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Selective Surface Electrostimulation of the Denervated Zygomaticus Muscle

This article describes a first attempt to generate a standardized and safe selective surface electrostimulation (SES) protocol, including detailed instructions on electrode placement and stimulation parameter choice to obtain a selective stimulation of the denervated zygomaticus muscle (ZYG), withou...

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Autores principales: Arnold, Dirk, Thielker, Jovanna, Klingner, Carsten M., Puls, Wiebke Caren, Misikire, Wengelawit, Guntinas-Lichius, Orlando, Volk, Gerd Fabian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7912406/
https://www.ncbi.nlm.nih.gov/pubmed/33525522
http://dx.doi.org/10.3390/diagnostics11020188
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author Arnold, Dirk
Thielker, Jovanna
Klingner, Carsten M.
Puls, Wiebke Caren
Misikire, Wengelawit
Guntinas-Lichius, Orlando
Volk, Gerd Fabian
author_facet Arnold, Dirk
Thielker, Jovanna
Klingner, Carsten M.
Puls, Wiebke Caren
Misikire, Wengelawit
Guntinas-Lichius, Orlando
Volk, Gerd Fabian
author_sort Arnold, Dirk
collection PubMed
description This article describes a first attempt to generate a standardized and safe selective surface electrostimulation (SES) protocol, including detailed instructions on electrode placement and stimulation parameter choice to obtain a selective stimulation of the denervated zygomaticus muscle (ZYG), without unwanted simultaneous activation of other ipsilateral or contralateral facial muscles. Methods: Single pulse stimulation with biphasic triangular and rectangular waveforms and pulse widths (PW) of 1000, 500, 250, 100, 50, 25, 15, 10, 5, 2, 1 ms, at increasing amplitudes between 0.1 and 20 mA was performed. Stimulations delivered in trains were assessed at a PW of 50 ms only. The stimulation was considered successful exclusively if it drew the ipsilateral corner of the mouth upwards and outwards, without the simultaneous activation of other ipsilateral or contralateral facial muscles. I/t curves, accommodation quotient, rheobase, and chronaxie were regularly assessed over 1-year follow-up. Results: 5 facial paralysis patients were assessed. Selective ZYG response in absence of discomfort and unselective contraction of other facial muscle was reproducibly obtained for all the assessed patients. The most effective results with single pulses were observed with PW ≥ 50 ms. The required amplitude was remarkably lower (≤5 mA vs. up to 15 mA) in freshly diagnosed (≤3 months) than in long-term facial paralysis patients (>5 years). Triangular was more effective than rectangular waveform, mostly because of the lower discomfort threshold of the latter. Delivery of trains of stimulation showed similar results to the single pulse setting, though lower amplitudes were necessary to achieve the selective ZYG response. Initial reinnervation signs could be detected effectively by needle-electromyography (n-EMG). Conclusion: It is possible to define stimulation parameters able to elicit an effective selective stimulation of a specific facial muscle, in our case, of the ZYG, without causing discomfort to the patient and without causing unwanted unspecific reactions of other ipsilateral and/or contralateral facial muscles. We observed that the SES success is strongly conditioned by the correct electrode placement, which ideally should exclusively interest the area of the target muscles and its immediate proximity.
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spelling pubmed-79124062021-02-28 Selective Surface Electrostimulation of the Denervated Zygomaticus Muscle Arnold, Dirk Thielker, Jovanna Klingner, Carsten M. Puls, Wiebke Caren Misikire, Wengelawit Guntinas-Lichius, Orlando Volk, Gerd Fabian Diagnostics (Basel) Article This article describes a first attempt to generate a standardized and safe selective surface electrostimulation (SES) protocol, including detailed instructions on electrode placement and stimulation parameter choice to obtain a selective stimulation of the denervated zygomaticus muscle (ZYG), without unwanted simultaneous activation of other ipsilateral or contralateral facial muscles. Methods: Single pulse stimulation with biphasic triangular and rectangular waveforms and pulse widths (PW) of 1000, 500, 250, 100, 50, 25, 15, 10, 5, 2, 1 ms, at increasing amplitudes between 0.1 and 20 mA was performed. Stimulations delivered in trains were assessed at a PW of 50 ms only. The stimulation was considered successful exclusively if it drew the ipsilateral corner of the mouth upwards and outwards, without the simultaneous activation of other ipsilateral or contralateral facial muscles. I/t curves, accommodation quotient, rheobase, and chronaxie were regularly assessed over 1-year follow-up. Results: 5 facial paralysis patients were assessed. Selective ZYG response in absence of discomfort and unselective contraction of other facial muscle was reproducibly obtained for all the assessed patients. The most effective results with single pulses were observed with PW ≥ 50 ms. The required amplitude was remarkably lower (≤5 mA vs. up to 15 mA) in freshly diagnosed (≤3 months) than in long-term facial paralysis patients (>5 years). Triangular was more effective than rectangular waveform, mostly because of the lower discomfort threshold of the latter. Delivery of trains of stimulation showed similar results to the single pulse setting, though lower amplitudes were necessary to achieve the selective ZYG response. Initial reinnervation signs could be detected effectively by needle-electromyography (n-EMG). Conclusion: It is possible to define stimulation parameters able to elicit an effective selective stimulation of a specific facial muscle, in our case, of the ZYG, without causing discomfort to the patient and without causing unwanted unspecific reactions of other ipsilateral and/or contralateral facial muscles. We observed that the SES success is strongly conditioned by the correct electrode placement, which ideally should exclusively interest the area of the target muscles and its immediate proximity. MDPI 2021-01-28 /pmc/articles/PMC7912406/ /pubmed/33525522 http://dx.doi.org/10.3390/diagnostics11020188 Text en © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Arnold, Dirk
Thielker, Jovanna
Klingner, Carsten M.
Puls, Wiebke Caren
Misikire, Wengelawit
Guntinas-Lichius, Orlando
Volk, Gerd Fabian
Selective Surface Electrostimulation of the Denervated Zygomaticus Muscle
title Selective Surface Electrostimulation of the Denervated Zygomaticus Muscle
title_full Selective Surface Electrostimulation of the Denervated Zygomaticus Muscle
title_fullStr Selective Surface Electrostimulation of the Denervated Zygomaticus Muscle
title_full_unstemmed Selective Surface Electrostimulation of the Denervated Zygomaticus Muscle
title_short Selective Surface Electrostimulation of the Denervated Zygomaticus Muscle
title_sort selective surface electrostimulation of the denervated zygomaticus muscle
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7912406/
https://www.ncbi.nlm.nih.gov/pubmed/33525522
http://dx.doi.org/10.3390/diagnostics11020188
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