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What Causes Corneal Reflex In A Patient With Facial Palsy?

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Posted on Thu, 7 May 2015
Question: Hi, can you help me understand The results of blink reflex and CMAP of my mum s facial palsy?
Do you think an EMG should have been conducted or not enough movement? 2 months later and some slight improvement with physio and acupuncture. From your experience will she regain some movement/smile?
Where can I attach results?
Many thanks
Kind regards
XXXX
XXXX
doctor
Answered by Dr. Olsi Taka (1 hour later)
Brief Answer:
Several bad predictors

Detailed Answer:
I read your question carefully and I am sorry about your mother's condition.

You don't state it in your question, but in the medications tried field you mention the facial palsy to be in the setting of XXXXXXX Hunt? Also since you mention it to have happened two months earlier and the date is 05 March it means the exam is made around 2 weeks later? Correct me if I am wrong.

The results show a complete lack lack of response from stimulation of the facial nerve on the right side, the CMAP shows the muscle response to nerve stimulation, the blink reflex response to cornea stimulation, both are absent indicating a severe damage to the right facial nerve as you already know.

She has several not good prognostic factors like the fact that is connected to XXXXXXX Hunt (worse recovery compared to common Bell palsy - if complete palsy in XXXXXXX Hunt only 10% recover function, if partial palsy around 66%), the very low CMAP (if lower than 25% of the other unaffected side is not a good prognostic factor) and finally her age, the older the age the less probable the recovery. However these are just percentages, every individual is unique in his recovery times and potential and she should continue her physio, improvement is still hoped for the first 6 months.

I remain at your disposal for further questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka (29 minutes later)
Many thanks for your response. In case of no recovery ( it was a XXXXXXX hunt oticus and she was hospitalised 2 weeks later due to severe vertigo) what do people do with their affected eye which does not close? It is fine now but can she live with a night bandage and artificial tears ?
Are there any form of physio which is more effective at your opinion? Laser, acupunture, croSystem massage? What would you do?
Many thanks again
doctor
Answered by Dr. Olsi Taka (1 hour later)
Brief Answer:
Read below

Detailed Answer:
If the inability to close the eye persists and looks likely to be permanent than often surgical approaches may be used. For the upper eyelid the most common one is using gold or platinum implants inserted in the eyelid which by their weight aid the closing or the eyelid. When laxity of the inferior eyelid is an important component it can also be intervened by the lateral tarsal strip procedure, a plastic procedure to shorten the lower eyelid.

As for additional physio methods it is a difficult answer especially for these conditions which may improve by itself like facial palsy - you can't judge by single patients as you don't know whether it was the therapy or would've improved anyway. So the benefit of any therapy is not evaluated by individual impressions but by large studies comparing groups of patients who underwent a specific therapy with those who didn't (all other conditions being the same). Only these type of studies can really prove benefit. Unfortunately there is a lack of such studies for electrical therapy, acupuncture or laser therapy. Those that are have only limited number of patients or lack of comparison groups, often published only in journals on laser/chiropractic/alternative therapies which might be biased. I confess I heard of croSystem only now, I imagine it is present mainly in Italy where the company which sells it is active, again it's hard to know how much commercial factors influence the centers where it's applied.
The above doesn't mean I can rule them out as uneffective, just that their benefit remains to be proven, so it's up to you to take a chance or not.

What I would do .... I would continue with physio till 6 months, then I would give up (surgical procedure for eye issue). But as I said if you want to give it a shot and try those other methods you'd be completely justified.

I hope to have been of help.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka (3 minutes later)
Thank you so very much. You have been immensely helpful.
Kind regards
XXXX
doctor
Answered by Dr. Olsi Taka (58 minutes later)
Brief Answer:
You're welcome!

Detailed Answer:
You're welcome, I hope things work out for the best.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3673 Questions

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What Causes Corneal Reflex In A Patient With Facial Palsy?

Brief Answer: Several bad predictors Detailed Answer: I read your question carefully and I am sorry about your mother's condition. You don't state it in your question, but in the medications tried field you mention the facial palsy to be in the setting of XXXXXXX Hunt? Also since you mention it to have happened two months earlier and the date is 05 March it means the exam is made around 2 weeks later? Correct me if I am wrong. The results show a complete lack lack of response from stimulation of the facial nerve on the right side, the CMAP shows the muscle response to nerve stimulation, the blink reflex response to cornea stimulation, both are absent indicating a severe damage to the right facial nerve as you already know. She has several not good prognostic factors like the fact that is connected to XXXXXXX Hunt (worse recovery compared to common Bell palsy - if complete palsy in XXXXXXX Hunt only 10% recover function, if partial palsy around 66%), the very low CMAP (if lower than 25% of the other unaffected side is not a good prognostic factor) and finally her age, the older the age the less probable the recovery. However these are just percentages, every individual is unique in his recovery times and potential and she should continue her physio, improvement is still hoped for the first 6 months. I remain at your disposal for further questions.