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Diagnostic value of electrodiagnostic parameters for assessing initial severity in Bell's Palsy: A retrospective
Ah-Hyeon Kim1, Ga Yang Shim2, Yunsoo Soh2
1Department of Physical Medicine & Rehabilitation, College of Medicine, Kyung Hee University, Seoul, , Republic of Korea.
Introduction:
The House-Brackmann grading system exhibits inherent subjectivity despite widespread clinical adoption. Although electrophysiological assessments provide objective neurophysiological data, their correlation with initial clinical severity remains inadequately characterized in large-scale cohorts with standardized methodologies. This study aimed to evaluate the diagnostic utility of electrodiagnostic parameters in determining initial severity among Bell's palsy patients.
Methods:
This retrospective study analyzed 3219 patients with unilateral Bell's palsy who underwent electrodiagnostic testing within 14 days of symptom onset. Patients were stratified using House-Brackmann (H-B) grades into mild (2-3) and moderate-to-severe (4-6) groups. Five electrophysiological parameters were evaluated: electroneurography degeneration index (ENoG DI), motor unit action potential (MUAP) interference patterns, compound muscle action potential latency, blink reflex, and abnormal spontaneous activity. Associations were analyzed using logistic regression and ROC analyses.
Results:
ENoG DI and MUAP interference patterns in orbicularis oculi showed strongest association with initial H-B grade (area under curve = 0.75). Patients with moderate-to-severe paralysis (H-B grades 4-6) had significantly higher prevalence of severe axonal degeneration (ENoG DI ≥ 90 %) compared to mild paralysis (34.9 % vs. 8.3 %, p < 0.0001). MUAP interference grades ≤3 were strongly associated with increased severity.
Conclusion:
ENoG DI and MUAP interference patterns serve as reliable early electrophysiological indicators of facial paralysis severity, providing objective markers for patient stratification. These findings establish standardized electrodiagnostic criteria for severity assessment, enabling evidence-based early rehabilitation decisions in Bell's palsy management.
