Neuromuscular retraining therapy combined with preceding botulinum toxin A injection for chronic facial paralysis

Abstract

Background

Neuromuscular retraining therapy (NMRT) is the central treatment for synkinesis. The efficacy of botulinum toxin type A (BTX-A) may be enhanced with the addition of physical therapy.

Objectives

To investigate the effects of NMRT combined with preceding BTX-A injection (NMRT-B) on facial synkinesis and asymmetry in chronic facial paralysis.

Materials and Methods

We recruited 99 patients with unilateral facial paralysis and no recovery for > 6 months who underwent NMRT-B for > 1 year. The patients were scheduled to receive NMRT after 1–2 weeks of BTX-A injection. We used a computer-based numerical scoring system to evaluate the facial functions. Primary, secondary, and final facial movement scores were evaluated before and after 1 year of treatment.

Results

Patients with chronic facial paralysis who underwent NMRT-B exhibited improved facial movement after 1 year of treatment. NMRT-B provided satisfactory control of synkinesis and improved the primary movements. The mean primary and final facial movement scores were significantly increased after treatment, while the mean secondary facial movement scores were significantly decreased.

Conclusions and significance

NMRT-B improved the final facial movement in patients with chronic facial paralysis and synkinesis, regardless of the degrees of facial synkinesis and asymmetry before treatment.

Chinese Abstract

背景：神经肌肉再训练疗法 (NMRT) 是面肌联动症的主要治疗方法。A 型肉毒杆菌毒素 (BTX-A) 的功效可以通过加入物理疗法来增强。

目的：研究 NMRT 联合前 BTX-A 注射 (NMRT-B)对慢性面瘫患者面肌联动和不对称性的效果。

材料和方法：我们招募了 99 名接受 NMRT-B 治疗一年多且6个多月未恢复的单侧面瘫患者。 患者根据部署在BTX-A 注射 1-2 周后接受 NMRT。 我们使用基于计算机的数字评分系统来评估面部功能。 在治疗之前和治疗一年后评估了初级、次级和最终面部运动评。

结果：接受 NMRT-B 的慢性面瘫患者在治疗 1 年后表现出面肌改善。 NMRT-B 导致了令人满意的面肌联动控制, 改善了初级面部运动。 治疗后平均主要和最终面部运动评分显著增加, 而平均次级面部运动评分显著下降。

结论和意义：NMRT-B改善了慢性面瘫和面肌联动患者的最终面部运动, 无论在治疗之前面肌联动和不对称的程度如何。

Keywords:

• Facial paralysis
• facial palsy
• neuromuscular retraining therapy
• botulinum toxin

Ethical approval

The Institutional Review Board of the Ilsan Paik Hospital, Inje University College of Medicine approved this study (2016-09-024). Written informed consent was obtained from all patients.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.