Treatment and Medical Rehabilitation of Patients in the Early and Late Recovery Period After the Facial Nerve Paresis

by Orazalieva, A., Berdyeva, E. B., Ashirova, D.

Orazalieva A, Berdyeva EB, Ashirova D (2017). Treatment and Medical Rehabilitation of Patients in the Early and Late Recovery Period After the Facial Nerve Paresis. In Young Scientist USA, Vol. 9 (p. 46). Auburn, WA: Lulu Press.



 

The number of patients who have suffered peripheral paresis of the facial nerve has increased in recent years. Many papers are devoted to the treatment of these patients in an acute period, and due attention is not given to elimination of residual phenomena. Although it has been established that people of young and most working age are exposed to the facial nerve paresis, thus the treatment of these patients is not only medically but also socially important.

The pathogenesis of this disease is based on the level of lesion often leading to motor disorders of facial muscles and often to disability. The issue of treatment and social-labor rehabilitation of patients with the facial musculature paresis is relevant. To date, various methods of restorative and physiotherapeutic treatment have not been sufficiently developed and described. Complexity of restorative-compensatory therapy is the need to combine a variety of treatment methods (1). The nature and direction of restorative treatment are associated with timing of formation of motor disorders; it depends on prescription and etiology of the disease. In the opinion of the majority of authors, it is advisable to start a complex of rehabilitation measures in the initial and early periods after development of motor disorders (2). But there are no indications for the use of restorative therapy in various periods after paresis.

Published data on the treatment of patients who have suffered peripheral paresis of the facial nerve, at various resorts are few. Previously, Turkmen scientists (including neurologists and physiotherapists) have shown in a number of papers that the external application of Mollagara mud has a beneficial effect in treatment of patients with certain diseases of the nervous system and joints (3, 4).

The purpose of this paper was to study the resistance of Mollagara mud application in combination with other physical methods of treatment, in patients with motor disorders as a result of peripheral paresis of the facial nerve.

This scientific work was performed on the basis of a neurological hospital in the Medical Resort n.a. S. Niyazov. We observed 61 patients (52 men, 9 women) aged 15 to 60 years (graph 1). As a result of statistical processing it was found that more than half of the patients are young people of working age of 20-40 years (36 people).

 

 

Figure 1.

All patients suffered from the peripheral paresis of the facial nerve in the form of neuritis or neuropathy, depending on the etiology, followed by the development of motor disorders of mimic muscles. According to the etiologic factor, 36 patients with neuritis were divided as follows (Table 1).

Table 1. Etiological factors of the facial nerve neuritis

Etiology

The number of patients

% of patients

Hypothermia

15

41,6

Otitis

9

25

Tonsillitis

12

33,4

The remaining 25 patients had neuropathy with the etiological factors given in Table 2.

Table 2. Etiological factors of the facial nerve neuropathies

Etiology

The number of patients

% of patients

Hypertensive disease

10

40

Diabetes

7

28

Atherosclerosis

3

12

Combined

5

20

 

In terms of the prescription of the facial nerve paresis, the patients were subdivided: less than 3 months – 20 people, less than 6 months – 26 and less than a year – 15 people (graph 2).

Figure 2.

Most patients in the acute period were on treatment in various hospitals: therapeutic (46 people), neurological (15 people). In the acute period, these 46 patients, despite the fact that they were in other medical institutions, were consulted by a neuropathologist. This ensured the correct diagnosis and the required scope of specialized care. Patients complained at the admission on: the face asymmetry, difficulty of performing mimic movements, forced twitching of the face muscles at rest or while making movements, lacrimation or dryness of the eye, headaches of varying duration and intensity, often in the afternoon, change in taste and auditory sensations.

The following was observed in the neurological picture: peripheral paresis of the facial nerve on the side of its focus, a disorder of taste sensations in the front part of the tongue, reduced salivation, scope of movements in the extremities was full, tendon reflexes were caused D=S. In terms of severity of motor disorders: mild paresis was observed in 39 patients and strong paresis – in 22. Of these, 17 patients had pathological synkinesia of the facial muscles (eyebrowing was accompanied by teeth grin, and an attempt to grin teeth causes eyebrowing on the side of the lesion) and in 5 people – contracture of the affected muscles (narrowing of the palpebral fissure and strengthening of the nasolabial fold on the side of the lesion, graph 3).

Figure 3. Degrees of severity of motor disorders

 

All patients during paraclinical examinations, except for laboratory tests, were subjected to a craniogram, examination of an ophthalmologist and a psychiatrist's consultation. The craniogram of 27 patients showed an increase in the vascular pattern and indistinct signs of convolutional markings, while in the remaining patients no changes were noted. In the ophthalmological study, 21 patients showed angiodystrophic changes in the vessels of the eye fundus, in 5 patients – whitening of optic papillas, in 7 patients – diabetic retinopathy. In terms of the mental status, the majority of patients showed: weakening of attention, instability of active attention, memory loss and asthenodepressive reaction. Psychological observation was conducted to confirm the opinion of L.G. Stolyarova and G.R. Tkachyova that intact psyche is required for carrying out rehabilitation measures. It is impossible to carry out restorative treatment without the patient's persistent desire to overcome his defect. As a result, we also held the same opinion.

The complex treatment that we carried out included mud therapy, massage, physiotherapy and drug therapy. To carry out mud treatment, sulphide-silt mud of Mollagara was used, which contains various volatile compounds (hydrogen sulphide, methane, carbon dioxide and ammonia). According to the central production laboratory of the State Committee "Turkmen Geology" this feature of the composition of the Mollagara mud [5] is comparable to the bittern of the Dead Sea (Israel, Jordan), the Anapa estuaries (Krasnodar Territory), the muds of the resorts of Saki (Crimea); Albena, Burgas, Varna, Pomorie (Bulgaria). The mud treatment course consisted of 7-10 procedures with mud, which was used with preheating. Its constant temperature was 34 degrees, the procedure duration increased from 20 to 40 minutes. Mud applications were laid on the affected side of the face. All patients well tolerated this therapy in conjunction with the medication: Cavinton and Neuromidine. Cavinton drug was used according to the CALIPSO scheme: in the form of infusions 1-4 days by 25 mg, 5-7 days by 50 mg, then orally at a dose of 30 mg per day in order to improve cerebral circulation by providing collateral circulation, since it has an anti-vasoconstrictor effect [6]. In addition, it refers to erythrocyte antiplatelet agents with vasodilatory action, thereby affecting deformability and elasticity of erythrocytes, contributing to the treatment of etiologic diseases in neuropathies. For direct stimulating effect on the impulse conduction on nerve fibers, interneuronal and neuromuscular synapses of the central and peripheral nervous system, we used Neuromidine of 20 mg 2 times a day for 2 weeks. Its pharmacological action is based on a combination of two mechanisms: blockade of the potassium channels of the membrane of neurons and muscle cells; reversible inhibition of cholinesterase in synopses [7]. In addition, an indispensable component of our rehabilitation complex was exercise therapy and massage.

As a result of the treatment, the majority of patients with mild paresis had no asymmetry of the face due to facial musculature paresis, in some patients muscle weakness retained or the asymmetry of the face was revealed slightly and only with mimic movements. At the same time, the headache diminished or disappeared in patients, the sleep normalized and the mood improved. Objective (pulse, blood pressure and body temperature) and subjective (ECG and REG) data did not reveal any significant changes before and after treatment.

The results were evaluated on the scale of "Criteria for the effectiveness of sanatorium-and-spa treatment". With a significant improvement, 23 people were discharged, with improvement – 35, without changes – 3 (graph 4).

Figure 4.

The study of the neuromotor apparatus by electromyography (EMG) was performed in all observed patients. Before and after treatment, bioelectrical activity was registered for symmetrical facial muscles by the application of skin electrodes.

Before treatment, for various functional conditions, a violation of electrogenesis was found in all patients. Thus, an increase in the bioelectrical activity of the initial background was found in 32 out of 61 patients, examined in the muscles of the diseased side (in 12 – type II of bioelectrical activity of 40-80 μV, in 19 – type II-b of 70-150 μV, in 1 – type III in the form of groups of volleys of oscillations). An increase in friendly bioelectrical activity was observed in 41 patients (in 8 – type I of bioelectric activity of 50-110 μV, in 21 – type II-b of 30-130 μV, and in 12 – type II-a of 40-80 μV). At the time of maximum reduction, in 18 patients, instead of the normal type I of bioelectric activity, changes in the qualitative nature of the examined muscles were recorded (4 patients had bioelectric silence – type I, 4 had rare potentials – type II of 10-60 μV, 6 had a decrease in biopotentials to activity of type II-b of 40-200 μV, and 4 had type 4-III). The remaining 43 patients had the first type of bioelectrical activity, but with a decrease in the height of biopotentials in the adductor muscles 100-2,000 μV and in the abductor muscles – 100-1500 μV in comparison with the healthy side.

These changes on EMG indicated a disorder in the innervation processes at all levels of the facial nerve. Qualitative changes with maximum activity indicated gross violations of motoneurons and predominance of inhibitory phenomena of neurons located around the lesion.

Improvement was noted in all patients after treatment with EMG. The initial bioelectrical activity was normalized in 25 people. In 7, it remained elevated, in 2 patients – type II-b, 30-40 μV, in 5 – type II, 40-70 μv. An increase in friendly bioelectric activity was observed in 19 patients, in 22 patients, it remained elevated. In 1 patient, bioelectrical activity was of type I, 8 μV, in 12 – type II-b, 10-60 μV, in 9 – type II-a, 30-40 μV. When studying bioelectrical activity with the maximum reduction, no patient had bioelectric silence and activity with rare type IIa oscillations. In 5 patients, the biopotentials were reduced to bioelectrical activity of type II-b and 30-100 μV. The remaining 56 patients showed a normal type I of bioelectrical activity with a difference in comparison with the healthy side of 50-600 μV.

This EMG study after the treatment indicated an improvement in motoneuron activity, apparently due to removal of inhibitory phenomena and other functional disorders in temporarily non-functioning cells, which was confirmed by the absence of qualitative disorders, an increase in the amplitude of biopotentials with maximum bioelectrical activity. Under the influence of combined treatment, there was a normalization of supra-segmental innervation, inhibition and excitation processes in those formations that participate in controlling the motor axons, which resulted in a decrease in excitability during tonic stress and at rest.

Thus, electromyography data confirm the beneficial effect of the selected complex treatment and indicate positive changes in the neurophysiological processes of different levels involved in restoration of impaired motor functions. Also, restorative treatment of residual phenomena of the facial nerve paresis with the complex that we applied with inclusion of Mollagara mud has a positive effect and can be recommended for practical use. In other words, the rich trace element composition of the Mollagara mud contributes to the treatment of diseases associated not just with the inflammatory process, but also with mineral metabolism disorder.

 

References

 

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