A COMPARISON OF TRANSCRANIAL MAGNETIC STIMULATION WITH ELECTRONEURONOGRAPHY AS A PREDICTIVE TEST IN PATIENTS WITH BELLS-PALSY

The aim of this study was to examine the neuronographic findings of el ectrical and transcranial magnetic stimulation of the facial nerve and to compare their ability to predict clinical recovery from idiopathic facial nerve palsy (Bell's palsy). Eighty-six patients were examined clinically and neurophysiologically immediately on presentation to Tam pere University Hospital. Electroneuronography (ENoG) and transcranial magnetic stimulation (TMS) were performed 1-6 times for each patient. The time interval between each examination varied from 2 to 7 days. S eventy-eight patients were followed for a median period of 13 months a fter the onset of palsy. Facial nerve function was graded according to the House-Brackmann grading system. Relative amplitude differences of ENoG and TMS during the acute phase were then correlated with clinica l outcome. Statistical analysis of the results showed that a TMS respo nse elicitable during the first 5 days of the palsy was correlatable w ith a good prognosis. ENoG results correlated with clinical outcome at a later time from onset of symptoms. TMS was well tolerated and no ad verse effects were seen. These results indicate that TMS is a useful m ethod for the early prediction of outcome in patients with Bell's pals y.