform.
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can mri quantify the volume changes of denervated Facial Muscles
European Journal of Translational Myology, 2020Co-Authors: V Mastryukova, Orlando Guntinaslichius, Dirk Arnold, Daniel Gullmar, Gerd Fabian VolkAbstract:Could manual segmentation of magnetic resonance images be used to quantify the effects of transcutaneous electrostimulation and reinnervation of denervated Facial muscle? Five patients with unilateral Facial paralysis were scanned during the study while receiving a daily surface electrostimulation of the paralytic cheek region, but also after reinnervation. Their Facial Muscles were identified in 3D (coronal, sagittal, and axial) and segmented in magnetic resonance imaging (MRI) data for in total 28 time points over the 12 months of study. A non-significant trend of increasing muscle volume were detected after reinnervation. MRI is a valuable technique in the Facial paralysis research.
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Ultrasound echomyography of Facial Muscles in diagnosis and follow-up of Facial palsy in children
European Journal of Paediatric Neurology, 2016Co-Authors: Maik Sauer, Orlando Guntinas-lichius, Gerd Fabian VolkAbstract:Abstract Background Ultrasonography is a reliable, non-invasive and painless tool for quantitative assessment of the static and dynamic changes of the Facial Muscles in adult patients with Facial palsy. Therefore it would also be worthwhile to establish the method for quantitative analysis of Facial Muscles in children with Facial palsy to improve and expand the diagnostics for paediatric Facial palsy. Methods Eight children, aged 1–18 years, with Facial palsy of different aetiology were scanned and their ultrasound-images analysed. Bilateral scans of the frontal, orbicularis oculi, zygomaticus major, orbicularis oris, depressor anguli oris, depressor labii inferioris, and mentalis muscle were performed at rest and if possible during contraction. Muscle cross-section area, muscle thickness and echo intensity were measured. Results All Muscles of our investigation protocol for adults could also be reliably identified in children. On the paralyzed side of the face a reduction of muscle size in rest and contraction and higher echo intensity could be convincingly detected. Based on these observations, we were able to make well-founded treatment decisions and avoid painful electrophysiological examinations. Conclusion Ultrasonography of Facial Muscles is also feasible in children and facilitates diagnostics in children with Facial palsy.
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Correlation between electromyography and quantitative ultrasonography of Facial Muscles in patients with Facial palsy.
Muscle & Nerve, 2016Co-Authors: Gerd Fabian Volk, Christian Leier, Orlando Guntinas-lichiusAbstract:INTRODUCTION: In this study we correlated results of ultrasonographic muscle thickness and contractility with Facial electromyography (EMG) in patients with unilateral peripheral acute or chronic Facial palsy. METHODS: Two hundred twenty measurements of 4 Facial Muscles (frontalis, orbicularis oculi, zygomaticus, and orbicularis oris) were performed in 44 patients. RESULTS: Facial muscle thickness at rest and during muscle contraction correlated best with EMG insertional activity, and Facial muscle contractility correlated with EMG voluntary activity. The correlation was much higher at >14 days after onset of Facial palsy. The orbicularis oris, followed by the frontalis muscle, showed the best correlation between ultrasound and EMG. CONCLUSIONS: Quantitative ultrasound of Facial Muscles helps confirm the results of Facial EMG and is of particular additional value in the first 14 days after onset when the reliability of EMG is low.
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quantitative magnetic resonance imaging volumetry of Facial Muscles in healthy patients with Facial palsy
Plastic and reconstructive surgery. Global open, 2014Co-Authors: Gerd Fabian Volk, Inna Karamyan, Carsten M Klingner, Jurgen R Reichenbach, Orlando GuntinaslichiusAbstract:Lower motor cranial nerve dysfunction has an effect on the target Muscles, typically leading to immediate flaccid paresis or paralysis and atrophy with fatty infiltration if the innervating cranial nerve is damaged.1 This effect is permanent if no reinnervation takes place or may lead to defective healing if the nerve damage is degenerative with spontaneous nerve regeneration or after nerve reconstruction surgery.2 Morphologically, the result of cranial nerve dysfunction is an alteration of the bulk of the target Muscles, a decreased or increased muscle tone, and a change of the muscle position. Involvement of adjacent and functionally associated Muscles with innervation by other nerves may occur. The magnetic resonance imaging (MRI) signal, computed tomography (CT) attenuation, and contrast medium enhancement are also affected.1 Facial palsy is the most frequent cranial nerve lesion.2,3 Case reports or small case series focusing on some exemplary Facial Muscles have demonstrated that CT can show qualitatively the consequences of end-stage appearance of denervation, like severe atrophy, asymmetrical muscle size, or fatty infiltration.4 On the other hand, MRI seems to facilitate depiction of the progressive evolution from an acute phase to a subacute and then to a chronic phase of Facial nerve damage by delineating asymmetrical decreases in affected muscle volume, fatty infiltration of the involved muscle group, and variable signal intensity changes, including both T2 prolongation and postcontrast enhancement.5 Detection of pronounced preoperative MRI Facial muscle asymmetry has been shown to predict a poorer functional outcome of Facial nerve reconstruction.6 So far, quantitative assessment of Facial musculature in patients has been restricted to selected Muscles like the orbicularis oculi, orbicularis oris, and the buccinator muscle in myasthenia gravis patients,7,8 Facial Muscles around the lips to support cranioFacial surgery,9 and the procerus after botulinum toxin injection.10 Furthermore, 3-dimensional (3D) reconstructions have not been performed in patients and have been restricted in healthy volunteers to only a few Facial Muscles.9,11,12 In this pilot study, we report on first quantitative MRI data of Facial muscle volumes after 3D reconstruction for 13 mimic Muscles and additionally for 2 chewing Muscles as controls innervated by the motor trigeminal nerve in 10 healthy volunteers. Additionally, first qualitative data are presented for 5 patients with different types of acute and chronic peripheral Facial palsy.
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Quantitative ultrasonography of Facial Muscles in patients with chronic Facial palsy.
Muscle & Nerve, 2014Co-Authors: Gerd Fabian Volk, Martin Pohlmann, Mira Finkensieper, Maik Sauer, Orlando Guntinas-lichiusAbstract:Introduction: In this study we introduce quantitative Facial muscle ultrasound as a diagnostic tool for patients with chronic unilateral Facial palsy. Methods: Muscle area, thickness, and echo intensity of 6 Facial Muscles (frontalis, orbicularis oculi, orbicularis oris, depressor anguli oris, depressor labii inferioris, and mentalis) and of 2 chewing Muscles (temporalis and masseter, as controls) were measured in 20 patients with chronic Facial palsy. Results: Aside from 1, all Facial Muscles were significantly smaller on the paralyzed side. With exception of frontalis and orbicularis oculi Muscles, all other Facial Muscles showed significantly higher echo intensity on the affected side. Muscle size and echo intensity of the chewing Muscles showed no side-to-side asymmetry. Conclusions: Quantitative ultrasound of Facial Muscles helps to better characterize their status in patients with chronic Facial palsy in the phase of denervation and during regeneration. Muscle Nerve 50: 358–365, 2014
Orlando Guntinaslichius - One of the best experts on this subject based on the ideXlab platform.
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can mri quantify the volume changes of denervated Facial Muscles
European Journal of Translational Myology, 2020Co-Authors: V Mastryukova, Orlando Guntinaslichius, Dirk Arnold, Daniel Gullmar, Gerd Fabian VolkAbstract:Could manual segmentation of magnetic resonance images be used to quantify the effects of transcutaneous electrostimulation and reinnervation of denervated Facial muscle? Five patients with unilateral Facial paralysis were scanned during the study while receiving a daily surface electrostimulation of the paralytic cheek region, but also after reinnervation. Their Facial Muscles were identified in 3D (coronal, sagittal, and axial) and segmented in magnetic resonance imaging (MRI) data for in total 28 time points over the 12 months of study. A non-significant trend of increasing muscle volume were detected after reinnervation. MRI is a valuable technique in the Facial paralysis research.
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quantitative magnetic resonance imaging volumetry of Facial Muscles in healthy patients with Facial palsy
Plastic and reconstructive surgery. Global open, 2014Co-Authors: Gerd Fabian Volk, Inna Karamyan, Carsten M Klingner, Jurgen R Reichenbach, Orlando GuntinaslichiusAbstract:Lower motor cranial nerve dysfunction has an effect on the target Muscles, typically leading to immediate flaccid paresis or paralysis and atrophy with fatty infiltration if the innervating cranial nerve is damaged.1 This effect is permanent if no reinnervation takes place or may lead to defective healing if the nerve damage is degenerative with spontaneous nerve regeneration or after nerve reconstruction surgery.2 Morphologically, the result of cranial nerve dysfunction is an alteration of the bulk of the target Muscles, a decreased or increased muscle tone, and a change of the muscle position. Involvement of adjacent and functionally associated Muscles with innervation by other nerves may occur. The magnetic resonance imaging (MRI) signal, computed tomography (CT) attenuation, and contrast medium enhancement are also affected.1 Facial palsy is the most frequent cranial nerve lesion.2,3 Case reports or small case series focusing on some exemplary Facial Muscles have demonstrated that CT can show qualitatively the consequences of end-stage appearance of denervation, like severe atrophy, asymmetrical muscle size, or fatty infiltration.4 On the other hand, MRI seems to facilitate depiction of the progressive evolution from an acute phase to a subacute and then to a chronic phase of Facial nerve damage by delineating asymmetrical decreases in affected muscle volume, fatty infiltration of the involved muscle group, and variable signal intensity changes, including both T2 prolongation and postcontrast enhancement.5 Detection of pronounced preoperative MRI Facial muscle asymmetry has been shown to predict a poorer functional outcome of Facial nerve reconstruction.6 So far, quantitative assessment of Facial musculature in patients has been restricted to selected Muscles like the orbicularis oculi, orbicularis oris, and the buccinator muscle in myasthenia gravis patients,7,8 Facial Muscles around the lips to support cranioFacial surgery,9 and the procerus after botulinum toxin injection.10 Furthermore, 3-dimensional (3D) reconstructions have not been performed in patients and have been restricted in healthy volunteers to only a few Facial Muscles.9,11,12 In this pilot study, we report on first quantitative MRI data of Facial muscle volumes after 3D reconstruction for 13 mimic Muscles and additionally for 2 chewing Muscles as controls innervated by the motor trigeminal nerve in 10 healthy volunteers. Additionally, first qualitative data are presented for 5 patients with different types of acute and chronic peripheral Facial palsy.
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3d ultrasonography for evaluation of Facial Muscles in patients with chronic Facial palsy or defective healing a pilot study
BMC Ear Nose and Throat Disorders, 2014Co-Authors: Gerd Fabian Volk, Martin Pohlmann, Mira Finkensieper, Heather J. Chalmers, Orlando GuntinaslichiusAbstract:While standardized methods are established to examine the pathway from motorcortex to the peripheral nerve in patients with Facial palsy, a reliable method to evaluate the Facial Muscles in patients with long-term palsy for therapy planning is lacking. A 3D ultrasonographic (US) acquisition system driven by a motorized linear mover combined with conventional US probe was used to acquire 3D data sets of several Facial Muscles on both sides of the face in a healthy subject and seven patients with different types of unilateral degenerative Facial nerve lesions. The US results were correlated to the duration of palsy and the electromyography results. Consistent 3D US based volumetry through bilateral comparison was feasible for parts of the frontalis muscle, orbicularis oculi muscle, depressor anguli oris muscle, depressor labii inferioris muscle, and mentalis muscle. With the exception of the frontal muscle, the Facial Muscles volumes were much smaller on the palsy side (minimum: 3% for the depressor labii inferior muscle) than on the healthy side in patients with severe Facial nerve lesion. In contrast, the frontal Muscles did not show a side difference. In the two patients with defective healing after spontaneous regeneration a decrease in muscle volume was not seen. Synkinesis and hyperkinesis was even more correlated to muscle hypertrophy on the palsy compared with the healthy side. 3D ultrasonography seems to be a promising tool for regional and quantitative evaluation of Facial Muscles in patients with Facial palsy receiving a Facial reconstructive surgery or conservative treatment.
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manual stimulation of Facial Muscles improves functional recovery after hypoglossal Facial anastomosis and interpositional nerve grafting of the Facial nerve in adult rats
Neurobiology of Disease, 2007Co-Authors: Orlando Guntinaslichius, Gregor Hundeshagen, Thomas Paling, Michael Streppel, Maria Grosheva, Andrey Irintchev, Emmanouil Skouras, Athanasia Alvanou, Srebrina K Angelova, Stefanie KuertenAbstract:The Facial nerve in humans is often prone to injuries requiring surgical intervention. In the best case, nerve reconstruction is achieved by a Facial-Facial anastomosis (FFA), i.e. suture of the proximal and distal stumps of the severed Facial nerve. Although a method of choice, FFA rarely leads to a satisfactory functional recovery. We have recently devised and validated, in an established experimental paradigm in rats, a novel strategy to improve the outcome of FFA by daily manual stimulation (MS) of Facial Muscles. This treatment results in full recovery of Facial movements (whisking) and is achieved by reducing the proportion of functionally detrimental poly-innervated motor end-plates. Here we asked whether MS could also be beneficial after two other commonly used surgical methods of clinical Facial nerve reconstruction namely hypoglossal-Facial anastomosis (HFA) and interpositional nerve grafting (IPNG) which, however, seem to have a poorer outcome compared to FFA. Compared to FFA, daily MS for 2 months after HFA and IPGN did not completely restore function but, nevertheless, significantly improved the amplitude of whisker movements by 50% compared with untreated animals. Functional improvement was associated with a reduction in the proportion of polyinnervated end-plates. MS did not reduce the extent of axonal branching at the lesion site nor the subsequent misdirected axonal regrowth to inappropriate targets. Our data show that a simple approach leading to improved quality of muscle fiber reinnervation is functionally beneficial after different types of clinically relevant surgical interventions.
Orlando Guntinas-lichius - One of the best experts on this subject based on the ideXlab platform.
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Ultrasound echomyography of Facial Muscles in diagnosis and follow-up of Facial palsy in children
European Journal of Paediatric Neurology, 2016Co-Authors: Maik Sauer, Orlando Guntinas-lichius, Gerd Fabian VolkAbstract:Abstract Background Ultrasonography is a reliable, non-invasive and painless tool for quantitative assessment of the static and dynamic changes of the Facial Muscles in adult patients with Facial palsy. Therefore it would also be worthwhile to establish the method for quantitative analysis of Facial Muscles in children with Facial palsy to improve and expand the diagnostics for paediatric Facial palsy. Methods Eight children, aged 1–18 years, with Facial palsy of different aetiology were scanned and their ultrasound-images analysed. Bilateral scans of the frontal, orbicularis oculi, zygomaticus major, orbicularis oris, depressor anguli oris, depressor labii inferioris, and mentalis muscle were performed at rest and if possible during contraction. Muscle cross-section area, muscle thickness and echo intensity were measured. Results All Muscles of our investigation protocol for adults could also be reliably identified in children. On the paralyzed side of the face a reduction of muscle size in rest and contraction and higher echo intensity could be convincingly detected. Based on these observations, we were able to make well-founded treatment decisions and avoid painful electrophysiological examinations. Conclusion Ultrasonography of Facial Muscles is also feasible in children and facilitates diagnostics in children with Facial palsy.
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Correlation between electromyography and quantitative ultrasonography of Facial Muscles in patients with Facial palsy.
Muscle & Nerve, 2016Co-Authors: Gerd Fabian Volk, Christian Leier, Orlando Guntinas-lichiusAbstract:INTRODUCTION: In this study we correlated results of ultrasonographic muscle thickness and contractility with Facial electromyography (EMG) in patients with unilateral peripheral acute or chronic Facial palsy. METHODS: Two hundred twenty measurements of 4 Facial Muscles (frontalis, orbicularis oculi, zygomaticus, and orbicularis oris) were performed in 44 patients. RESULTS: Facial muscle thickness at rest and during muscle contraction correlated best with EMG insertional activity, and Facial muscle contractility correlated with EMG voluntary activity. The correlation was much higher at >14 days after onset of Facial palsy. The orbicularis oris, followed by the frontalis muscle, showed the best correlation between ultrasound and EMG. CONCLUSIONS: Quantitative ultrasound of Facial Muscles helps confirm the results of Facial EMG and is of particular additional value in the first 14 days after onset when the reliability of EMG is low.
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Quantitative ultrasonography of Facial Muscles in patients with chronic Facial palsy.
Muscle & Nerve, 2014Co-Authors: Gerd Fabian Volk, Martin Pohlmann, Mira Finkensieper, Maik Sauer, Orlando Guntinas-lichiusAbstract:Introduction: In this study we introduce quantitative Facial muscle ultrasound as a diagnostic tool for patients with chronic unilateral Facial palsy. Methods: Muscle area, thickness, and echo intensity of 6 Facial Muscles (frontalis, orbicularis oculi, orbicularis oris, depressor anguli oris, depressor labii inferioris, and mentalis) and of 2 chewing Muscles (temporalis and masseter, as controls) were measured in 20 patients with chronic Facial palsy. Results: Aside from 1, all Facial Muscles were significantly smaller on the paralyzed side. With exception of frontalis and orbicularis oculi Muscles, all other Facial Muscles showed significantly higher echo intensity on the affected side. Muscle size and echo intensity of the chewing Muscles showed no side-to-side asymmetry. Conclusions: Quantitative ultrasound of Facial Muscles helps to better characterize their status in patients with chronic Facial palsy in the phase of denervation and during regeneration. Muscle Nerve 50: 358–365, 2014
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3D-Ultrasonography for evaluation of Facial Muscles in patients with chronic Facial palsy or defective healing: a pilot study
BMC Ear Nose and Throat Disorders, 2014Co-Authors: Gerd Fabian Volk, Martin Pohlmann, Mira Finkensieper, Heather J. Chalmers, Orlando Guntinas-lichiusAbstract:Background While standardized methods are established to examine the pathway from motorcortex to the peripheral nerve in patients with Facial palsy, a reliable method to evaluate the Facial Muscles in patients with long-term palsy for therapy planning is lacking. Methods A 3D ultrasonographic (US) acquisition system driven by a motorized linear mover combined with conventional US probe was used to acquire 3D data sets of several Facial Muscles on both sides of the face in a healthy subject and seven patients with different types of unilateral degenerative Facial nerve lesions. Results The US results were correlated to the duration of palsy and the electromyography results. Consistent 3D US based volumetry through bilateral comparison was feasible for parts of the frontalis muscle, orbicularis oculi muscle, depressor anguli oris muscle, depressor labii inferioris muscle, and mentalis muscle. With the exception of the frontal muscle, the Facial Muscles volumes were much smaller on the palsy side (minimum: 3% for the depressor labii inferior muscle) than on the healthy side in patients with severe Facial nerve lesion. In contrast, the frontal Muscles did not show a side difference. In the two patients with defective healing after spontaneous regeneration a decrease in muscle volume was not seen. Synkinesis and hyperkinesis was even more correlated to muscle hypertrophy on the palsy compared with the healthy side. Conclusion 3D ultrasonography seems to be a promising tool for regional and quantitative evaluation of Facial Muscles in patients with Facial palsy receiving a Facial reconstructive surgery or conservative treatment.
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Quantitative Magnetic Resonance Imaging Volumetry of Facial Muscles in Healthy Patients with Facial Palsy
Wolters Kluwer, 2014Co-Authors: Gerd F. Volk, Carsten M Klingner, Inna Karamyan, Jurgen R Reichenbach, Orlando Guntinas-lichiusAbstract:Background: Magnetic resonance imaging (MRI) has not yet been established systematically to detect structural muscular changes after Facial nerve lesion. The purpose of this pilot study was to investigate quantitative assessment of MRI muscle volume data for Facial Muscles. Methods: Ten healthy subjects and 5 patients with Facial palsy were recruited. Using manual or semiautomatic segmentation of 3T MRI, volume measurements were performed for the frontal, procerus, risorius, corrugator supercilii, orbicularis oculi, nasalis, zygomaticus major, zygomaticus minor, levator labii superioris, orbicularis oris, depressor anguli oris, depressor labii inferioris, and mentalis, as well as for the masseter and temporalis as masticatory Muscles for control. Results: All Muscles except the frontal (identification in 4/10 volunteers), procerus (4/10), risorius (6/10), and zygomaticus minor (8/10) were identified in all volunteers. Sex or age effects were not seen (all P > 0.05). There was no Facial asymmetry with exception of the zygomaticus major (larger on the left side; P = 0.012). The exploratory examination of 5 patients revealed considerably smaller muscle volumes on the palsy side 2 months after Facial injury. One patient with chronic palsy showed substantial muscle volume decrease, which also occurred in another patient with incomplete chronic palsy restricted to the involved Facial area. Facial nerve reconstruction led to mixed results of decreased but also increased muscle volumes on the palsy side compared with the healthy side. Conclusions: First systematic quantitative MRI volume measures of 5 different clinical presentations of Facial paralysis are provided
Flavia Pauri - One of the best experts on this subject based on the ideXlab platform.
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shortened cortical silent period in Facial Muscles of patients with migraine
Pain, 2007Co-Authors: Antonio Currà, Francesco Pierelli, Gianluca Coppola, Piero Barbanti, M G Buzzi, F Galeotti, Mariano Serrao, A Truini, Carlo Casali, Flavia PauriAbstract:Despite intensive neurophysiological research, evidence is lacking to show whether abnormal cortical excitability in migraine reflects a primary cortical disturbance or reduced control by thalamo-cortical loops. One way to contribute to the scientific discussion on this topic is to deliver transcranial magnetic stimulation (TMS) and test the cortical silent period (SP) recorded in Facial Muscles. The Facial-muscle SP is a purely cortical phenomenon that reflects the excitability of inhibitory interneurons, and can disclose changes in cortical inhibition even in patients without documented primary lesions of the motor cortices. To test the interictal excitability of cortical motor inhibitory interneurons in migraine, we investigated the Facial-SP in patients with migraine with and without aura between attacks. In 26 patients and 15 age-matched controls, high-intensity magnetic stimuli were delivered with a round coil centered at the vertex during a maximal muscle contraction. Electromyographic responses were recorded from surface electrodes placed over the subjects' perioral Muscles. Facial SPs were significantly shorter in patients than in controls. The SP shortening provides neurophysiological evidence showing hypoexcitability of cortical inhibitory neurons in patients with migraine between attacks. Despite a possible primary deficit of cortical inhibitory interneurons in migraine, we favor the interpretation of a secondary disfacilitation by hypoactive thalamo-cortical loops. Based on this interpretation, the interictal reduced cortical inhibition documented by the shortened SP could be considered the motor counterpart of the reduced preactivation excitability level in the sensory cortices purported to explain why cortical evoked responses habituate poorly in patients with migraine.
